Over half of U.S. adults might benefit from GLP-1 drugs, which are transforming care for people who are overweight or obese, or who have diabetes or cardiovascular disease. The drugs are expensive, however, costing around $1,000 a month. Even cheaper GLP-1s cost hundreds of dollars monthly.
The high cost and large potential patient population for GLP-1 medications threaten the budgets of insurers and states. Among the remedies are a forthcoming Medicare-Medicaid program in which drug manufacturers may offer lower GLP-1 prices and weight-loss lifestyle interventions to some enrollees.
“These deals could encourage expansion of GLP-1 coverage,” said LDI Senior Fellow Matthew Klebanoff. “But coverage is more nuanced than a yes-no decision.”
Insurers may respond to lower GLP-1 prices by increasing restrictions, which are already stringent, as Klebanoff showed in two studies with LDI Senior Fellows Jalpa Doshi and Judith Long, and colleagues.