GLP-1 weight loss medications have gained popularity as a treatment option for obesity. However, recent data suggests that these treatments may not be cost-effective despite their potential benefits in reducing medical costs associated with diabetes and cardiovascular disease.
A study by Prime Therapeutics found that individuals taking GLP-1 therapies without diabetes over a two-year period saw no medical cost offset, with average healthcare costs increasing 46% compared to baseline levels. This contradicts expectations that these treatments would reduce overall medical costs.
Another study published in the SELECT trial found that semaglutide-based products like Wegovy could avert 538,000 major cardiovascular events at an incremental cost of $613 billion. However, this is above the $150,000 per quality-adjusted life year (QALY) threshold considered cost-effective by most healthcare technologies.
The issue may be the time frame being considered, with many studies only examining short-term effects. Long-term studies have not been conducted to determine the potential cost-effectiveness of GLP-1s for obesity treatment.
Insurers face challenges in covering these medications due to high upfront costs and high patient churn rates. Even if these treatments are found to be cost-effective or cost-saving in long-term studies, insurers may struggle to maintain coverage as patients discontinue their medication.
The Biden administration’s proposed reinterpretation of Medicare Part D coverage for weight loss medications aims to increase access to these therapies, but the incoming Trump administration’s stance on this issue remains uncertain. The high upfront costs and limited persistence of GLP-1 users create challenges for insurers seeking cost-effective treatments.
Source: https://www.forbes.com/sites/joshuacohen/2025/01/02/glp-1-drugs-for-weight-loss-arent-cost-saving-yet