It was late 2022 when spikes in search activity began showing up in the RxSS member portal. Fast forward to today, and clearly GLP-1s and related medications for diabetes and weight loss are beyond trending. They have transformed the healthcare landscape.
Originally developed to manage type 2 diabetes, their potential indications and therapeutic benefits have expanded from weight loss to cardiovascular risk reduction, even neurological and metabolic conditions.
Maybe it’s no surprise that 24% of all drug searches by members in the RxSS portal are for medications such as Ozempic®, Zepbound®, Wegovy®, and Mounjaro®.1 Or is it surprising the percentage isn’t higher?
It’s a good bet more members will be looking for more information and cost and clinical transparency, given recent developments in 2025:
- Oral GLP-1s are on the horizon: Novo Nordisk’s oral Wegovy is expected to receive FDA approval by late 2025. If approved, it would become the first oral GLP-1 therapy for obesity.2
- Eli Lilly’s orforglipron is another small-molecule oral candidate in Phase 3 trials and awaiting FDA review, possibly in late 2026.3
- GLP-1s are now being studied for metabolic dysfunction–associated steatohepatitis (MASH), polycystic ovary syndrome (PCOS), and even Alzheimer’s disease.4
- GLP-1s are part of Medicare’s drug price negotiations under the Inflation Reduction Act, with new pricing expected in 2027.5
What Hasn’t Changed
The consistent factor in GLP-1s remains the cost of coverage to plan sponsors, typically ranging between $12,000 and $16,000 per patient.6 While the market continues to evolve, plan sponsors must strategize on a forward-thinking approach to balance access and cost while ensuring members receive the care needed.
Where can plans turn for help?
- Real-time education to help members navigate their plan design or possible alternative therapies in collaboration with their healthcare providers
- Data-driven insights to help plans manage utilization and budget impact
- Manufacturer programs that provide self-pay options for consumers.
The GLP-1 boom illustrates how difficult it can be to predict and prepare for a sudden surge in utilization and demand for high-cost drugs.
The most reliable defense is using all available measures to reduce spend across the pharmacy benefit. More than ever, plans can benefit from providing cost and clinical transparency to covered members regarding alternatives and effective, lower-cost treatment and fulfillment options.
When members, providers and pharmacies are empowered with comprehensive, actionable information, more cost-effective medication decisions can be informed throughout the care continuum and a patient’s GLP-1 treatment journey.
Disclaimer:
This article reflects the state of the GLP-1 landscape as of the publication date. Product indications, pricing, and coverage details are subject to change and may vary depending on manufacturer updates and individual member coverage. Members should consult their healthcare provider and their benefit plan for the most current information. All treatment decisions are made solely between patients and their healthcare professionals. No information herein should be construed as an endorsement of any compounded, non-FDA approved, or off-label GLP-1 products.
1 RxSS internal data; portal searches, January-August 2025.
2 https://www.drugs.com/history/orforglipron.html
3 https://thisweekinpublichealth.com/blog/2025/08/10/fda-approval-for-obesity-pill-orforglipron/
5 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2833038
6 https://msibg.com/glp-1s-gene-therapies-and-the-new-frontier-in-drug-costs-navigating-2025-renewal-pricing-and-formulary-management/