A 2025 Update on the GLP-1 Landscape

Prescription-level weight loss drugs are making waves across the country, changing health norms, social norms, and economic models for healthcare spend. Often referred to as GLP-1s (Glucagon-like Peptide-1), these drugs have not only expanded utilization amongst type-2 diabetics but have more recently become a widely accepted approach for weight loss. The number of plans expanding coverage of GLP-1’s to include weight loss has nearly doubled in the past several years, currently representing approximately 15% of self-insured plans.

For employer-sponsored health plans a script can translate to an annual expense of up to $10k per utilizer. As these drugs become more popular, employers need to consider how this trend will affect their health plans and find their desired balance between the benefits these medications offer to patients, and the financial impact of coverage.

We have reviewed, and followed closely, the studies expanding the indications for GLP-1s to include kidney disease, cardiovascular disease, and even sleep apnea. While research is still ongoing, once approved, these new indications will increase the number of utilizers.

AssuredPartners recently went back and analyzed trends across one of our data sets of self-insured employers (over 3.7M member months) to better understand the increased utilization of GLP-1s from 2019 through 2024. These results showed notable increases in the PMPM costs of the top 6 GLP-1 drugs. Please see the attached exhibit: The total PMPM costs of these medications increased from $1.43 in 2019 to $24.59 in 2024 - a compounded annual rate of 77% per year. The primary drivers of this increase were Ozempic, Wegovy, and Mounjaro.

 

*Note: Approximately 40% of employer groups covered GLP-1s for anti-obesity within this data set.

Can Employer’s manage the expanding utilization?

Employers who intend to expand access for weight loss may want to explore comprehensive solutions, such as third-party wellness programs that include behavioral health support and nutritional advice that aid in supporting members health goals. New programs are coming to market that will guide members through how to incorporate anti-obesity agents to effectively monitor results and outcomes. These programs are designed to increase member engagement, which may include a health coach or nutritionist, increasing the likelihood of more sustainable outcomes.

Where do we go from here?

As the impact of GLP-1s continues to evolve, employers should collaborate with their consultants to formulate a comprehensive coverage strategy and closely monitor its effects on their health plans. Approaches include implementing coverage with recommended safeguards, such as prior authorization, or restricting coverage to anti-diabetic/anti-obesity agents based solely on medical necessity. So far, the medical community has not embraced safeguards or controls such as weight loss thresholds, limited durations, or target BMI, to limit or manage access.

We expect the majority of employer sponsored plans to continue with restricted access for weight loss, for now.

Be sure to sign up for our newsletters, as we will be releasing a more comprehensive review of GLP-1 trends in the coming weeks.