GLP-1 Coverage and Its Impact on Employment-Based Health Plan Premiums: A Simulation-Based Analysis

The rapid growth in usage of glucagon-like peptide (GLP-1) drugs — initially developed for diabetes but now widely used for weight management — is reshaping employment-based health benefits. As these medications are increasingly prescribed to individuals with obesity, and even to those who are overweight without comorbidities, employers are grappling with how to manage access and costs. While the clinical promise of GLP-1s is expanding, their high price point and growing demand have raised concerns about their impact on premiums.

This Issue Brief uses a simulation model to assess how GLP-1 coverage may affect employment-based health insurance premiums under varying assumptions related to drug costs, adherence rates, cost-sharing structures, and eligibility criteria. Drawing on data from MarketScan and current literature examining GLP-1 usage trends, the model estimates how different combinations of these variables influence total spending and insurance premiums for large and small firms.

Currently, GLP-1 drugs are very expensive. According to a recent estimate, the net price for a 30-day supply of GLP-1 drugs ranges from $617 to $766.
Additionally, GLP-1 usage is relatively low: Only 3 percent of non-elderly adults covered by employment-based health insurance had a GLP-1 claim in 2022, and a 2024 survey found that one in eight respondents had ever taken a GLP-1. However, there is a massive pool of potentially eligible enrollees. Over 40 percent of privately insured adults — more than 57 million people — are clinically eligible for GLP-1 drugs resulting from diagnoses of diabetes, obesity, or being overweight with additional risk factors.
Employer coverage is expanding: 55 percent of employers cover GLP-1s for diabetes, and 36 percent cover them for both diabetes and weight loss.
Perfect adherence leads to higher premiums: More consistent drug use may improve individual well-being and health outcomes but drives up overall plan spending in the short term. Simulations assuming perfect adherence result in premium increases that are several percentage points higher than simulations assuming adherence patterns observed in recent studies.
The impact of expanding GLP-1 coverage on employment-based health insurance premiums is sensitive to assumptions surrounding uptake and drug prices:
- Using real-world drug cost scenarios, premium increases ranged from 5.3 percent to 13.8 percent, depending on adherence, cost-sharing, and eligibility assumptions.
- Using a hypothetical lower-priced GLP-1 with a $200/month cost, increases ranged from 1 percent to 3.9 percent, reflecting the potential for future price reductions to mitigate cost pressures.
Cost sharing helps but does not fully offset cost growth: Introducing a $90 copay reduced premium increases across all scenarios by 1–2 percentage points but could not fully neutralize the effect of expanded eligibility or perfect adherence.
Broad eligibility significantly increases cost impact: Expanding coverage to include individuals who are overweight — along with those who are obese or have diabetes — resulted in notably higher premiums due to the increased size of the eligible population.
While GLP-1s may eventually generate some medical cost reductions, these benefits would not be manifested immediately, and there is no evidence to suggest that the savings would fully offset GLP-1 prices. Long-term GLP-1 usage is necessary to achieve weight loss. Furthermore, studies of GLP-1 discontinuation indicate that patients regain weight they lost while taking GLP-1s, and improvement of cardiovascular risk factors regress towards the patient’s baseline, suggesting that GLP-1s may need to be taken indefinitely, which could further increase cost pressures on insurance premiums.

As GLP-1 drugs gain FDA approval for a broader range of conditions such as cardiovascular disease, employers may need to revisit coverage policies. Without strategies such as targeted eligibility, prior authorization, or alternative payment models, rising GLP-1 utilization could drive sustained increases in health insurance premiums, affecting both employers and employees in the long term.

This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, JP Morgan Chase, and PhRMA.

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Jake Spiegel is a GLP-1 Coverage and Its Impact on Employment-Based Health 2 t is as n o en We d sa iu s c m iat 2 taAvail i0 ve led e s P 2o5 t ac r m h t 85 e o s at ab r u o v o a r d p s lp a ve e el s c er at le o at e al y c m id p en en n lb h b s y c t tit c rn t s em e en tp m at h rs eg e ed o ar i:io u /In f / n m iai iw o S c t i o n s al w er n f e by tw c c n fh lf r ac o .at e eas ev s 1 - tit w Rep – o o er r es 2 ei n rat s n al g p ,io f o h er o iF o r n .trto c c a h r ten u lh .t u s c n e e d o tma d y d iag m n at l O g o l/e il o ar s e dt p r n b r,t f o u io c e an iig rn lfm es/ s td p E si m r e tis ib m mpl y cp p u es p ec ltAm o r,o yee c o iyi al o ad vem u n to y lh g d B -er n d 5 en en nr g 0 en o u 0 ef t U.S tg w c o f- ie tu t f o rlPl c len lrevel y ker ar an . n d d Ad eu s s sis o - ,( t an va to IF c r u al o d ac s E ls - c itB z t u c u s - e P) o tls b ar iu lh ti,n h z ar y 55 at tr e fo ii S sn ie o kg p fr n ft d fer ec .d ac a iesi c ff ttten e e o o rg a rfen ts n e o ,n rc x feg an es d p em an r T d ies n p d el e s rled o ir i s g ty r k o ier it b el w p io ls io ar ig t o r y c id b ly o in s c iver l r g itti; t y h t er e o hira. e Health and Wealth Research Associate at the EBRI. Paul Fronstin is Director of Health Benefits Research at EBRI. This O We ur ssiim mu ullat ate io dn p m reo m diel um d riew ncr ease upon s a fo rran a gheypo of te hm etp ic iral ic al lar d gat era fs iro m u rw ces ith t5 o, 0 in 0f0 o rw mo ke rker y s p,ar as am wet eler l ass an un dd er as svar umio pu tis o n ss c. en Tar o ios The $200 monthly drug-cost scenario, representing potential pricing for future oral GLP-1 formulations, resulted in Plan Premiums: A Simulation-Based Analysis 8 • Drug Costs Drive Prem ium Impact: Premium increases were significantly higher when using current net drug O medi G pat LP uri en -ran 1 esu td ’ s irn p lu b tcer s g ras ea sh f ec el ifses g oih tn r le. ad a d igir ab h h e An ter et tth h en d e e e ,s s c l,c o am e rw n .it g h ie cer i fo al le- trr 36 er o 5l m 0 ep 0 o er a sfp c n a en en d dh 5 d t er ,ic 0 no 0 en gver 0 o w cn e o tG o h rker n L eP m p - fi r 1fe r s om ms rm ib u ,ay o bu m t h n it n o t dctih r ab e ease dec et 95res ease s per . an W c en d h ap ilw