Cost saving from GLP-1 weight loss medicines

Injectable peptide-1-like glycogen or GLP-1s were first approved as diabetes drugs 20 years ago. They have become popular as weight loss drugs. Combined with a proper diet and exercise, the GLP-1S is effective in reducing a person’s weight. However, insurers in the commercial and public sectors were reluctant to compensate them as obesity drugs. Policy analysts report various reasons for the holders they hold, including the impact of drugs on pharmaceutical budgets combined with the lack of short -term cost savings associated with their use. Further composition of the problem is the absence of adequate patients’ obsession in medicines: a relatively large part of patients interrupts these drugs Within a yearwith numbers increasing by the end of the years two and three.

Despite the high demand for the new generation of weight loss drugs, they currently face numerous trade insurance coverage restrictions. According to Goodrx, a company operating a telemedicine platform that monitors drug prices and provides discounts drug coupons, the number of people with No Commercial insurance coverage for Zepbound (Tirzepatide) increased by more than 180% in 2025. For those with insurance coverage, more than nine in ten must meet additional requirements such as previous license. Although wegovy (semaglutide) coverage is generally better than for Zepbound this year, 88% of people taking Wegovy through their insurer still face obstacles, including previous authorization and the required protocols in which the cheapest treatments must be tested before.

And in the latest survey published by the International Foundation for Employees’ Benefits Plans in May, 55% of employers said they provided GLP-1 only for diabetes, while only 36% provide coverage for both diabetes and weight loss. And from these employers who currently offer GLP-1 drugs exclusively for diabetes, only 17% are considering the return of drugs for obesity.

For insurers, the problem with GLP-1S is their major budgetary impact, sometimes referred to as a financial report, if they cover them. GLP-1s for weight loss represents more than 10% Annual allegations of prescription drugs for plans based on employers who return them, according to recent data. Payers do not consider this viable as it affects their ability to cover drugs in other therapeutic categories. In addition, they are concerned about the substantial increase in registered premiums.

And whatever further problems insurers are large-scale studies show that GLP-1 does not lead to medical cost savings, at least not in the short term. To show it, recent study Of the 23,000 people in hemiglutide -based products on multiple types of payers did not find a decrease in medical spending for those who were prescribed the medicines. In fact, it increased. For those patients who started in the GLP-1s, healthcare costs have increased, with the cost of patients representing the largest share. This was observed for patients with and without diabetes.

The good news from the study is that patients developed improvements in blood pressure, overall cholesterol level and HBA1C level, stressing the association of products with the prevention of cardiovascular disease risk. However, they lost weight, however, the observed reductions in clinical practice were less than those reported in clinical trials.

The findings of the research emphasize the absence of a connection between clinical benefits and short -term cost savings, with the authors of the study concluding: “Our 24 -month analysis did not show cost savings, as opposed to models funded by the long -term industry.”

Fewer studies have been performed on the most recently approved drug based on Tirzepatide Zepbound. However, the evidence Points in the same direction as for Wegovy: Despite the supply of strong clinical benefits, in the short term, both products are not cost savings due to their high costs.

For insurers, the flexibility of short -term savings is important because so many registered “churn“Through different health insurers over time. Payers are not necessarily incentive to invest in long -term cost savings found in industry -funded models.

The net values ​​of the branded GLP-1 should be further reduced to save costs within, for example, two years. The availability of cheaper, general publications is on the horizon. In addition, in the framework of the inflation prices trading program, both OZEMPIC (SEMAGLUTIDE) and Wegovy prices are currently negotiating between Medicare and Medicaid Services and Pharmaceutical Giants Novo Nordisk. The so -called maximum fair prices will be publicly published by the beginning of 2026 and will be implemented in 2027.

Nevertheless, even with lower net prices, medical cost savings will be based on improving levels of persistence in therapeutic regimens, along with More intensive dietary support and lifestyle management (diet and exercise).

There are some encouraging news on this front. The most recent primary therapeutic study About perseverance shows that patients remain more and more in GLP-1 for at least one year. While just over 30% of people in Wegovy made it on their medicine at the one -year mark in 2021, the year approved for weight loss, that number had almost doubled by 2024. The best perseverance could change the calculations of payers, as they would get better.

Fresh analysis The clinical and economic impact of the total GLP-1S Medicare coverage for all current FDA (type 2 diabetes diabetes, obesity, heart disease and metabolically related to steatopatitis) offers some hope for long-term cost savings. Researchers estimate that if Medicare will lift the prohibition of GLP-1s for weight loss only and for the widespread coverage of semi-based products, this could prevent approximately 39,000 cardiovascular events and the program could save more than $ 700 million. These benefits are largely driven by the results of type 2 diabetes, where costs from fewer hospitalizations and complications offset the cost of drugs.

The study also demonstrated clinical benefits for semi -based products that were strictly used in obesity care, but models added a net cost for their use only to weight loss.

One way to bypass the problem of cost saving lack is the best target return, by laying out obese patients to those who are expected to benefit most to those for whom the return is not so good. It has been shown, for example, that greater savings can be achieved for those with comparatively higher body mass indicators. If politics managers want to extend GLP-1 to include the indication of obesity in Medicare, Medicaid or the Commercial Insurance Sector, they will need one strategy for the management of the use and targeting of populations that will probably benefit. This in turn could yield cost savings so far.