Glucagon-like peptide (GLP-1) medications are highly effective at helping patients lose 15% or more of their weight. But they are expensive, generally costing employers $7,500-$9,000 annually, even after rebates and discounts. Some employer plans find that these two medications, semaglutide (Wegovy) and tirzepatide (Zepbound), represent as much as 10% of their total outpatient pharmacy spending, and an outsized portion of pharmacy inflation. These drugs are available directly from pharmaceutical companies for about $6,000 per year for those without insurance coverage.
GLP-1 drugs have been used for about two decades to treat diabetes. Their safety and side effect profiles are well understood.
The Food and Drug Administration (FDA) has approved Wegovy (semaglutide) and Zepbound (tirzepatide) to treat those with obesity or those who are overweight with metabolic complications (such as heart disease, hypertension or hypercholesterolemia). An older drug, Saxenda (liraglutide), was approved in 2014 but requires daily injections and results in only ~5% average weight loss. About 42% of the adult population could be eligible for these medications. Most long-term studies of GLP-1 drugs are in people with diabetes, as semaglutide was only approved for obesity in June 2021, and tirzepatide was only approved for obesity in November 2023.
The diabetes versions of the obesity-labeled GLP-1 drugs are the same drug. Maximum doses available for semaglutide for diabetes (Ozempic) are lower than those labeled for obesity (Wegovy). Doses available for Zepbound and Mounjaro are identical. Drugs labeled for diabetes are generally about 20% less expensive than drugs labeled for obesity.
GLP-1 drugs clearly offer substantial health benefits for members with obesity and can prevent serious future disease. However, the cost of the drugs is far higher than savings from preventing these bad outcomes. Demand for these drugs is high and could increase when oral versions become available. The high price of these drugs places coverage out of reach for some employers. Some pharmacy benefit managers say they have achieved better net prices by restricting their formulary to either Zepbound (tirzepatide) or Wegovy (semaglutide). Future new market entrants could help lower the acquisition price for these medications.
FAQ – Frequently asked questions
Glucagon-like peptides:
- Glucagon-like: Because GLP-1 looks like another hormone called glucagon
- Peptide: A smaller type of hormone that’s made out of amino acids
- 1: Just a naming convention; there’s a GLP-2 hormone but there is no GLP-3
- Agonist: This term usually means a drug activates a process in the body
GLP-1 drugs like semaglutide (Wegovy and Ozempic) and tirzepatide (Zepbound and Mounjaro) were developed to treat type 2 diabetes, but they’ve gained media attention in the past couple of years for their ability to help people lose weight. These drugs are expensive and mostly given as a self-injection. The drugs to treat obesity and to treat diabetes are the same, although the obesity medications are more expensive and sometimes come in higher doses.
In addition to weight loss and better diabetes control, these drugs have been shown to decrease onset of diabetes in those with prediabetes, decrease progression to kidney failure, and decrease heart attacks in those at high risk. They are also approved for obstructive sleep apnea (Zepbound), metabolic liver disease (MASH, Wegovy), and heart disease prevention (Wegovy). Studies have shown lower risk of obesity-related cancers, too.
- Ozempic
- Rybelsus
- Saxenda
- Trulicity
- Victoza
- Wegovy
- Zepbound
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