te pc ei r b o ec g et nh fi itab td er en lo ly ad sc,se as h (ier In n tm en t eer rai va cn n e at lts en is iar o as an n eal m sco e F u co c id at u h on w ed sd es iat de w — io r it f n hto h o re f d Is as ef ssu iin g eed n B el r b iie g yf i b d w irlas u itg y w c cro riit s ter tten , i c a ow fp oiay t rh G las L evel Ps -i1 s,t an d el r iu c gg e i b sf,ir l io w ty m e c u t rh is t e er e dIn i a, ps rtan o itb ud ab t e’ ais ld i th r y esear er den istc rc ie b hu as an tis ou d nm s e p b d tas itio o ed n ris al .o Dr snt af u d g at fs .c a o An f srto y m sc vie en the w ar s B i o ex eh s p iavi n rc es lo usrd ed al ed R i n ics u k tr h rien s t substantially lower premium increases across all groups. With BHI adherence and a $0 copay, premiums increased 1.7 ¶ E Gac ofo hr em thPr , p Al le o an v yee a . le "S w nu c as re ve al y: o so f 3 Se as 6% s lfi g -o R n f ed e em p o a prlb te oo yd d er y O s m b nas o ew s si ty c in od v A e er m x G ( o BLP n M gI - ) 1 U sd. r S faw o.r A w nd ei fu rg o lts h m t b la o y s lo sSta g & -n d o te irab m aet al nd es d iT ,s" e trB rib ren iu to te io r fiy n t,s ( PR B as R O d F i(SS, sM cu as y 2 s2 ed 07 1, 1 in 2 9 0t2 h5 e ). prices compared with the $200/month scenario. B sm y alK lee r fi shob rms b ec Sha ause rma of , thP eih.D., r shallo Jake wer risk S p poie olg . e l, Employee Benefit Research Institute, and Paul iE lm om w pp e rlo sotvy ed e ee ff ec h Be en tal ive teh f i d to oPl ustag an coe s m , te 2 os0 ,ac 2 i5 th )al i.eve s M oo ls an etad id n ss m u to ai red n hti g ai ad hner u w l td s ei rw g uh g ht o ul o th is lave is z at — it o a ar nken e an p d rG i c p LP ed lac - 1 s es im mu ed ilp ar w ic ly ar at tid o o n p in s r es ithial ad su an rat e d ol east n e sp cral eam at piiu o om n rt is d o.o n s o es. f th e report are those of the authors and should not be ascribed to the officers, trustees, or other sponsors of EBRI, F nac et tp orri cSin ug rvei anlld an a ce lo w Sys ert, eh m yp (o BtR hF et SiS cal ). B $o 2d 0y 0 m ma os nst h in ly dex co s(tB tM o I) ref valu lecte fsu w tuer re e pas ricsiin gg n ed po s us sib inilg it ia eslo . g F-onro eac rmal h s dc is en triar bu io ti,o w n, e percent when only those with diabetes and obesity were eligible and 3 percent when overweight individuals were also October 9, 2025 • No. 644 data • s Avail ectB io rab o nad )l,e al el at lo i g w hib titn ip lg its y :c /ls / as w igs w nifiw fic ic .at b an en iotn le y f iiin t ns tc o pr r ease o over .cos w m c ei /o 2 g s 0h t2 ti5 m an /0 pd 5 ac /o 2 t: b 7 ese E /sxu pr an vey cat deg i-n 36 g o r-ciof es. over -e m Aag p dlie o ab yer to et is e n -sc n ld o uw id ag e -c n io n over d siivid s- w glp uaal s - 1s sa w s-s fh o ig o rn - w ar ed ei e ght-loss-- Ad Fro cosdtis ns t io co n tiver al n, ly, ed P sh.D., cben y t ar hei i oEmp r s iin ns vu o loye rlvin ersg .e S h uB ig re vey her ne d d fir at t u a gRe al coss s oe t ssa h h rch o ad w a tI h s ns autb t o sin t tan ut e itn e ial ei ly gh gtr eat adu er lt sim hp ave act ev on er p r ue sm ed iu a m G s,LP reg -1ar dd ru less g, w oift h en m Em o ab d pel llo in ed yg ee c blB o as t en h s ie f pifc er itat fR ec io esear n t ad of h c in er hd en In ivid s cte u ital u an tse d as - Er d eal ouver c-at ww io or ei n ld gan h atd d o h R r er es oen bea ecse rec lh evel — F an us n d b e as s (s Eed en BR tI o ial -n E R d det F at )er ,a o m fr r o itn m han ei B rt HI s otf. a el fHer fs ig . ie b N,iei liw ttyh e er fp o rrE e G s Ben L RP It- n 1 to hre E rB es Ru Il-ts 3 eligible (Figure 5). With BHI adherence and a $90 copay, premium increases dropped to 1 percent and 1.6 percent, A recent CDC study leveraging the National Health Interview Survey found 26 percent of adults with diabetes take a GLP-1 • Eligibility E x p a n s io n M at t e r s : In clu d in g o ver w ei g h t ind ivid u al s ( b eyo n d t h o s e w it h o b esit y an d diabetes) led p Tr aken obab d tiiab lo io s gtver et et ical es/ hw er lye . , iw g th h ite t h — ra e s 1 al u 0o l tp n s er gu n c wen d iter h t sltc ih kel oors e ie hto w hoat h do . p B ar ras em e eo id u b m o es n e i m t h ope rac sh e t ave sf ac ar t d e oia rns b o , et ti n o es d nilvid y — a u resu fal us n c lw tted ier on e i n o d fn et d oer r tab um gl iy n p ed rh ic ig i n tho g er b b e p u r tel eal m ig siio u b m lo e fsf o dru G e LP to- ad usag her e en ris cie. ng to four in 10 among those with diabetes and one in four among those who have been overweight or obese t E for rR eat F t h lm o eb en 5 b,it000 es . o-rw to ake rker s p fio rm sit.i o M ned s oian n s p pr ec em ifiicu m po liin cc yr eases propo sar ale s .s E hB oR wI n in in vit Fes iguc ro es m 2 m an end t o 3n , w thiitsh rte hse ear 5tc hh an . d 95th percentiles respectively. (see https://www.cdc.gov/nchs/products/databriefs/db537.htm), and 55 percent of employers currently offer GLP-1 coverage to larger premium increases across all scenarios. 1 b eh treat avio m ren tal h,e tc u iln is n ciin rceased g al ,o an ne d s o if p z e o s ev lo icfy er t h d al e ec cel ilsin iig oic in b al sle — c p r io t ser p uu cia h lat : as id oi n a ad .b et her esen wcite, h o co ver st-w sh eiar gh intg , ddiab esig etn e,s an wid th el oig bies biliitty y , ex or pd an iab siet on es . As al oG nLP e. -1s in the past five years (Montero et al., 2024). Another survey by the IFEBP found that GLP-1 drugs prescribed for weight represented by error bars. for Type 2 diabetes, implying roughly 47 percent of patients with Type 2 diabetes have coverage through their employer. This Hegland, Thomas A., Zhengyi Fang, and Karen Bucher. "GLP-1 Medication Use for Type 2 Diabetes Has Soared." JAMA, Co ar Elie g sitc b -o s le n hs ar in id id n er ig vid ed m u ec fal os r h an a wer b isre m oad r san s er u d co shm et as l y o fc s o el inp ec daic y tat ed mien o fn ots r s , tcp ran eat oli c h m ym el en pak tr e w er dis u th can ie n d teac h e e m h fip n slan o cen yer ciar al s im o b. uur s dten w ei og nh i nts hu er er fin san an cd ial em imp pllo icyer atio s,n b s ut Suggested Citation: Sharma, Keshob, Jake Spiegel, and Paul Fronstin, “GLP-1 Coverage and Its Impact on G AdhLP eren- c1 C e to GLP ov -1e mr eda icg atie an ons wasd moI dts eled I usmp ing real act on -world find E ingmpl s from o a By HI me studnt y bas -Bas ed on Bed lue Cr H ossea Bluelth l oss accounted for 10.5 percent of total claims in 2025, up from 6.9 percent in 2023, underscoring the rapid growth in • is noA t d a h pe errfe en ctc e es tA ima mp te lif oie f p so C ten os tital s t : ak Per e-fu ec p t rad ates her am enocn e g le a dn t ew o g lyr eat eligi er bl e p o rem veriu wm ei gin hc t ran eases d obe th se an po real pul- aw tio on rl,d a ad s sm her alen lerc fi e, r ms • volWh . 