The employer debate over GLP-1 drug coverage has fixated on pharmacy spend, but Jennifer Collier, President of Health and Risk Solutions at Sun Life US, headquartered in Wellesley Hills, Massachusetts, says that framing is costing employers more than they realize.
According to Sun Life's claims data, GLP-1 claim volume rose 24 percent in a single year, while hepatic liver disease spend climbed 43 percent year-over-year to $63.9 million, with the average claimant cost reaching $230,000.
"Everyone kind of looks at it as a pharmacy expense issue," said Collier, who holds a clinical background as a registered nurse. "But it really should be a cardiometabolic risk strategy. That's how I believe employers should be looking at it."
Collier spoke with Insurance Business Benefits US in a wide-ranging interview covering GLP-1 plan design, the broker's role in reshaping the employer conversation, the power of second opinions, and her personal journey from bedside nursing to one of Sun Life's most senior leadership roles.
Sun Life's High Cost Trend Report reveals the scale of comorbidity overlap that makes GLP-1 coverage a risk management decision, rather than just about drug spend. Of Sun Life's high-cost claims book, 22 percent involve cancer and cardiovascular conditions simultaneously; 11 percent combine cancer and kidney disease; and 23 percent combine cancer and orthopedic conditions.
"The comorbidities and that connection to the metabolic component is really amplifying both the volume of those claims, but also the cost associated with them," Collier said.
She highlights the implications for stop-loss coverage: everything she listed in the comorbidity data "shows up in our disability data as well." For self-funded employers already absorbing rising stop-loss premiums on top of elevated first-dollar claim costs, the downstream connection is actuarial.
"The brokers are exceptionally well positioned to have those conversations and really thinking about what that benefit plan looks like, and making sure that that's translating to employers' understanding," she said.
Several large employers have already pulled GLP-1s from their plans entirely, while others are restructuring cost-sharing. In either scenario, how employers and brokers communicate the clinical rationale - and not just the cost - to employees matters enormously for adherence and long-term outcomes.
Collier draws a clear line between open-ended GLP-1 access and a targeted benefit design. Effective coverage, she says, starts with evidence-based eligibility criteria: body mass index combined with type 2 diabetes, cardiovascular risk, or kidney disease. From there, the plan design must address two equally important levers - structured support programs and thoughtful cost-sharing.
On support: "Adherence is a challenge. There are reasons - side effects, et cetera - where people choose not to continue. And then you are mitigating, you're losing out on the value that you would get further down the road after you've taken on the expense," she said.
On cost-sharing: the financial reality for most American workers makes high out-of-pocket GLP-1 costs a direct driver of non-adherence. "Most Americans don't have $800, $1,000 in disposable cash," Collier said. "They want to have the benefits. It's not for lack of want, but then you get into a decision between my finances and my health choices."
She noted that the broader employer trend of passing more costs to employees creates a structural tension for any benefit plan built around long-term behavior change.
Employers with stable, long-tenured workforces, such as large professional service firms, face a very different return on investment calculation than those in high-turnover sectors such as restaurants. "The decision to include GLP-1s is very different than if you have a population that's very stable," she said.
Medical trend, she noted, "has made a material step up" in recent years; a dynamic she compared to the era of smoking cessation programs, when the true return on investment was measured in claims avoided 10 to 15 years later, not immediately.
Collier's longer-term view challenges brokers to reframe the GLP-1 debate entirely. The most valuable conversation, she suggested, may not be about these drugs at all, but about how to build comprehensive wellness frameworks for every employee, regardless of their cardiometabolic profile.
"A key component, no matter what, is helping people navigate through the healthcare journey," she said. "It's not easy here in the states - being able to identify who's the right doctor, how do I know if I have the right diagnosis, how do I actually get in from an access perspective."
The navigation challenge extends to GLP-1s specifically: the visibility of these drugs in consumer media has created a misconception that coverage is primarily a lifestyle choice.
Read more: Benefits brokers face pressure to deliver year-round value
Collier is clear that employers and brokers have both an accountability and a responsibility to reframe the clinical narrative, not to steer employees away from GLP-1s, but to connect their use to longer-term outcomes such as cardiovascular protection, joint health, and quality of life.
"This is not just 'I'm going to be able to fit into my skinny jeans,'" she said. "This is going to prevent cardiovascular disease. It is going to prevent issues with your knees and your hips. You have better quality of life. You can walk your children down the aisle."
GLP-1s do offer one meaningful advantage over traditional weight management approaches, she acknowledged: visible, near-term results that support adherence in a way that diet and exercise programs historically have not. But the support systems including coaching, behavior change reinforcement, and navigation, must be built around them.
Beyond the GLP-1 conversation, Collier flagged Sun Life's expert second opinion program as another underused lever for brokers and plan sponsors. The data, she said, is striking; 50 percent of individuals who receive an expert second opinion through Sun Life experience some change to their diagnosis or treatment plan. Ten percent receive a total change of diagnosis; 40 percent see a change to their treatment or diagnostic path.
"I think that is a mind-boggling number," Collier said. "It puts some financial teeth into when I say how important it is to help people through the journey. Support systems are not nice to haves. They are actually critical to getting the best outcome and the best financial picture for your employees."
For brokers building the case for comprehensive employee health navigation, beyond any single drug class, those figures represent a clear and verifiable return on investment argument.
Collier's path from nursing to a senior leadership role at Sun Life is, she says, rooted in personal experience with a broken system.
After approximately five years as a registered nurse at an academic health center, where she was trained as a holistic nurse focused on the patient and their family, she became frustrated with a discharge model that set patients up to fail at home.
The inflection point came when her son was born premature and spent three months in the neonatal intensive care unit, coming home without a formal diagnosis but with a range of cognitive and physical challenges. "He needed a full-time nurse," Collier said. "So he got mom."
She spent three years running national grants for children with disabilities, an experience that shaped a core conviction: "Not much moves until big business gets on the bus." She cited speech recognition technology - invented for people with disabilities but stagnant for 20 years until commercial airlines and interactive voice response systems commercialized it - as the defining illustration.
What she did not do during her son's healthcare crisis was file for paid family leave or disability benefits; benefits she was entitled to but never thought to use. "I was just trying to manage day to day," she reflected. "We have to figure out a way to make this better, because the last thing anyone needs to think about when they're in the middle of a crisis is the logistics of benefits."
That experience, she said, is why she joined the insurance industry. "I had to understand how this $5 trillion industry functioned in order to try and make it better."
