University of Mississippi researchers say many insurance plans still limit coverage for GLP-1 medications even though an independent review found the drugs are cost-effective, and they are studying the reasons and implications for patients.
The Institute for Clinical and Economic Review found GLP-1s such as Ozempic, Wegovy and Zepbound are cost-effective, the researchers said. Sujith Ramachandran, an associate professor of pharmacy administration at Ole Miss, said in a study published in the Journal of Managed Care and Specialty Pharmacy that “cost-effective” does not necessarily mean “cost-saving” for insurers. He said the potential patient pool is large and that the drugs could push spending well past ICER’s budget impact threshold of $821 million.
Ramachandran noted that about 40% of Americans are obese, according to the Centers for Disease Control and Prevention, and said insurers could face billions in added costs even if only a fraction of eligible patients seek treatment. He also said existing data do not show that wider use of GLP-1s produces long-term savings for conditions tied to obesity.
Researchers said making GLP-1s more cost-effective for insurers requires longer treatment and the same supportive services used in clinical trials. “All of the clinical trials, GLP-1s were not tested against no treatment; they were tested against lifestyle management interventions,” Ramachandran said. He urged insurers to provide access to registered dietitians, fitness programs and other services rather than limiting coverage to six months or a year.
Liang-Yuan Lin, a doctoral candidate in pharmacy administration at Ole Miss, warned that lower-cost compounded GLP-1 drugs can be risky because they do not undergo the U.S. Food and Drug Administration’s evaluation. “The FDA has already issued warning letters about compounded GLP-1s,” Lin said, adding that some websites sell unapproved or incorrect ingredients. Lin and Ramachandran recommended that patients consult a physician before and during treatment to manage side effects and ensure they receive FDA-approved medications.
Jon Ross Myers is the executive editor and publisher of the Mississippi News Network, Mississippi's largest digital only media company. He can be reached at editor@tippahnews.com
