GLP-1s have quickly emerged as the fastest-growing drug class in the U.S., with spending surpassing a whopping $70 billion in 2023. Although originally developed for diabetes, demand has continued to rise as consumers have found it to also be an effective weight-loss treatment. Employers are now facing growing pressure to include coverage for GLP-1s. This decision requires careful consideration about the potential health benefits for employees against the substantial cost implications for employer-sponsored health plans. Employers must find a way to ensure their benefits plans both support employee wellness and control overall healthcare expenses.
Who is using GLP-1s?
Understanding who is using GLP-1s is essential for employers as they evaluate coverage decisions. GLP-1 users span a broad demographic:
- The average age of a user is 51 years old
- Women represent 63% of users
- Users come from all health risk strata, from low to very high
- 60% of GLP-1 users cite weight loss as their primary reason for use, slightly higher than 58% who use it for diabetes management.
The cost impact on benefit plans
GLP-1s are driving up healthcare costs with 96% of employers reporting being concerned about the long-term cost implications. While GLP-1 prices aren’t as high as many specialty medications, the demand for these, especially for weight-loss, has been a concern for employers.
As employers grapple with these rising costs, understanding how patients use GLP-1s over time becomes critical to managing overall spending. One key factor amplifying these cost concerns is the difficulty many patients face in maintaining consistent treatment. Treatment continuity is a major challenge as 45% of users discontinue their GLP-1 therapy due to cost before achieving meaningful results. This leads to substantial upfront spending with little return, as interrupted treatment negates progress.
Employer strategies for managing GLP-1 costs
With rising demand and significant costs associated with these medications, employers must balance affordability while ensuring patients have access to treatments that deliver meaningful health outcomes. Employers are adopting several strategies to manage the financial impact of GLP-1s while supporting effective care:
- Utilization management: Implementing prior authorization, step therapy, and quantity limits to ensure appropriate use.
- Eligibility criteria: Setting BMI thresholds (in line with PBM contract terms) and requiring participation in behavioral support programs before GLP-1 coverage is approved.
- Behavioral health integration: Investing in lifestyle and behavioral support programs to improve adherence and long-term outcomes.
GLP-1 therapies represent a breakthrough in managing obesity and diabetes, but the increased adoption of the drug presents complex challenges for employers. Balancing clinical benefits with rising costs requires a structured approach that integrates clear eligibility criteria, behavioral health support, and strategic cost management. Employers who proactively develop thoughtful GLP-1 coverage policies will be better positioned to meet employee health needs while maintaining financial sustainability in their benefit plans.
