3 health plan strategies for managing access to GLP-1s
More than 70% of adults in the U.S. today are either overweight or obese, evidence of a significant public health crisis. Individuals with obesity are at increased risk of serious comorbidities, including type 2 diabetes, cardiovascular disease, acute and chronic pain, several types of cancers, mental illness, sleep apnea and osteoarthritis. Various treatment approaches for obesity exist, but none have changed healthcare like GLP-1s.
What are GLP-1s?
GLP-1s (glucagon-like peptide-1s) are a class of medications that play a critical role in regulating blood sugar by stimulating insulin production and suppressing glucagon secretion. While GLP-1s have been approved for diabetes since 2005, additions like Wegovy and Mounjaro (in 2021 and 2022, respectively) offer significant weight-loss advantages over previous drugs, accelerating demand for them and fueling their popularity.
The effects of GLP-1s on health plans
The popularity of GLP-1s may be driving better health outcomes for patients with obesity, but this has introduced an acute financial challenge for payers, who are being forced into difficult coverage choices for their members.
In this white paper, we share strategies that commercial health plans can implement to offer coverage of these obesity drugs now—without breaking their budgets. We offer:
- An assessment of the impact of coverage expansion for GLP-1s
- Three strategic questions for payers to ask
- Three policies to preserve the balance between member outcomes and fiscal responsibility
- The outlook for coverage of GLP-1s as they expand beyond obesity
