A summary of peer-reviewed findings from the Journal of Comparative Effectiveness Research on affordable access to GLP-1 obesity medications for U.S. employers.
Over 100 million U.S. adults qualify for GLP-1 medications based on BMI criteria. If coverage expands without cost controls, national spending on these drugs alone could exceed $100 billion annually within 5 years.
Worst financial performance on record. GLP-1 drugs drove more than $300 million in costs, representing 20% of total pharmacy costs and double the prior year.
GLP-1 costs doubled every 6 months, making budget projections impossible. The state is now reconsidering its coverage approach.
To sustain GLP-1 coverage without a managed approach, the plan estimated insurance premiums would need to double — an untenable position.
Average healthcare costs rose approximately $7,000 in the first year after GLP-1 initiation, with no medical cost offsets observed. Per-member-per-month costs increased more than tenfold from January 2023 to December 2024.
Per-member-per-month cost estimates swung from $3 to $20 to $16, making financial planning nearly impossible for administrators.
The research identifies managed carve-out programs — like JoeyMed — as the most effective approach for employers who want clinical results without uncontrolled costs.
Connecticut's state employee program (Flyte Health) achieved 10% average weight loss across all participants, with GLP-1 users achieving 12%. Non-GLP-1 patients still lost 4% on lower-cost alternatives.
Half of participants were successfully managed on non-GLP-1 medications — phentermine/topiramate at ~$1,465/yr vs. $9,000+ for GLP-1s. Step therapy is "clinically reasonable" per expert consensus.
Carve-out programs report a 3-to-1 return on every dollar invested. By managing the clinical pathway, employers get outcomes without the open-ended cost exposure.
Unmanaged GLP-1 coverage sees only 14.3% of patients remaining on therapy at 2 years. Managed programs with weekly check-ins and clinical support dramatically improve adherence and outcomes.
67% of large employers (17.1M employees) cover GLP-1s — another 19% are considering it
At least 5 state plans (WV, NC, DE, CO, NM) have rescinded or are reconsidering coverage due to cost
Only 14.3% of commercially insured patients remain on GLP-1 therapy at 2 years without clinical support
Less than 1% of ACA marketplace plans include obesity-only approved GLP-1 drugs
13 state Medicaid programs now cover GLP-1s, adding further cost pressure to the system
2+ million Americans received compounded GLP-1 treatments — now under FDA enforcement transition
Pearson SD, Whaley CM, Emond SK. “Affordable access to GLP-1 obesity medications: strategies to guide market action and policy solutions in the US.” Journal of Comparative Effectiveness Research, July 2025. Published by Future Medicine.
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