The conversation surrounding GLP-1 medications continues to evolve as new evidence emerges regarding both their clinical and financial impact.
A recent study published in Diabetes, Obesity and Metabolism found that older adults with obesity or overweight who remained on tirzepatide (Zepbound®) experienced lower healthcare costs compared to matched untreated individuals. According to the study, healthcare costs were approximately 25.4% lower, representing roughly $319 per member per month in savings after 12 to 18 months of treatment.
For plan sponsors, these findings add an important dimension to the ongoing discussion around obesity management and GLP-1 coverage strategies.
One of the challenges with evaluating GLP-1 medications is that pharmacy costs are highly visible and immediate, while potential medical savings often occur over a longer period of time.
Historically, benefit decisions have focused heavily on the significant pharmacy cost associated with medications such as Zepbound®, Wegovy®, Ozempic®, and Mounjaro®. However, obesity is linked to numerous costly chronic conditions, including:
As a result, many employers and health plans are asking a broader question: "Can higher pharmacy spending today translate into lower total healthcare costs tomorrow?"
Studies such as this suggest the answer may be yes for some populations, although results will vary based on member demographics, engagement, adherence, and overall health status.
While the emerging data is encouraging, coverage decisions should not be viewed as an all-or-nothing proposition.
Employers must balance:
The most successful strategies often include a combination of evidence-based utilization management, lifestyle intervention programs, member education, and ongoing clinical monitoring.
At ProAct, we believe obesity management should extend beyond simply providing access to medication.
GLP-1 therapies can be a valuable tool, but sustainable outcomes are often achieved when pharmacotherapy is paired with behavioral health support, nutrition counseling, physical activity programs, and chronic disease management initiatives.
As the evidence continues to develop, plan sponsors should evaluate both the pharmacy costs and the potential impact on overall healthcare utilization, including hospitalizations, emergency room visits, and treatment of obesity-related conditions.
The obesity treatment landscape is rapidly changing, and new data continues to demonstrate that treatment decisions should be evaluated through the lens of total cost of care, not pharmacy spend alone.
As more long-term outcomes data becomes available, plan sponsors will be better positioned to determine when, where, and how GLP-1 therapies fit into their overall population health strategy.
The key question is no longer simply "How much do GLP-1s cost?"
It is increasingly becoming: "How do GLP-1s impact the total cost of care and long-term health outcomes for our population?"
At ProAct, we continue to monitor emerging clinical evidence and market trends to help plan sponsors make informed decisions that balance cost management, member outcomes, and long-term value.
