GLP-1 Prescriptions for Weight Loss by Differences in Insurance Plan Coverage

Abstract

This cross-sectional study reports trends in glucagon-like peptide-1 (GLP-1) prescriptions for plans that do and do not cover GLP-1s for weight loss.

Introduction

Coverage of glucagon-like peptide-1 (GLP-1) drugs for weight loss is controversial. While clinical benefits are generally acknowledged,^1,2 many worry about the financial strain on patients and payers,³ and uncertain cost-effectiveness for weight loss among patients without other associated conditions (eg, diabetes).^4,5 As employers consider coverage for the obesity-only indication, impact on utilization and cost from an employer perspective is important and has not been empirically quantified. To fill this knowledge gap, in this cross-sectional study we use novel data to report trends in GLP-1 prescriptions for plans that do and do not cover GLP-1s for weight loss.

Methods

We used 2021-2024 data from employer-sponsored plans administered by UnitedHealthcare. All plans covered GLP-1s for diabetes alone and with cardiovascular disease indications. The present data included information on whether plans also covered GLP-1s for weight loss without a diabetes diagnosis, patient diagnoses, and prescriptions covered by the plan. We extracted claims for all dual-labeled GLP-1 drugs and classified each claim by whether the patient had a history of diabetes, cardiovascular risk, or a prior diagnosis of obesity/overweight (eMethods in Supplement 1).³ To be conservative, a filled prescription was considered to be for weight loss if there was an obesity/overweight diagnosis and there were no prior diabetes or cardiovascular disease diagnoses. We measured cost of GLP-1 drugs per member per month (PMPM) using cost numbers from Institute for Clinical and Economic Review reports. The study was approved by the institutional review board at Harvard Medical School.

Results

Claims data covered approximately 6.3 million unique patients over the study period, corresponding to 5787 plans offered by 1756 employers. A total of 14.2% plans covered GLP-1s in January 2021, and 14.9% covered GLP-1s in December 2024. Populations covered by both types of plans were similar (Table).

Table. Demographic Features of Members in Plans Studied and Glucagon-Like Peptide-1 (GLP-1) Days Supplied by Coverage of Weight-Loss Indications.

Feature	Plans that cover GLP-1s	Plans that do not cover GLP-1s
No. of patient-months	36 034 701	108 103 282
Member age, mean (IQR), ya	35.0 (20-51)	34.9 (20-50)
Member sex, %a
Female	48.7	48.4
Male	51.2	51.6
Prevalence of indication, %a
Diabetes	7.0	7.1
Cardiovascular risk	1.3	1.2
Obesity	22.8	22.9
No. of GLP-1 patient-days supplied
Liraglutide (Victoza)	468 232	1 726 831
Liraglutide (Saxenda)b	568 430	26 651
Semaglutide (Ozempic)	6 666 262	22 206 200
Semaglutide (Wegovy)b	3 257 926	89 140
Tirzepatide (Mounjaro)	2 927 242	10 157 131
Tirzepatide (Zepbound)b	747 849	1348

^a Weighted at the patient-month level.

^b The generic product has an explicit weight-reduction indication.

In January 2021, employer plans that did not cover GLP-1s for weight loss experienced a mean of 121.5 days supplied per 1000 enrollees. In comparison, plans that covered GLP-1s for weight loss alone had 5.5% greater use (128.2 days supplied per 1000 enrollees). Both types of plans experienced an increase in GLP-1 per-patient days supplied by December 2024, but plans that did not cover GLP-1s for weight loss had a smaller increase in prescription fills than plans that covered GLP-1 use for weight loss (766.8 days supplied per 1000 enrollees vs 1260.0 days supplied per 1000 enrollees) (Figure). This increased the gap in GLP-1 per-patient days supplied between plans that did not cover the weight loss indication and those that did to 64.3%. Plans that covered drugs for weight loss had much higher per-patient days supplied of drugs with explicit weight-loss indications (Table).

Figure. Line Graphs Showing Trends in Mean Days of Glucagon-Like Peptide-1 (GLP-1) Drugs Supplied per 1000 Enrolled Patients by Plan Coverage of Weight-Loss Indication.

Patients were assigned to mutually exclusive diagnosis categories in the order of diabetes, cardiovascular disease, obesity, and other indications, depending on prior diagnoses.

The spending associated with the incremental use depends on the price net of rebates, which has been declining, albeit not fast enough to fully offset volume growth, from an estimated $12 000 for an annual supply in 2021⁵ to an estimated $6830 in 2025.⁶ Utilization estimates suggest that in 2024, GLP-1 coverage for weight loss added between $16.21 PMPM in plan cost at the 2021 price and $9.23 PMPM at the 2025 price.

Discussion

This cross-sectional study found a substantial increase in GLP-1 per-patient days supplied in employer plans over the study period, with higher growth in plans that covered GLP-1s for weight loss. With increases in utilization, the estimate of differential PMPM cost for GLP-1 coverage is increasing over time and could signal higher financial burden on patients and payers in the future, though some of the added drug cost (yet unquantified) is likely offset by lower medical spending.¹ Limitations of the analysis include our inability to assess cost-sharing differences, reliance on claims data that only included drugs that were covered by the plan, and listed diagnoses, which may be imperfectly recorded. Additionally, the estimate of PMPM cost relies on assumptions about average rebates (which may be changing). Finally, utilization trends may change as new agents become available and shortages are alleviated. Since this analysis focused on costs incurred by employers, we did not account for drugs that may have been procured through self-pay. Further empirical research assessing the clinical benefits and costs (net of offsets) in this population is needed.

Supplement 1.

eMethods

Supplement 2.

Data Sharing Statement