33il2 e n GoLP . 1 -2 1, s 9 m 5ay 2– 9 ev 53 en (tJu AM ally A g Nen etw ero at rk e, sAu om ge u sm t 3 ed 0i,c 2 al0 2 co 4s )t . r Av ed ai ulc ab tio le n s at , these benefits would not be manifested ag t Eh m ey ai pn lo d sy o t m tn hen o et tp f-u o Bltas len y ed o tifal f s He et loal n th g th e -t er Pl efan m fec h Pr ts eal eom tf h ib u b rm o en ad s:ef er Ai t S sel im fio gu rib la at ilig tio yr o nan w -Bid n as g hed ip go h An p ad ual lat hys er ioien s n, ”o c f E e B el rR at ig I es ib Is l. e s O upe u at rB ifen riin ef t ds ,i .n n g os. u 6n 4d 4er (E sm cop re lo yee that Benefit Shield claims data, which provided empirical estimates of treatment duration among patients. These adherence d emand (International Foundation of Employee Benefit Plans, 2025). Premium Increases Using Current Net Drug Costs Plan Premiums: A Simulation-Based Analysis may be less likely to cover GLP-1s and also, by their nature, employ fewer workers than larger firms. However, the popularity even with cost sharing in place. Not alh l tin tp id m sivid :m //ed d uo al iiat .so el r el g yi/g ,1 ian b 0l.e 1 d 0 tto 0 h 1 er t/ ake Je AM i sa A. n p o 2ar 0 e2 tvid i4 cu .1 en lar 82 c e 1 d9 rtu o . g s ac ugtg uest ally t h dat o sto h.e Ts oavin mog ds el w po ou ten ld t fiu al ll yt ake offs-et up G rLP ate -s 1, p w rie c es as.s L uo m ne gd - tter he m expanding eligibility — especially to include overweight individuals or those with newer indications — can significantly R esearch Institute, October 9, 2025). patterns were used to define both the “real-world” and “perfect-adherence” scenarios described in the study design. Introduction of GLP-1 drugs may encourage more overweight and obese workers to take them up. In the current net-drug-cost scenario, premium increases varied notably based on eligibility criteria, adherence level, proportioG nLP of- 1 th u es ag hypo e is th n et ec ices allsyar el yi g to ib ac le h oib eve ese w an eid g hotver losw s.ei F gu hrtt h per op m uo lat re, io n ss tu td aik es in g o f uG pLP G- LP 1 -d 1is s cw on otuin ldu at bei osn im in ild ar ic at toe the that By Keshob Sharma, Ph.D., Jake Spiegel, Employee Benefit Research Institute, and Paul E am mp pllio fy yer pr se an mid u m he ial nc tr hea ps lan ess , rar aie s in ing c rieasin mporg tan ly tc o qn uc eer stn ioed ns ab abo ou utt tlh oe ng c-ots er tsm as as ffoocrid at ab ed il iw tyi tan h G d Lb Pen -1ef dirtu d gesig s fon r . w eight • Cost Sharing Helps: Introducing a $90 copay reduced premium increases by 1–2 percentage points across G In lu ter cag nat on io -ln ike al F po ep un tid dat e i(oG nL o Pf- 1) Em rec plo ep yee to rB ag eno ef niits tPl s an are s"a GtLP yp-e 1 o Dr f m 3ug ed s:i c 2at 02 io 5n Pu orlisge inS al ulr y ve dy evel (Uo .S p.ed )" (tIn o ther eln pat m io an nal ag F e ou Tn ype dat 2 io n and cost-sharing structure. 4 L C po o im p puyr lita at ig iop h t nat t ions oiIen fn p ftat o s riren m eg a tai s t in w o n iw th :ei T tgype h hits t rh 2 ep ey do i ab rlo t s et is t es w coh p c ilyr u er irtg en akin htted ly g d b G o y LP i n th g -1 e s so E , .m an p Sd lio m iye m ilar p e rlB o y,v en em ne often i tal R tl esear o in f dciar vic d d h u i o al In va ss s ttic akin tu ultar e g ( rE p isB rk esc R fI) ac r.i t p Y oto r io s u n rm eg day rr ues gcss o py, Fronstin, Ph.D., Employee Benefit Research Institute As • o f Oc Cu tor be ren r 2 t 0h2eal 5, t th h e car lise t p srp icen e d foin r W g d eat goa vy w ier s $ e1 s ,3 o4 u9 rc .0 ed 2: s free omh tth tps: e M //ar wket wwS .n co an vo c da at re ab .co as m/ e,o w be hsi icth y/ pr coo ndu taicn ts/ s w co eg mo pvy reh /let en -s us ive - management, especially as their popularity continues to rise. One survey found that 27 percent of employers reported most scenarios. diabeto es. f E m Th pey loyee mim Bien c tef heit ef Plfan ecs ts , 2 o0 f 2 a 5n ). atAuvail ral ab holr em at o nhet ttphsa :t/ /iw s w rel we.as ifeb ed p .af ortg er /r eso eatiu nrg c. es Th --i-sn h ew orsm /sounre v ey hel -rp ep s o th rte s/bgolp d- y1 l-ower ad Loo hkin ere gt o ah to c w ead liar nic d , al st h tg e hu e iin d p fan at luen icen e.c te Ac ’s ob cfo aG r sd el LiP n in -g 1s e, ly, s o u w ng e em gm esp o tlid o nel y gm ed th en at ad t -G h be as LP ren ed -1c s e h m eal to ay tG hn LP p eed l-an 1s s t o u is n b d le ier k t el aken ty wto o s icn c od en nef tar in inu iio te el s:ty, o ex wh pian ch dc o as u ld th fese urt her print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and help/explc aliai nim ngs- ld isat t-p ar f ic re o.m ht ml em . ployment-based health plans. We used this database to obtain the synthetic firm’s baseline This study has several important limitations that should be considered when interpreting the results. GLP-1 drug costs accounting for more than 15 percent of their annual claims (International Foundation of Employee Assuming take-up rates that mirror GLP-1 take-up among adults with Type 2 diabetes, and with the adherence rates blood d sru ug gar s- us by-- in 2c 0r2easin 5-pug ls e in -s su urlivey n, r.ed ucing another hormone called glucagon (which raises blood sugar) and slowing Figure 5 drugs gai in nc F rease DA ap cp or so t val pres fo sru ad res dio tin o n in al s uin ran dic cat e ip ornesm , s iu um ch s .a s cardiovascular disease and other metabolic conditions. As all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report, health care spending. B 5 enefit Plans, 2025). Additionally, insurers have identified the growing use of GLP-1 medications as a contributing • Range of Premium Impacts: Net prices — inclusive of rebates and discounts — were obtained from an Institute for Clinical and Economic Review (ICER) observed in the BHI paper and a $0 copay, premiums increased 6.1 percent when only those with diabetes and obese how •q uicP kly er ffec oo t dad leav heres en c th ee : A stll otm reat ach m . en Totg iet nd hier vid , u th alese s rem effai ec nted s h o el np the peo m pled e b icet attier on m foan r 1 ag 2 e o rt hm eio r rb e lo woeeks d su.g ar levels — Premium Increase Using $200 Drug Cost First, the assignment of GLP-1 drugs in real-A woT rld clA inic al G settL ingA s rN eflec CtsE ind ividualized decision making based on the eligible population grows, employers may need to reconsider coverage strategies, potentially introducing stricter provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s