The popularity of GLP1-s is hitting a fever-pitch, with many touting that it’s a miracle weight loss drug, despite its eye-popping price tag. The high demand is creating a pressure point on health plans and employer pharmacy teams, making the expensive drug accessible to their members but not bankrupting the whole plan. According to a recent report from GoodRx, Americans spent more than $200 million on weight loss medications in 2024 alone. The report stated that fills for two GLP1-s, Wegovy and Zepbound, increased by 100% and 300%, respectively, and there is no sign of slowing down in 2025.

High Cost Not Impacting Demand

GLP-1 medications, originally developed to manage Type 2 diabetes, became popular for its off-label effect on weight loss. Fills for GLP1-s more than doubled even though insurance coverage for the off-label use is limited.  Americans are determined to access these treatments even when it means sacrificing a chunk of their paycheck.

As noted in the report, many individuals are paying full retail price, often exceeding $1,200 per month to get the drug. The willingness to shoulder steep out-of-pocket costs reflects the life-changing impact GLP-1s can have, or promise to deliver, from significant weight loss to improved mental health and reduced risk of cardiovascular diseases.

Limiting Coverage to Salvage Pharmacy Budgets

Despite the weight loss benefits, GLP-1 medications remain largely inaccessible under many insurance plans. The report found that roughly 20% of people with commercial insurance lack any coverage for GLP-1s prescribed for obesity. Other health plans simply charge a higher copay, increasing out-of-pocket costs by an average of $2,500 annually.

State health plans are also grappling with the financial implications of covering these drugs. North Carolina’s State Health Plan banned GLP-1 coverage for weight loss in 2024 after their costs ballooned to over $170 million. At the same time, North Carolina expanded  Medicaid coverage to include GLP-1s for obesity treatment, recognizing the long-term cost savings associated with managing obesity-related conditions like heart disease and diabetes in older patients.

The stark contrast in GLP-1 accessibility in a single state highlights a growing debate: should everyone have affordable access to weight loss drugs or should they remain a luxury item?

Short-Term Versus Long-Term Cost Savings

While employers and health plans are moving to limit GLP-1 coverage, Medicaid programs are recognizing the value of these treatments. North Carolina’s Medicaid expansion mirrors a national shift, with the outgoing Biden administration proposing federal Medicaid and Medicare coverage for weight loss medications. Experts argue that investing in these drugs makes fiscal sense because of the even greater cost of managing obesity-related diseases.

Medicaid programs receive significant rebates on medications, reducing the overall cost burden and paving the way for broader accessibility. As states like North Carolina embrace GLP-1s to combat chronic disease, the question remains whether private insurers will follow suit.

Debate over GLP-1s Will Intensify in 2025

As 2025 quickly approaches, GLP-1s are at the center of cost containment efforts. Patient demand will likely continue to soar, driven by the transformative health benefit promises of GLP-1s. Affordability and insurance coverage will remain key challenges for weight loss, unless payers and employers explore HealthTech solutions, like RazorMetrics.

Members who want the drug for non-diabetes treatment purposes will have options through discount card programs to avoid overspending. RazorMetrics uses advanced data analytics to give members’ physicians more transparency of GLP-1 prescriptions, minimize unnecessary off-label use, and reduce unpopular paperwork associated with prior authorization.

Demand for GLP-1 drugs will continue to rise, adding to the pressure on health plans and employers to find sustainable coverage solutions. By providing key insights to physicians, RazorMetrics reduces unnecessary prescriptions of high cost drugs and helps contain pharmacy spend while ensuring that these popular medications remain accessible to members.