Rising GLP-1 demand challenges employer health plans
With the steady increase in obesity rates, GLP-1 drugs seem like a convenient solution. But for employers looking to manage costs, a more holistic approach to weight management may be a better option.
With 2 in 5 adults and 1 in 5 children considered obese, the numbers speak for themselves: Obesity is prevalent in America. It’s also expensive.1 Obesity and related conditions cost the U.S. health system nearly $173B a year.1
Combined with other chronic and metabolic conditions — like type 2 diabetes, heart disease and some types of cancer — that cost rises to $4.9T.2 In 2023, 28% of UnitedHealthcare members had a metabolic condition, and those members accounted for 56% of their employer’s total health care spend — 4x more than those without a metabolic condition.3 This may help explain why 60% of surveyed employers said they are looking for more support from the health care industry in improving care management for costly conditions.4
Many have been wondering about the buzz surrounding glucagon-like peptide-1 (GLP-1) medications. Chief Data & Analytics Officer Craig Kurtzweil and Chief Medical Officer Dr. Rhonda Randall have a word of caution for employers: Don’t rush to make decisions about covering these drugs. Instead, they suggest considering a whole-person approach that could be more effective and cost-efficient.
Breaking down GLP-1 drugs and disease management
Drugs like Ozempic, Rybelsus, Wegovy, Zepbound and Mounjaro are out in the market and surging in popularity. Total U.S. spending on drugs like these increased by more than 500% between 2018 and 2023 — from $13.7B to $71.7B.5 This sharp rise underscores the importance of understanding their impact on weight loss.
Originally developed to help manage type 2 diabetes, GLP-1 drugs stimulate the body to produce more insulin when blood sugar levels start to rise. The boost in insulin helps lower glucose levels, which helps control type 2 diabetes. Most GLP-1 drugs are administered by injection, although oral versions are becoming more widely available.6
Several of these drugs, such as Wegovy and Zepbound, were approved for use as a treatment for obesity, obstructive sleep apnea, heart attack or stroke prevention in those who have already experienced a cardiovascular event. Researchers are also looking at their potential use for the treatment of certain types of heart failure and even some cancers.7
As a result, carriers are thoughtfully evaluating the efficacy and use cases of these new drugs to determine how they should be covered, based on the latest clinical studies and medical evidence.
“UnitedHealthcare constantly monitors drugs that are under development as well as potential new uses for those already approved,” explains Susan Maddux, chief pharmacy officer for UnitedHealthcare Employer & Individual. “Even before approval, we typically start discussions to determine what our approach will look like and begin to build our strategy.”
“It’s important for us to stay ahead of the curve and develop a strategy around availability and cost. That includes looking at all the angles of GLP-1 drugs, including their potential side effects and how effective they are when used for treatment or prevention of diabetes, obesity and other conditions.”
Challenges for employers and employees
91%
increase in PMPM costs between 12 months prior to starting a GLP-1 compared to 12 months after9
The average cost of GLP-1 drugs can exceed $1,000 per patient per month.8 The combination of high drug costs and a large patient population may have profound implications for employers’ overall health care spend. In fact, costs per member, per month (PMPM) increased 91% between the 12 months prior to members starting a GLP-1 compared to 12 months after.9
As a result, employers may find it difficult to decide whether they should cover these drugs or exclude them. And those who choose to cover these drugs may have to explain their decision to employees if they later stop covering them for financial or other reasons.
“We’re starting to see a trend where many people stop taking GLP-1s after a few months,” Kurtzweil says. “Because of this and other challenges, employers aren’t seeing a significant return on their investment or improvements in their employees’ health.”
Part of the reason for this low adherence may be attributed to the fact that it can take several months for individuals to work up to the full, effective dose and that some may experience uncomfortable side effects, such as nausea, diarrhea, constipation, vomiting and other gastrointestinal issues — contributing to the 10% increase in ER visits that were seen among members after starting a GLP-1.9
58%
of patients stop taking GLP-1s before seeing a clinically meaningful health benefit10
“We have to be cautious with GLP-1s, as we’re still learning where they are most effective and what the long-term side effects are,” explains Dr. Randall. “I get concerned that people are losing more muscle mass than fat cells, which can lead to long-term complications — reinforcing the importance of pairing these drugs with lifestyle changes and other weight loss support strategies.”
GLP-1 medications for weight loss are currently available only as injections, but pill forms are in development. These new forms could improve accessibility and enhance the user experience. However, concerns about efficacy, long-term effects and the sustainability of outcomes may still persist.
Taking a whole-person approach to weight loss
While pharmaceuticals are one option for treating obesity, lifestyle changes may contribute to long-term weight management, too.
Weight-loss programs that take a whole-person approach — including pharmaceutical, clinical and behavioral support — can be more effective at treating all aspects of a person’s health. That’s why UnitedHealthcare developed Total Weight Support, a program that addresses multiple aspects of an employee’s weight management.
Total Weight Support helps encourage members to approach weight loss holistically by integrating capabilities that:
- Teach sustainable lifestyle modification habits, such as maintaining a balanced diet and increasing physical activity
- Support drug adherence and side-effect management if GLP-1s or other weight-loss medication therapies are used
- Provide access to digital tools and social support throughout the member journey
While employers may be feeling pressure from employees to cover GLP-1s, it’s imperative for them to consider the costs and adherence challenges associated with these drugs. Instead, employers should work with their carrier to build a benefits strategy that includes a comprehensive weight-loss approach and addresses the many factors that can contribute to obesity and other related conditions.
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