Cost and access limit the number of people using GLP-1 drugs for weight loss, but health care experts said there are ways to make them more available and affordable to patients using both market-based and regulatory approaches.
“A lot of people who could benefit from these drugs can’t get them,” Alex Azar, former HHS secretary, said during a National Academy of Medicine webinar.
Data on the number of people in the US taking glucagon-like peptide-1 medications, both to reduce obesity and to help control diabetes, show a somewhat stable trend. KFF tracking poll data in 2024 found that about 6% of people in the US were currently taking a GLP-1 drug and 12% had taken one. RAND research released in August showed 11.8% of people had used a GLP-1 medication this year. Claims-based data from FairHealth found the number of adults prescribed a GLP-1 drug increased from 0.9% in 2019 to 4% in 2024, and the number of adults with overweight, obesity or diabetes prescribed the medications increased from 0.3% in 2019 to 2.05% in 2024.
Studies show these drugs may help treat diabetes and have cardiovascular benefits, but there also may be broader effects, such as reducing risks for other diseases. Research is ongoing on dozens of other potential indications.
Still, the cost of these drugs can be more than $1,000 per month, although many people pay about half that amount or less through discounts from pharmaceutical companies such as Eli Lilly, and programs from online providers such as Hers for Women’s Health and Noom, which offer access to less expensive compounded versions of the drugs. Even at half the retail cos or less, the drugs remain out of reach for many patients or cause patients to use them only for a limited time, potentially reducing the effects and leading to regained weight and poorer health measures.
The KFF data showed 54% of adults who had used GLP-1 drugs said it was difficult to afford them and 22% of that group described it as very difficult. Even among adults with insurance coverage for the drugs, 53% said it was difficult to afford them. A study published in JAMA Network Open found that discontinuation rates for GLP-1s were 26.2% at three months, 30.8% at six months and 36.5% at one year, with each 1 percentage point increase in patient costs per month associated with higher risks of stopping the medication.
Determining benefits, ROI
Health and policy experts participating in the NAM webinar said better and more data on the cost-effectiveness of these medications will drive future access and cost reductions. Govind Persad, associate professor at the University of Colorado Law School, said more empirical data are needed, but incentives to drive data generation are lacking. “We’re increasingly getting positive signals of improving cost-effectiveness findings,” Persad noted.
But a key question is how to look at cost-effectiveness. Who will benefit, payers or patients, and in what ways? Patients may benefit from being healthier and having reduced health risks and costs, and being better able to do the daily activities they enjoy. On the other hand, do insurance companies or other payers benefit from assuming the cost burden through lower health care costs down the road?
“We need to work more on engaging with payers and insurance companies to better model and understand where and how they are seeing the return on investment across their books,” said Tracy Zvenyach, director of Policy Strategy & Alliances at the Obesity Action Coalition. Zvenyach added that more data are needed on both medical and pharmaceutical spending because of the broad implications for these drugs. “We have to start looking at this differently,” she said.
Dr. Jaime Almandoz, medical director of the Weight Wellness Program at the University of Texas Southwestern Medical Center, said more real-world studies are needed to collect data because “our patients don’t live in clinical trial environments.” He said the value to people and society needs to be evaluated as people start and then stop the medications. “What we’re really doing is losing the gains that are achieved through the health of helping people to achieve a healthier body weight and adjusting some of the cardiometabolic complications that are part of that,” he said.
Ways to cut costs, improve access
There are options, involving patients, payers and government regulators, for reducing costs and improving access to these medications.
A program launched this week by HealthEquity, a health savings account and consumer-directed benefits administrator, connect its 10 million HSA members to GLP-1 medications, both brand name and less-costly compounded dosages, through Agile Telehealth. It also is offering an app-enabled direct enrollment platform. HealthEquity CEO Scott Cutler said GLP1s account for 7% of total prescription costs, so the company is trying to address the affordability crisis and looking at the role that HSAs can play.
“We’re bringing together and bringing greater proximity to the products, the services, the offerings that people are already spending their HSA dollars on into the health equity ecosystem and making those products and services and platforms more easily accessible and integrated with our platform, which is set up for saving, spending and investing for health,” he said.
Health care insurance coverage for GLP-1 drugs is spotty, and many large health plans have declined to include them in their formularies. Companies that do offer coverage may put restrictions on which patients get them and for how long.
On the regulatory and government end, Zvenyach said state Medicaid programs can decide whether they want to provide coverage — about a dozen of them already do — but there is a regulatory prohibition on Medicare coverage, which affects older adults and certain people with disabilities. She said advocacy groups are working with the CMS “to provide evidence and rationale to update that coverage determination.” TRICARE, which covers military service members, families and retirees, had been covering the drugs but is pulling back.
Zvenyach said the CMS Innovation Center, which studies health care payment models, also may be looking at whether it can create a pilot program to test the idea of having Medicare cover GLP-1 medications.
KFF data showed two-thirds of state Medicaid programs said cost was a decision factor when determining coverage of GLP-1 drugs. But some states are taking more direct action. Illinois and Connecticut provide coverage of GLP-1 medications through their state employee health plans, and North Dakota offers GLP-1 drug coverage through individual Affordable Care Act plans.
Jeffrey Singer, a senior fellow at the Cato Institute, said another solution is to have the FDA reclassify GLP-1 medications as over-the-counter drugs. “Our experience has been that when drugs become over-the-counter, prices tend to drop, there’s more price competition, there’s more consumer investigation and price comparison shopping,” Singer said.
Govind suggested taxpayer or other third-party subsidies may be an option to make the medications more affordable or lowering the amount pharmaceutical companies are paid for the drugs. “The tricky question there is about balancing incentives for future innovation in this space against near-term sort of maximizing access for patients right now,” he said.
Azar suggested that the US could look at what other countries are doing, but coverage of GLP-1 drugs elsewhere is limited and evolving. Still, he said, other countries are treating the drugs as public health interventions, which raises the question of whether the US should do the same.