factor to rising health insurance premiums. J rep am oes, rt o n Dav affy. ordab "Hep le at ac itcis e ss C Dr to G ug LP s -Dr 1si,ve wh In icc hr,ease in turin n , we Aver re ag pe roC du os ct ed o usi f Sp nec g d ial atta y fr Pr oesc m SS ripR ti o Hn ea ,"l tPh h, In arm c.ac y Times (April 2, were eligible. They increased 10.4 percent when overweight individuals were also eligible (Figure 4). With a $90 copay, As an dG , LP in -m 1 an dru y gcsa s ges, ain al FD so A lap ead p rtooval si gfn oirf ia c an brto w ad ei er g hrtan logse s.o f conditions such as cardiovascular disease, employers may C ost-sharing assumptions were drawn from the KFF Employer Health Benefits Survey, focusing on typical structures for factors such as injection frequency, side-effect profiles, comorbidities, and insurance coverage (Defnet, 2025). Our p elriig oirb iex lity prc ersitser pier a,m pirsio siro au n. tF hoorr ip zer atm ion is srieq onu si,r e pm leen ase ts c , o on r tiac nn to E vat BRiI ve at p p ay er m m en iss t im onosd @ eleb s tro i. o m rg an . age costs. Without proactive ? Current Net Drug Cost + Perfect Adherence + Broad Eligibility: Up to a 13.8 percent increase. The rapid growth in usage of glucagon-like peptide (GLP-1) drugs — initially developed for diabetes but now widely • 201 R5eal ). - Aw vail orlab d ad le h at er h en ttp ce s::/ A /w dw her wen .ph car e m foac lloyt wied mes.c pato ter mn /vie s ow bs /er hep ved atitin is -ac -Bdlu ru eg He s-dal ritve h -In intcel rease ligen-c in e- ( aB ver HI) ag se t- ucdoys t-of- p 6 remium increases were slightly reduced to 5.3 percent and 9 percent, respectively. These results show that expanding need to revisit coverage policies. Without strategies such as targeted eligibility, prior authorization, or alternative s s ip W m ec e uilal c at htio y ose n d rrtu an og m s d,o os m de ulcy l a h a s as sc s en u am a $es r9io 0 d ic n io f wh fp er ay en icm ht G en GLP LP t p --1 er 1 s d c 3r o 0 u s-g td s $ ay 2 a0 m s 0u o , p n as p gl t yel h . a ig ti ibs lea ipr ndic ivid e pu oal ins t, t w arh get ich ed b does y f in rms ot s fuullcyh a cap s C tu ign rea th (se e e T plh an is nIs insg u,e th Be ri ef w id ee xs pp lo rr ead es tad he op po tito en n to ial f G im LP p-ac 1st c oo f uG ld LP d-r1 ive ut isliu zb at sito an n to ial n p inrc em reases iums in fo r p reem mpiu lom ym s, en aftf- ec bas tined g bhoeal th te hm in ps lo uyer ransc e used for weight management — is reshaping employment-based health benefits. As these medications are increasingly Initiallsyp , ec ex GLP ial am t-y 1i-n p d in rre u gs g c G sr LP iw pter -i1 oe nt .rap eat pm roen ved t p fo er rs d isai ten ly c in ej,ec wtiito hn 4 t2 o p m er an cen agte o T f yp ind e ivid 2 du iab alset ces on.t iB nu uti nbget tw reat een m 2 en 01 t 4 fo an r 1d2 + 20 w 16 e,eks , 15 el igibility to include overweight individuals significantly increases premium impacts, and copays blunt premium Report Availability: This report is available on the internet at www.ebri.org h p taym t p s: ?en / / w t$ w m 2w 0 o.0 d ev el Dr er su ,n g o ri rsC tih n o.g s c t oG m + LP / B a-rH 1 ti I cu lAd es tili/h zeat er ver ien on nc o e c rtoh + u- lld N au ar d nrc rio ve hw es s-E u nls ew ig tai ib -n ben ilied ty efi + int c$ -ro 9 eases p 0t io Cn o- p d in a ry: ives heal A-slo t h lw o w ienr s -an u se r an ta -c1 c o e st p p er -w rc e ei en m gh itu tm i-n lo c sss r , ease a -me ffec .di ticn in ges b)o, th nuanced clinical decision making guided by protocols such as those outlined by the American Diabetes Association an und d er em var plo io yees us s.c enarios and adds to the emerging body of literature focused on the financial implications of GLP-1 use. prescribed to individuals with obesity, and even to those who are overweight without comorbidities, employers are longer-ac pter inc gen , otn fco er- w 8– ee 12 kly w eeks versi,o n an s d b ec 42am per e ca en vail t fab orl e 4 – — 8 iw nc eleks udin . g dulaglutide (Trulicity), albiglutide (Tanzeum), and increases, but it does not do so by much. To reflect common eligibility approaches used by employers in determining GLP-1 drug coverage, we modeled scenarios employers and employees in the long term. Hims (see https://investors.hims.com/news/news-details/2024/Hims--Hers-Announces-Access-to-GLP-1-Injections-Passing- (American Diabetes Association Practice Committee, 2025). Khan, Sadiya S., Chiadi E. Ndumele, and Dhruv S. Kazi. "Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists," grappling with how to manage access and costs. While the clinical promise of GLP-1s is expanding, their high price semaglutide (Ozempic) (Reisdorf, 2024). These more convenient formulations contributed to the growing popularity of based on multiple criteria: Cost-Savings-Onto-Customers/default.aspx), and Noom (see https://www.noom.com/med/glp1- Treated JAM inA d, ivid vou l. al 3s 3 3 w er noe . 2 ran , 1d 1o 3m –114. ly as s(iJ gAM ned A, o N no e vo em f th ber ree 1 G 3,LP 2- 01 2 4 m 0ed . Avail icatio ab nlse : at Sax enda, Wegovy, or Zepbound. List point and growing demand have raised concerns aboutF th igu eir rie m p 4ac t on premiums. GLP-1 medications among individuals managing Type 2 diabetes (Hegland et al., 2024). Table of Contents Second, although GLP-1 drugs have been shown to be effective in promoting weight loss, this benefit is often Dis microc dus oses /?s ion rslt id=AfmBOopzqQcLWvGakWVjx8N9OLEjSqCjtiGNEGQBOdUs_dbi5z-jBsxp). Additionally, international pricing L Rand eferse cnc ape es o f GLP-1 Usage and Coverage 4 prices hfto tp r s G :LP //d-o 1i .d orru gg /1 s 0ar .1e 00 ver 1/y JAM hig A. h2 ; 0 fo 2r4 .in 2s 2t2 an 84 c.e, Wegovy currently has a list price of $1,349.02 for a 30-day supply. • Individuals with both diabetes and obesity. Premium Increase Using Current Net Drug Cost Introduction .......................................................................................................................................................... 