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Background

The rising use of GLP-1 medications is reshaping how self-funded health plans approach both chronic disease management and pharmacy benefit strategy. In a recent Serve You Rx webinar, clinical experts broke down how these drugs evolved, where the market is heading, and what plan sponsors can do to manage utilization and cost effectively.

The Science and Evolution Behind GLP-1s 

GLP-1, or glucagon-like peptide-1, is a natural hormone produced in the gut after eating. It plays a key role in glucose regulation and appetite control.

• It stimulates insulin production
• Helps maintain normal blood sugar levels
• Signals satiety, reducing food intake

These biological effects led to the development of GLP-1 receptor agonists—a class of medications now used for type 2 diabetes, weight management, and more recently, other chronic conditions.

Milestones in GLP-1 Development:

• 1987: Identified as a hormone that helps trigger insulin release
• 1992: Discovery of exendin-4 in Gila monster saliva led to drug development
• 2005: First GLP-1 (Byetta) approved for type 2 diabetes
• 2014: Saxenda approved for chronic weight management

What began as a niche treatment has now grown into one of the most high-profile therapeutic areas in pharmacy today.

The GLP-1 Trend: Growth, Costs, and Complexity

The use of GLP-1s has skyrocketed—fueled by new weight loss approvals, changing guidelines, and rising demand among members.

Key Drivers of Utilization:

• Obesity prevalence: Over 100 million U.S. adults (2 in 5) are obese
• Diabetes burden: 38 million Americans have diabetes, mostly type 2
• Costs: Obesity and diabetes drive a combined $586B+ in annual costs
• New Indications: Drugs like Wegovy and Zepbound are driving broader adoption

Between December 2023 and December 2024, the number of GLP-1 prescriptions filled increased fourfold, with nearly 2 million prescriptions filled in one month alone.

Average cost per prescription: $1,000–$1,500/month before rebates

At Serve You Rx, GLP-1 plan costs grew more than 300% year over year, with diabetes-related use rising over 319% and obesity-related use jumping more than 460%.

What’s Fueling the Acceleration?

Beyond utilization, new approvals and supply disruptions have also shaped the current GLP-1 landscape.

Market Dynamics Include:

• Expanded FDA Approvals:
  • Wegovy approved to reduce cardiovascular events (Mar 2024)
  • Zepbound approved for sleep apnea with obesity (Dec 2024)
  • Ozempic approved for chronic kidney disease (Jan 2025)
• Shifting Coverage:
  • Many employers previously excluded GLP-1s for weight loss
  • Off-label prescribing increased, contributing to shortages
• Compounding Trend:
  • Compounded GLP-1s appeared during shortages but pose safety and regulatory risks
  • FDA has since declared the shortage resolved

These developments are expanding the therapeutic role of GLP-1s, but they also raise new questions about access, affordability, and formulary alignment.

Choosing the Right GLP-1: Clinical and Plan Considerations

With more GLP-1s on the market—and more indications—the choice of therapy must be personalized.

Key Factors Influencing Drug Selection:

• Diagnosis (e.g., diabetes, obesity, cardiovascular disease)
• Route and frequency (oral vs. injectable; daily vs. weekly)
• Adherence potential (weekly doses may improve consistency)
• Side effect profile (GI issues are common early on)
• Expected outcomes (some GLP-1s show up to 20% weight loss)
• Formulary restrictions (e.g., step therapy, prior authorizations)

Patient engagement is also essential—over 70% of patients stop GLP-1s within two years when prescribed for weight loss alone. Setting expectations from the start can help ensure better outcomes.

Looking Ahead: The GLP-1 Pipeline

Research into GLP-1s is rapidly expanding beyond diabetes and obesity.

Future Indications in Development:

• Cardiovascular: Heart failure, peripheral artery disease
• Liver disease: MASH (advanced fatty liver disease)
• Neurologic: Alzheimer’s, Parkinson’s (early but promising)
• Musculoskeletal: Osteoarthritis of the knee
• New Formulations:
  • Oral GLP-1 for weight loss expected late 2025
  • New combo GLP-1 agent for diabetes + weight management by late 2026

These pipeline drugs and indications will only add complexity for plan sponsors, reinforcing the need for agile, data-driven benefit strategies.

Serve You Rx’s Strategy: Clinical Value Meets Cost Control

At Serve You Rx, proactive benefit design is at the core of our approach. As GLP-1s gain traction, our clients rely on us to help manage costs while ensuring appropriate use.

Our Key Tools Include:

• Plan Design Customization:
  • Choose to cover, limit, or exclude GLP-1s based on client goals
• Utilization Management:
  • Step therapy for cost-effective alternatives
  • Prior authorization reviewed by clinical pharmacists
• Diabetes Care+ Program:
  • Free glucose meters and education
  • Value-based cost shares on generics and supplies
  • Adherence outreach and mail delivery
  • Annual reporting to measure outcomes

The result is a flexible strategy that protects both clinical quality and budget sustainability.

Final Thoughts: What Payers Should Be Thinking About

The GLP-1 landscape is still evolving, and that means benefit strategies must evolve with it.

Consider These Strategic Questions:

• Do our policies reflect the latest guidelines and FDA labels?
• Are pharmacy and medical benefits aligned (e.g., weight loss surgery vs. medications)?
• Are we leveraging available rebates to offset costs?
• Are we supporting patients with education, digital tools, and case management?
• Have we evaluated reimportation or point solutions where appropriate?

Serve You Rx is actively developing a new Cardiometabolic Program to further support plans managing conditions like obesity, diabetes, and cardiovascular disease in an integrated way.

Take the Next Step 

If you’d like to explore how your plan can adapt to GLP-1 trends with confidence, contact your Clinical Account Executive or reach out to us at Sales@ServeYouRx.com.

About Serve You Rx®   
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.