GLP-1s reshape obesity care as use rises, persistence and cost remain key questions

Most days, including World Obesity Day, the conversations around weight management have been much different than they were just a few years ago. Obesity rates remain high, but new data suggests injectable glucagon-like peptide-1 (GLP-1) drugs are beginning to influence both clinical practice and utilization trends across the healthcare system.

According to the Gallup National Health and Well-Being Index, 37% of U.S. adults now report obesity, down from 39.9% three years ago. Globally, more than 1 billion people are living with obesity today, and projections suggest that by 2035, roughly half of the world’s population could be living with overweight or obesity.

The estimated global economic impact is projected to reach $3.23 trillion by 2030. However, the share of Americans taking GLP-1 medications such as Ozempic and Wegovy (both semaglutide) and Zepbound (tirzepatide) has more than doubled over the past 18 months to 12.4%, according to the Gallup survey.

A recent KFF Health Tracking Poll found that about 1 in 8 adults shared they are currently taking a GLP-1 drug for weight loss, diabetes or another condition, and nearly 1 in 5 have used one at some point. Yet more than half of users have said the drugs are difficult to afford and 14% of former users report stopping due to cost.

For managed care organizations and employers, those trends raise two central questions: how long are patients staying on therapy and what happens when they stop?

Pat Gleason, Pharm.D., assistant vice president of health outcomes at Prime Therapeutics, told Managed Healthcare Executive that GLP-1s are rapidly moving into a foundational role in obesity treatment.

“GLP-1 drugs are becoming the first-line obesity medication treatment, and as researchers, we are beginning to see that it’s potentially a lifelong treatment,” Gleason said. “Prime’s recommendation to health plans and employers is that if you intend to cover GLP-1 obesity treatment products, organizations should strongly consider offering weight loss care and case management to ensure individuals receive the health coaching, dietary education and GLP-1 medication management to help individuals see the best possible outcome from therapy.”

His comments reflect a broader shift toward treating obesity as a chronic disease rather than a short-term weight loss effort. This shift has more focus on benefit design, utilization management and long-term cost modeling.

Gleason shared that Prime continues to study GLP-1 trends in its claims data. While the company doesn’t track when members reach individual weight loss goals, it has analyzed one-year treatment persistence among commercially insured patients.

Research published in the Journal of Managed Care & Specialty Pharmacy found that among those who newly started Wegovy or Zepbound in the first half of 2024, nearly two thirds remained on therapy at one year. Those rates are higher than earlier real-world estimates, suggesting that better coverage, improved drug supply and more experience among clinicians are helping patients stay on treatment longer.

However, persistence beyond one year remains an open question. Data from Cedar Gate Technologies revealed that while GLP-1 use increased 67% over the past two years, other analyses have found that only about one third of patients remain on therapy after one year, and fewer take the medication exactly as prescribed.

When patients stop their treatment, clinical trial data published in Diabetes, Obesity and Metabolism suggests discontinuation can reverse many gains. Findings from the STEP 1 trial evaluating once-weekly semaglutide 2.4 mg revealed that one year after withdrawal and lifestyle intervention, participants regained two thirds of their prior weight loss, with similar changes in cardiometabolic variables. These findings confirm the long-lasting effects of obesity and urge ongoing treatment to maintain improvements in weight and health.

For payers, those findings highlight the tension between short-term pharmacy spend and long-term medical value.

Despite rising demand, coverage remains uneven. Gleason noted that most fully insured health plans do not cover GLP-1s for weight loss. Self-insured employers are also struggling with the high cost of these drugs and the lack of strong real-world evidence showing they reduce other medical costs for patients with obesity who do not have diabetes.

Separate research highlights the financial balance. Dhruv S. Kazi, M.D., a cardiologist at Beth Israel Deaconess Medical Center, and colleagues found that semaglutide used for secondary prevention could prevent more than 358,000 heart attacks, strokes and cardiovascular deaths over patients’ lifetimes, generating nearly $23 billion in avoided healthcare spending. However, at 2023 U.S. prices, the drug itself would cost an estimated $344 billion over those same lifetimes.

Their modeling suggests semaglutide becomes cost-effective as prices decline, particularly if U.S. pricing approaches levels seen in Europe, but widespread uptake across all eligible patients could strain short-term healthcare budgets.

Additionally, Cedar Gate estimated the average annual cost per patient for GLP-1 prescriptions at roughly $5,200 in 2024, compared with an average bariatric surgery cost of more than $24,000. While surgery carries a higher upfront price, long-term data show sustained weight loss over many years. In comparison, long-term outcomes data for GLP-1 therapy are still emerging.

As for the affordability issue, it’s reflected in the KFF poll, where 27% of insured GLP-1 users said they paid the full cost themselves, and 56% reported difficulty affording the drugs.

However, the market continues to evolve. In late February, Cipla announced the U.S. launch of a generic version of Saxenda (liraglutide) following FDA approval of an abbreviated new drug application. Increased generic competition could eventually influence pricing and access dynamics.

The managed care path forward

As use of these therapies grows, Gleason said payers and PBMs can help shape outcomes by identifying preferred obesity treatment services, supporting contracting and enabling data sharing and reporting aligned with professional guidelines and World Health Organization recommendations.

Evidence increasingly supports pairing GLP-1 therapy with nutritional counseling, lifestyle intervention and dose management to minimize side effects and improve adherence. Although FAIR Health data show a sharp decline in behavioral health services among patients prescribed GLP-1s, suggesting an opportunity for more coordinated and connected care models.

This World Obesity Day, managed care leaders face a turning point. GLP-1 drugs are reshaping obesity treatment, but their long-term value will depend on how long patients stay on therapy, whether coverage is sustainable and how well plans support ongoing care.

In the end, these therapies’ success could rely just as much on a smart benefit design and well-thought-out patient support as on the clinical results seen in trials.