4 c ontingent on continuous use. Studies indicate that discontinuation frequently leads to rapid weight regain (Khan et al., for several GLP-1s indicates that $200 may be a realistic price point for GLP-1s purchased in the United States (see This study assessed the impact of GLP-1 drug coverage on health insurance premiums in employment-based health Ac Am cer orid cian ng Di toab a et KF es F A su ss rvey ociat an ioal n ys Priac s, t4 ic2e p C er om cen mtit t oee. f n o"Ph n-el ar dm erac ly o ad lou glit cs A w pip th ro p ac rih vat ese t o in s Gulyc ran em ce ic— T ran eat est men imtat : S ed tan 5d 7ar .4d m s io llifo n This Issue Brief uses a simulation model to assess how GLP-1 coverage may affect employment-based health insurance As Ho w Gever LP-1, d m ru an gs u fb ac ec tu am rer es m so om re et wim ide elsy ouff ser ed dan iscdo u stn utd s ied an,d rr eeb sear ates, cher lo sw fer ouin ng d t th hat e ef th fec eyt ic ve oup ldr ic pe. ro m Th ou te s , sd ig rn uig fi c can ost t sw w eier gh e t This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), 2 ht0t2 p5 s:;/ / Wi ww ldw in.g hea etl tal hsy ., s2 te 0mt 22r)a . cHo kerw .o erver g/br , itef her /pr ei cies s l-im ofi-tdr ed 1 u gs em -fp oirr-iw cal ei gh dat t-a los osn - in lo-n th ge--tus er- m an ad d-h pe er er en - ce and the share of plans. Through a series of simulations incorporating different drug costs, adherence level, cost-sharing designs, and iLan ndivid dsCar cu ap ale e s i— o nf Di G arLP ab e - c et 1 li n es U ics — al ag 2 ly 0 e 2 el an 5ig ,d "i b Di Co le ab ver foet r ag G esLe P Car ................................ -1 e d,r u vo gls.. 4 8 A(m 1o ) n (A g m th er os i................................ ce an w iDi thab em etp es lo ym Assen octi- at b................................ ia osn ed Pr h ac eal tic te h Co ben mef mititst,ee, t................ hi s J anuary 6 Montero, Alex, Grace Sparks, Marley Presiado, and Liz Hamel. "KFF Health Tracking Poll May 20254: The Public’s Use and prem •i umIn s u dn ivid der u al var s w yin ith g o as bs eu sm ity ptal ioon nse r . elated to drug costs, adherence rates, cost-sharing structures, and eligibility s lo osu sr c — ed even from i na in rec divid entu s al tu s dw y ito hfo tu hte dp iab ricet e e osf. G TLP his - 1l ed dr u to g sa n set ur g oe f rieb n off ate -s lab an eld ud sie sco ofu G nt LP s -(1 F ig du ru re g s2 f)o . r T wrei eat gh m t en man t dag urat em ioe nn t, with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, JP Morgan nations/#List%20prices%20of%20drugs%20used%20for%20weight%20loss%20in%20the%20U.S.%20and%20peer%20nati individuals who remain on GLP-1 therapy over extended periods to sustain health outcomes. eligibility criteria, we estimated how various scenarios affect overall health care spending and resulting premium translat 20 es 25t)o . A ap vail pro ab x ilm e at at el h y t t 4 p 9 s :. / 3/ d m o ii l.lo i o rn g /el 1 0 i g. i2 b3 le 3 7 i n / d d c i vid 2 5 u - S al 0 s 0 ,9 w . it h 3 6 . 2 m i ll io n el i g ib le b a s ed o n an o besity diagnosis Views of GLP-1 Drugs," KFF (May 10, 2024). Available at https://www.kff.org/health-costs/kff-health-tracking- c riteria. Drawing on data from MarketScan and current literature examining GLP-1 usage trends, the model estimates M s pc ar et alth ed icoud ld ar sr u ................................ ly g am cos otn s ga s o b fo elslo e w an s: dt w o................................ ver o uw niei tsg fhotr a4 d– u8lt s w . ee Inks 2................................ ,0 2 th 1r,ee sem una itgsl u ft oid r e 8– w 1as 2 ................................ w oeek fficis al , lan y ap d p fo ro uved r un ifto sr ............................... fc oh r r1 o2 n+ ic w weeks eight. To 6 Chase, and PhRMA. ons). al choan ne •g . eS si.B n Ac c ro ead rG os LP er s -al el 1ls i g s ar icben ie li tar ryel ito at hsat i,vel t h in y ec n lfu ie n dw d es i,n tg o hs ver e rleve an wei dal s gc ed hap t ic n eo do n ivid fs iG stu LP en al-s t1 iw n uic strag heases at e h le as as in s t h p oirfn e te m ed w i us ei m ig g sn h i— f t- ic r an el that o tlu y ed g . h B c et tohn w e deen im tio ag n 2 .n 0it1u2d e an vd ar 2 ied 02 2, poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/. h ow different combinations of these variables influence total spending and insurance premiums for large and small r m ef an lec ag t e pm oten entt iu aln d fu er tu t rh e ep b rircan ing d d nyn am ae mWe ics,g w ovy e al . S so im m ilar odly, el ed tir zan ep at altid er e, n at firive st ap scp en ro ar ved io w fo hrer de iab Get LPe-s 1 a dsr u M go su cnojs ar t o $,2 l0 at 0er p er Our analysis relies on general cost-sharing assumptions for specialty drugs due to limited availability of detailed, drug- Study Design ..................................................................................................................................................... 6 Anderer, Samantha. "Study Identifies Benefits and Risks of GLP-1 Drugs Across 175 Health Outcomes." JAMA, vol. 333 7 d epending on the underlying assumptions. the share of Americans under age 65 covered by private insurance who filled at least one GLP-1 prescriptio6n rose by For instance, the Congressional Budget Office (CBO) estimated in 2024 that if Medicare covered anti-obesity medications firms. m r ec oei ntved h, alap low prin og val u sf otr o w eei valu ghat t le o sh so u w n d loer w er th e prb ic res an d m n ig ah m t ein Z flep uen bo cu e np dr em (Rei iusm do irm f, p2 ac 02 t 4 an ). d patient cost burden. specific cost-sharing data for GLP-1 medications. We use a $90 copay as a proxy, which might not accurately reflect the We characterized the distributio ¶n of BMI and diabetes prevalence in the simulated employee population using BRFSS Reisdo nr of., 1 A2 na , 1 . 0 "2 Hi 3s t(o JA ry M o Af N Get LPw -1 o rM k, ed Feb icat ru io ar ny s"2 (1G , LP 20-2 15 Hu ). h bt,t p De s:c /e /d m ob i.er or g 1/9 1,0 2 .1 00 20 41 )./ JAv AM aiA. lab 20 le 2 5 at .0 h 5t4 t2 ps . ://glp- Data ..................................................................................................................................................................... 8 717 percent. DespPr ite etv ha el e fas nc t e pac oe f o Ofb ue tis liizty at iB on a s ge ro dw o th n, Se holw f-e R ver ep , o rr el te at d ivel Wy eifg ew ht ad an ud lt sH te ak ig e hG t LP Am -1s o, na gs only 3 percent such as GLP-1s, Medicare would spend $7.1 billion covering these drugs in 2034, but the cost savings realized from healthier actual variability in out-of-pocket costs across different employer plans and formularies. U dat nd a er an th de su lopw per or-td inrg u gli-tc er os at t u srce en sar pec ioi f(ic $ 2 t0 o 0ad /m uo ltn st h w)i,t h p reem mpiu lom ym in en crteas -baes sed w er heal e rtel h at plian velsy. m Th ois d est allo b wued t r e um s ai ton a ed ss isg en n s real itive is ttio c 1hub.com/history-of-glp-1-medications/. Figure 2 • Currently, GLP-1 drugs ar U e. S. ver A yd ex ulp ts en b sy ive Sta . Ac te co a rn did n g T e to r ra ito rec ry en , B t R est FSS, imat e 2, 0t2h3 e net price for a 30-day supply of M suedi bm ciatrte ed b en a c ef lai icm iar ifes or w a oG uLP ld -t1 o tm al e od nilc y at $i1 o n bi iln lio 2 n0 . 