Loading...Loading...March 25, 2025
GLP-1s have become a significant driver of prescription drug spending, reaching more than $50 billion globally in 2024. The past, present and future of these drugs was the topic of a recent webinar led by experts from Regence. Watch a recording of the webinar.
Here are some webinar highlights:
The U.S. Food and Drug Administration (FDA) initially approved GLP-1s in 2005 for Type 2 diabetes management. GLP-1s have received FDA indications for obesity and in people who are overweight in recent years, in addition to other comorbidities with obesity or being overweight. Manufacturers have launched unique brands for GLP-1s that the FDA has approved for the treatment of obesity and being overweight. These brands of the same drugs have been priced up to 35% higher than the GLP-1s marketed for Type 2 diabetes.
Many policymakers, employers, insurers and consumers are concerned about the cost of GLP-1s, and there’s uncertainty about whether the benefits justify the high price tag. Clinical studies have demonstrated that these drugs are highly effective for weight loss and can reduce the risk of heart attack and stroke in patients with existing heart disease. Long-term effects on sustaining weight loss or preventing heart disease are still unknown. With these efficacy and cost considerations in mind, here’s how many insurers—including Regence—have opted to respond:
- Preferred GLP-1s indicated for Type 2 diabetes are covered with pre-authorization.
- GLP-1s used for obesity and being overweight are excluded. This is common within the industry.
- Self-funded groups can choose to cover GLP-1s for obesity and being overweight with a pre-authorization requirement. Very few Regence self-funded groups have opted for this coverage.
GLP-1 drug manufacturers are seeking new FDA indications in addition to obesity and being overweight. For example, Wegovy recently received a new FDA indication to reduce the risk of heart attack and stroke in adults with established heart disease and either obesity or being overweight. Zepbound has received FDA approval for the treatment of obstructive sleep apnea.
All Regence plans cover Wegovy for the additional cardiovascular indication when pre-authorization criteria are met. Regence is currently reviewing Zepbound’s indication for obstructive sleep apnea. Several additional indications for GLP-1s are being studied, such as fatty liver disease, high blood pressure and osteoarthritis of the knee. As with any new drugs and new indications for existing drugs, Regence will use its established evidence-based review process to determine coverage and pre-authorization criteria.
Regence continues to monitor developments and will provide updates as the landscape evolves. We remain committed to ensuring access to appropriate treatments while managing costs effectively.
Questions? Please view our webinar “GLP1s Master Class: Past, Present and Future,” available on demand. Note, the CEU credit is only available to those who attended the live webinar.