GLP-1s and Their Impact on Pharmacy Benefits Plans

Health care costs are expected to rise by 8% in 2025, with experts pointing to GLP-1 medications as drivers of this trend. GLP-1s are the injectable agents—Glucagon-like peptide-1 (GLP-1) agonists and the combination agents, Glucagon-like peptide-1 agonists with glucose-dependent insulinotropic polypeptides (GLP-1/GIP). First discovered for the treatment of diabetes, these medications were found to have multiple impacts on the body that led to weight loss.

Market Growth Expectations

• The global GLP-1 market is expected to grow from $37 billion in 2023 to over $100 billion by 2030.
• By 2030, the market is expected to be driven equally by diabetes and weight loss utilization.

Growing GLP-1 Indications and New Agents

Indications for GLP-1 medications are steadily growing, meaning these drugs may be used for more health issues beyond diabetes and weight loss. In addition to expanding indications within the GLP-1 space, new agents are also in development, offering different delivery options and combinations of agents.

Cost Effectiveness

Studies have shown that the net pricing, lifetime health benefits and cost-effectiveness of GLP-1s are out of balance. Using GLP-1s for disease states beyond diabetes and weight loss indications will further impact plans. With other drug classifications, generic medications have improved plan sponsors’ cost savings while offering their members the same levels of effectiveness and quality. However, GLP-1 medications are newer to the market with limited generic opportunities. A handful of generics are available in the space, but they’ve had little impact due to their dosing difference and lower effectiveness.

Long-Term Impact on Plan Sponsors

In most surveys, plan sponsors cover GLP-1 agents for weight loss less than 50% of the time. This isn’t surprising, considering data shows an increase of over $14 per member per month (PMPM), with some as high as $30 PMPM, drastically impacting plan sponsors’ pharmacy benefits costs. It’s important for those plans that do opt to cover GLP-1 medications to have controls in place, including:

• Utilization management with PBM plans, including prior authorization for new prescriptions and at renewal.
• Implementing disease state management programs, such as health coaching and engagement requirements for members.
• Offering GLP-1s to a smaller population group, such as those with a higher BMI.

We will continue to monitor the ever-changing GLP-1 landscape and its impact on plan sponsors and their pharmacy benefits plans. Our on-staff pharmacists can help you navigate this new class of therapies and provide an unbiased assessment on your plan’s overall cost and/or savings opportunities.