22. Further, discontinuation rates are high, which further reduces Al T ot heosu tig m hat GeLP to -1 tal d rhueal gs th have car e b een cost s av pai olsab t-tlr eeat for m sen ever t, tal he yea cos rs t ,o rfec Gen LPt- 1 ap dp ru ro gvals s for obesity treatment have triggered a Results ................................................................................................................................................................. 9 BioPharmaAPAC. "25 High-Value Dr ugs Losing Patent Protection in 2025: What It Means for Healthcare" h beal otht h ad rh iser k en pro cfei le an s d to c t oh pea y syn level thet s.i cIn wdoivid rk fu oal rc se w an ith d p uer nd fec ers t tad anh der hen owc e elc ig oin bs iliis ty ten ex tlp y an ex sh ioib ni tced ou lh di g im her pac pt r eo m ver ium all iu nt cirliease zatiosn GLP-1 Drug Costs GLP-1 drugs ranges from $617 to $766. s u wu tas irlig z e at ad iin o d n e dd .e F m to oan r t ih n des . tfT an irhm icse, ’ sd b e rese m asan elar id nc eh i s s ie p nx en dp ic ec d at in tes ed g. tN th o ew at c o 2p n 6rt e ip nm er uie u cen m grs o t w w ofie n u re gs er as ths en nde is w cer on d tiem nue og wriap thin hi ctsh,r iee nc lm ud oin ntgh s y oan utd h ,3 g 6ai pn er ac cen cets s d o 8 Fourth, while GLP-1 drugs have demonstrated clinical benefits beyond weight loss and diabetes — such as For instance, see Wilding et al. (2022) and Khan, Ndumele, and Kazi (2025). Pear Prs em o (B nii,u o S m Ph teven In arm cr aA ea D.s PAC, , es Ch U r s iDe sin to g cp e Cu h m er b r r er M en .2 tWh 7N , et 2 al 0 e Dr 2y, 4u )an .g Av Co d ai S sltar ab s a ................................ lh e K at . E hd ttm pso:n //db. io "A pfhfar orm d................................ ab aap leac Ac .c co ess m/ an to al Gy LP si- s1 /6 O ................................ 0b /5 esit 727 y /M 25 ed -hic ig at hi-o valu ns: e -9 t an han d c to hsots se . with real-world adherence (based on BHI data), even when cost sharing was introduced. This pattern may ( c sE o alver c w uiltn at hoied n rt h a uHeal y sear ingt h ( th D S e oer s et a vic m al e e.s ,8 , 2 5 20 0 p 22 er 45)) c . .en TThthese e m p ed er hiic c gal en h d lto ag is sc se o rn o at tfi in o ad u . at u Tlh ito s e n c p o rer at ns c es ien d er rtai ag es de e o cboes nceer hn ass, ias nc rp ease atien dt s d rm am ayat nic oal t lex y s pier ncien e 2c0 e1 t1 h;e improvements in cardiovascular risk factors and other comorbid conditions (Anderer, 2025) — our model focuses on drugs-losing-patent-protection-in-2025-what-it-means-for-healthcare.html. Figure 3 9 Strategies to Guide Market Action and Policy Solutions," Institute for Clinical and Economic Review (April 9, 2025). Premium Increases Using Lower Drug Cost ($200/month) ...................................................................................10 reflec • t thAd e fd ac itito tnhal at ly, m G oLP re -ad 1 u hs er ag en e t is p at rel ien atitvel s ar y e loal ws:o O m nlo y re 3 en per gc ag en etd o w f in th o nt-hel ed h er eal ly tad h D cu rar u ltg s e c so ys ver Nte etm ed C,o b fsiy ltl ifn e og m r a p p r l3 o e0 y s-m c dra en ip yt tiso -u b n p a sp s led y There was, for instance, a $57 difference between the retail prices for a 30-day supply of the 0.25mg dosage of Ozempic full clinical benefits of the medication without sustained adherence. c whitan h g oe besit in p yr e af m fec ium tin sg w at as l east com p 2u 0t ed per b cy en cto m ofp ad ariu nlg ts tih ne ever new y p Ur.em S. s iu tm at ew — ith an thd e exceeding one-third of the adult short-term impacts to employment-based health insurance premiums and does not incorporate potential medical-cost Adherence to specialty drugs like GLP-1s Model Inputs Available at https://icer.org/wp-content/uploads/2025/04/Affordable-Access-to-GLP-1-Obesity-Medications-_- health insurance had a GLP-1 claim in 2022, and a 2024 survey found that Sa x oe nne da in eight respo$766 ndents had ever regularly and thus driving up overall drug utilization. The presence of a $90 copay reduced premium increases in all Di ans d cu th se s i2 omg n ................................ dosage in the Market................................ scan database, although ................................ this does not reflect p ................................ otential manufacturer d ........................... iscounts or rebates . 11 o pr oip gu inlat al io bn as iel n i23 ne . sT tat o es ac c(o Cen untt er fosr fso to r cDi has sease tic var Coiab ntrio litl,y 2in 0 2 c4 o)s t— s, tel hie g ip bo ilt iten y, tan ial dm arket for GLP-1 drugs in weight B oflu fse etHeal s resu th lIn tintg el flirg oen m cim e. p"rR oeal ved -Wo heal rld th T o ren utc do sm in e s G . LP Fu -t1u r Te rerat esear men cth P ser ho siu sltd en as ce sean ssd t h Pr e elo sc nrg ib -itn er gm fo irm W pac eig t h otf M Gan LPag -1 e um se e n otn ," varies widely in practice. Low adherence Category Value / Source ICER-White-Paper-_-04.09.2025.pdf. Wegovy $617 taken a GLP-1. However, there is a massive pool of potentially eligible enrollees. Over 40 percent of privately scenarios, suggesting that even modest cost sharing can shift financial responsibility from the plan sponsor to the E Sim mi pllaory lyer , r c eo tai ver l pag rice in o g f f o an r Z depb spen oud nid n g th o ro nu G gh LP Li -1 lly s D has ire ccth ran ang ged es fr sio gm nif$ ic3an 49t lfy ora t sh w e el 2.l5 . mg A 2 do 02sag 4 IF e, E wh BP s ile urtvey he 5 fm ou g, n 7 d .t5h mg at ,3 4 t m reat anag men em t en dut rn at oiw on s , u th rp is as ss im esu t lat hat io n fo w r a dsia rb ep ete es at ed treat 10 m ,0 en 00 t. t imes per scenario. Limitations .......................................................................................................................................................... 12 overalB l lh ueal e Heal th ctar h eIn ex tel plen igen ditcue res, Issu pe ar B tircie uflar (M ly ay as 2 w 02 ei4g)h . tAv loai sslab mlay e at red uce the incidence and cost burden of chronic Population 5,000 employees rates may result from high out-of-pocket Zepbound $725 employee in s an urded d aad mu plen ts — th e mim orp e ac thtan on 5 p 7r em mililu iom n sp . eH oo pw le e— ver ar , even e clin iw cal ith ly cel op igaiys ble , p fo er r fG ec LP t -ad 1 h der ruen gs cre esu stilltl in resu g frlo ted m d in iag hin go hser es p 10 er mg, cen 1 t 2 o.f5 mg, emp a lo nyer d 1s5 m su g d rveye osad ges coar ver e ed all G prLic Pe -d a 1s tf o$r4 b 9o 9t as h doiab f Aet ugu es st an 2d 0 ,w 2ei 02 g5 h.t loss, an 8 percentage point increase from Number of simulations 10,000 per scenario disease htst,p s as :/ /w wel wl w as .b p cb os ten .cotm ial/ m im ed prio a/ vp em df/ en BH tsI_ in Is h su eal e_tB h ran iefd _ G qLP1 uali_ ty Tro en f ld ifs e. p od uft side the context of cost savings. Wilding, John P. H., Rachel L. Batterham, Melanie Davies, Luc F. Van Gaal, Kristian Kandler, Katerina Konakli, Ildiko c Co osntc sl, us siid oe n ef ................................ fects, low engagemen ................................ t with .......................................................................................... 12 premiumo b f u drid ab en et ses, th an ob esit mory, e toyrp b icei aln ad g o hver eren wei ceg h ptat w ter ith n s ad . ditional risk factors. the year before (Goforth, 2025). A survey of employers conducted by KFF found that one in four employers that do not We modeled two cost-sharing scenarios to reflect common benefit designs in employment-based health plans: Log-normal (meanlog = 3.33, sdlog = 0.210251); based Lingvay, Barbara M. McGowan, Tugce Kalayci Oral, Julio Rosenstock, Thomas A. Wadden, Sean Wharton, Koutaro prescribing providers, discouragement from BMI distribution c Ru ef rrer en en tly ces co ................................ ver GLP-1s for weight................................ loss are considering d ................................ oing so (Claxton et al o................................ .n , 2 su 0r2 v4 ey ).d T ah tae stark dis.......................... parity between th e 13 F Cen inal ter ly, s tfh oer p Di risceas inge oC f o Gn LtP ro -1 l. d "r N uegw s iCD s eC x p Dat ecta ed S h to o w d ec Ad lin ue lt o Over besit tim y e, Pr epvale artic nu cle arR ly em asai g nen s Hi erg ich f,o " rCen multat erio s n fo s rb Di ecsoeas mee Control Yokote, and Robert F. Kushner. "Weight regain and cardiometabolic effects after withdrawal of semaglutide: The U a n lac der •k o th f E e rm esu cu pr llo rten s y, er to rn c o et lac ver p kr ag o icfe es s u is cs en tex aiar n ped an io, d p in rg em : 5 iu 5m p er inc cen rease t ofs em wer pe loyer mos re co pver ron o GuLP nc-ed 1s ac for r odsis ab al et l es gro , u an ps d. 3 T6 h e p er mc oen st ts c ig on ver ific ant • $0 copay: Represents full coverage of GLP-1s by the insurer or employer, with no out-of-pocket cost to the Health Characteristics 10%; assigned probabilistically number of individuals eligible and this relatively low number of claims suggests that GLP-1 utilization within availab Pr le ess fo lR loel wea ing se p ( at Sen ept t em exp bier rat 1 io 2n , s2 0 (B 2i4 o)Ph . Avail armaAPA able at C, h 2t0t2 p5 s: )/. /W ww idw espr .cdea c.gdo v/ adm op ed tio ia/ n ro el f ease lower s/ 2 c0 o2 st4 / G pLP 09-1 1 2m -aed duilctat - ions Endnotes ............................................................................................................................................................ 14 STEP 1 trial extension." Diabetes, Obesity and Metabolism, vol. 24, no. 8, 1553–1564 (April 19, 2022). Available iac nccress eases . H t h o oem w cc ever u fro red r, b c lo a in tm h ic o al dni ab g r esear iet ndes ivid can hu al d in s d w iw c ei at ig th e h s tp ler osfs ec . t adherence and those eligible under expanded criteria that included employee. Eligibility Criteria-1 Diabetes or Obesity employment-based health plans is likely to continue rising. may do rb ive esit hy.h ighter m lu .Cl tilax izat toio nn , G inar ty, he M fu at tu th re. ew O R uae, r resu Aulb ts r ey ref Wi lecn t gcer ur,r en ant d oErm hm yp ao W thag etier cal . "E prm icip nlg o yer scen Heal ariots h b Bu en t d eo fi tn so 2 t0 c2ap 4 ture at https://doi.org/10.1111/DOM.14725. o th ver at w prei og lo hn tg setd at u us se . E is x p can ritid cal ed t el o irgeal ibiilz itiy ng to include overweight individuals — many of whom may have comorbid Eligibility Criteria-2 Diabetes, Obesity, or Overweight the dyn An an m uial c e Sfu fec rvey" ts o f( K fu FtFu,r O e cptroic bier ng 2 s0h2if4t) s., Avail eligib ab ilitle y at ex p ha ttnpssio :/n /,w o w r w b.rk ofad f.oer rg /m heal arktet h- c ac oc ses ts/s2.0 F 2u 4t-uerm e p slto uy der ies -h s eal hotu hl-d • Perfect adherence leads to higher premiums: More consistent drug use may improve individual well-being and • $90 copay: Represents a typical tiered formulary design, where the employee pays $90 per 30-day supply, lco on ng d-itter ion ms h se ual ch t ha s b en hyp efer itst,en as s ion or cardiovascu Plar erf e dct is e Aas dhe e r— en ce compounded th1 e0 p 0r % em on iu dm ru g im fo prac 12 t. + T wh eese eks findings suggest Fig ures explorb een thef ese its -fsac urtvey/ ors, .i ncluding the impact of price reductions, expanded clinical indications, and long-term cost offsets, Yeo, Yee Hui, Ali Rezaie, Tina Yi-Jin Hsieh, Xiaoqin Hu, Srinivas Gaddam, and Kevin Sheng-Kai Ma. "Shifting Trends in health outcomes but drives up overall plan spending in the short term. Simulations assuming perfect reducing the insurer’s share of drug costs. 42% (12+ weeks), 15% (8-12 weeks), 42% (4-8 d th is at co as nt it nh ue atn io un m o bfer ten o fr esu eliglitbsl ei ni nw dei ivid ghutal s grows, so too will the financial burden on employment-based health plans. Methods Real-world (BHI) Adherence Figure 1, Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory ............................................ 4 to more comprehensively assess the implications of widespread GLP-1 adoption on insurance premiums. the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptionw s:e A eks) Nationwide Analysis." Annals of adherence result in premium increases that are several percentage points higher than simulations assuming regain (Wilding et al., 2022). Given the Defnet, Ann Marie. "What’s The Best GLP-1 For Weight Loss?," The Well (Northwell Health, May 12, 2025). Available at 9 drugs (e.g., Ozempic, Wegovy, Mounjaro) assigned To eval Inu tat ere nal th M e ed effiec cinte s , ovfo d l.i f177 feren nto el . 9 ig, ib 1i2 li8 ty 9– c1 ri2 ter 90 ia, . ( J w ue ly c 2 o3 m , p2ar 02 ed 4) .n ar Avail row ab an led at b rhotad tps i:n // cd lu osi.io on rg t/h 1r0 esh .73o 2l6 d/ sM ; 2 o4 n- e0 s 0c 1en 9.ar io Importanad tly, her th en ese ce rp esu attler tsn h si g oh bls ig er hved t a pio nt en recten ial tt r sad tud eio es ff . in the broader adoption of GLP-1 therapies. While clinical GLP-1 medications iS m tp ud ory tan Dce es o ig f n ad herence to both health Figure 2, GLP-1 Drug Costs .................................................................................................................................... 7 randomly https://thewell.northwell.edu/obesity/glp1-treatment-options. limited eligibility to individuals with both diabetes and obesity, while broader scenarios included those with obesity With perfect adherence and a $0 copay, premium increases were 2.3 percent when only those with diabetes and research increasingly points to the efficacy of GLP-1s for a range of conditions beyond diabetes and obesity (e.g., outcomes and financial impact, we Net prices sourced from ICER report, normalized to a We simulated hypothetical increases in health insurance premium rates using a modeling approach designed to C onclusion Drug Costs • The impact of expanding GLP-1 coverage on employment-based health insurance premiums is sensitive to al ob oes ne ity o rw ter hoe se el w igh ib ole w an erd e o 3v .9 er p w er eicg en htt. w Th hese en o s ver cen war eiig oh s tr e infd lec ivid t ru eal als- w wo er rle d al po slo ic el y id gec iblie si. oWi ns tan h p der evo fecltvin ad gh c er lien niccal e g an uid d el a in $9 es. 0 c Far igu dr io e vas 3, c M uo lar del d iIn sea pu stes, ................................ sleep apnea, PCOS), ex ................................ panding eligibility co................................ uld drive 3 s0 ig -d na ify icsu an ptp ily n................................ creases in premiums. ........... In our 8 modelled multiple adherence levels in the Do, Duy, Tiffany Lee, Samuel K. Peasah, Chester B. Good, Angela Inneh, and Urvashi Patel. "GLP-1 Receptor Agonist estimate changes in total health care spending and corresponding premium adjustments under various eligibility, cost- The rapid as rs is ue mip nt ito hn e sp soupru ro lar un itd yi n og f G up LP take -1 d an rug ds d m ruir gr o prrsic tes: he t rajectory of other high-cost specialty medications that have copay, premium increases declined to 1.3 percC en ost t an sca dl i2 ng .2 percent, respectivel 1xy. (4 -8 weeks), 2x (8-12 weeks), 3x (12+ weeks) s imulations, inclusion of overweight individuals alone led to substantial upward pressure on premiums. And, while s imulation to assess their influence on Discontinuation Among Patients With Obesity and/or Type 2 Diabetes," JAMA Network Open, vol. 7 no. 5, s Th har e ifn in gal , an ou dt p ad uth o er f en the cem so cen delar is io tsh . eK p ey er m cen od tel ag ie n p ch uan ts g inec liu nd p erdem heal ium th s c uar nd e er d at eac a fhr osm cen th ar e io M. ar Rk eet suS ltcsan ar e dat su ab mas me, ar iel zed igi bility Figure 4, Premium Increase Using Current Net Drug Cost ......................................................................................... 9 historically influenced insurance premiums. For C e ox sta S m hp alre in,g the introduction of $ h0 ep co at pia tiy s C treatments such as Sovaldi and insurers may eventually realize savings in the form of medical cost offsets, these benefits may not necessarily be emploe24 yer 1p3r1 e7 m 2i u(m JAsM . A Network, May 24, 2024). Available at https://doi.org/10.1001/JAMANETWORKOPEN.2024.13172. Endnotes o Using real-world drug cost scenarios, premium increases ranged from 5.3 percent to 13.8 percent, c u Ers ven iitn er g i u a, th n e d ad er 5h t er h red , en 5u 0c cte ed h l( evel m dred us g, i an p hrypo ) ic , es an t,h d et a d 9 ic h 5al er th en cp oer s cte c -s en rh ear m tiliai es ng ned o sft rta u h c e kt ey u sirm es du r,li at ver an ed d o o fp b rpe srer m em ved iuim um as c h in an w crel g eas es l as ,e p sh .r ypo o Per vidtfih ec net gt ia c ad al dh id s er trru en ib gu cp te iro ip c nes ral od . vi ue ced w of With perfect adherence and a $0 copay, premiums increased 8.1 percent when only those with diabetes and obesity Harvoni contributed significantly to national drC ug o st s p Sen had riinn gg (Davy, 2015). Sim $i9 lar 0 lco y, pan ay p Ee vrer 3n 0o -dra th y su rep pp oly rt from 2022 manifested immediately. While some benefits are realized in the short term, long-term use is necessary to mitigate Figure 5, Premium In c reas e U s in g $ 2 0 0 Dr u g C o s t ................................ ................................ ................................ . 10 depending on adherence, cost-sharing, and eligibility assumptions. p go reat ssib er le co ou sttc io m m pes ac.t than BHI adherence, likelyC d ou ste S th oa s riu ns gtained drug utilizati$ o2 n0.0 per month (reflecting oral GLP-1 pricing) w foer un e del th igat ib lal e tan hod u g 1h 3 .l8 es p ser th can en t2 w pher en c en ovter ow f tei hg e hU t .iS n.d p ivid opu ual las ti o w ner ue se al ss s op el ecig ial ibtly e.d Wi rug th s, p ter hes fec e tp ad res hcer rip en tio ce nsan ac dc a ou$n90 t f o cro pay, A aild m et en aitls ed c osn uc m om mar itan y to fw al ith l d oat besit a soyu an rces d o an ver d weight, such as obstructive sleep apnea. Those potential 2 savings will not be Evernorth Health Services. "Navigating GLP-1 demand, cost, and sustainability." Pharmacy in Focus (Evernorth, March We generated synthetic firms of varying sizes, each populated with randomly assigned employees. For each simulated 1 Health Care Spending MarketScan claims data The KFF study defines eligibility as adults with obesity, diabetes, or overweight with other risk factors present, such as premium increases were somewhat mitigated, dropping to 7.1 percent and 12 percent, respectively. These findings one-half of total pharmacy spending (Evernorth Health Services, 2022). m ref old ec elt2 ed i5 n,p i2 u n0 t t2 p h5 ar e) .s a Avail h m oet rter a ter b s lm e is ,at p as r o h vid tit npsed su:r/an /in wc w ew c.o ever ntrac no ts r tar h.e co n m eg /ar ottiiat cles/ ed n oavig n a y at ear ing ly -gb lp as -1 is - dan em d an md ed -cic oal st--c an osdt- o su ffsstet ais n ab ariis liitn yg o Using a hypothetical lower-priced GLP-1 with a $200/month cost, increases ranged from 1 percent to f irm, health care spending values were randomly allocated. Ten percent of employees were assigned zero health care Zero-spend probability 10% of individuals coronary heart disease, hypertension, hypercholesterolemia, previous strokes, previous heart attacks, or angina. indicate that higher adherence levels — even with cost sharing — still lead to larger increases in premiums, driven by F frio gm ur e few 3. er ailments concomitant with obesity and overweight may not be realized for many years. Further, the 3.9 percent, reflecting the potential for future price reductions to mitigate cost pressures. spending, while the remaining employees received spending values drawn from an empirical distribution of nonzero Medical Cost Ratio (MLR) 85% sustained medication usage. 7 potential medical-cost offsets may be smaller than the cost of the drugs. 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