Glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide (Wegovy) and liraglutide (Saxenda), have emerged as highly effective weight loss treatments for individuals struggling with obesity. These medications, which are designed to curb appetite and promote weight reduction when combined with diet and exercise, hold great promise for patients battling obesity-related health issues like diabetes and cardiovascular disease. However, despite their effectiveness in weight management, recent studies suggest that the financial benefits of GLP-1 drugs remain unproven, as they do not yet result in significant reductions in overall healthcare costs.
In October 2024, pharmacy benefit manager Prime Therapeutics released a report revealing that GLP-1 therapies used for weight loss in people without diabetes did not yield any medical cost savings over a two-year period. The analysis, which examined health insurance claims, found that average healthcare costs increased by 46% among patients using these drugs, rising from $12,695 to $18,507 per patient. These findings contradict the expectation that weight loss drugs would reduce long-term medical costs by alleviating obesity-related conditions.
Similarly, the Congressional Budget Office (CBO) has stated that there is no conclusive evidence to suggest that GLP-1 weight loss therapies lead to a reduction in medical costs, even accounting for potential cardiovascular benefits. A significant clinical trial, SELECT, which studied the cardiovascular effects of semaglutide (Wegovy), showed some benefits for individuals with preexisting heart conditions. The trial found a 20% reduction in the risk of cardiovascular events like heart attack and stroke, though the reduction in risk of cardiovascular death was not statistically significant. The absolute risk reduction was also relatively small, indicating that a large number of patients—67, to be exact—would need to be treated with Wegovy to prevent just one cardiovascular event.
Further cost-effectiveness analysis of semaglutide-based weight loss drugs highlights the economic challenges they pose. A study published last autumn estimated that the use of semaglutide could prevent approximately 538,000 major cardiovascular events over the lifetimes of 4.7 million U.S. adults eligible for treatment based on the SELECT criteria. However, the projected cost for these outcomes reached a staggering $613 billion, translating into an incremental cost-effectiveness ratio of $443,000 per quality-adjusted life year (QALY) gained. In comparison, most U.S. healthcare interventions are considered cost-effective if they fall below $150,000 per QALY, meaning that semaglutide does not currently meet cost-effectiveness thresholds at its current price point of $700 per month.
While some specialty drugs can be considered cost-saving—where each dollar spent leads to reduced downstream medical costs—most prescription medications, including GLP-1s, do not generate such savings. For the majority of drugs, additional spending does not offset medical costs, a concept known as value for money. As a result, GLP-1 medications, at least at their current prices, are not cost-saving, nor do they offer a clear return on investment in terms of long-term healthcare savings.
Looking to the future, it is possible that long-term studies could demonstrate that GLP-1s become cost-effective or even cost-saving over time. However, these potential savings may be difficult to realize due to the issue of “churn,” or turnover in health insurance coverage. As individuals frequently switch health plans, insurers may never see the long-term cost benefits of these medications. This challenge may contribute to the coverage restrictions faced by many patients seeking access to GLP-1 therapies. In 2025, several insurers and self-funded employers are reducing or eliminating coverage for these high-cost medications.
In addition to the churn issue, there is the problem of patient non-persistence. According to Prime Therapeutics’ study, only 25% of patients remained on Wegovy or Ozempic for two years. This figure drops even further, to 15%, according to a white paper from the Blue Cross Blue Shield Association. This lack of persistence undermines the potential long-term benefits of GLP-1 drugs.
Despite these cost concerns, GLP-1 medications undoubtedly provide value to a subset of patients who are able to stay on the treatment long enough to experience clinically significant weight loss. However, the growing hype surrounding these drugs must be tempered by a thorough and realistic analysis of their economic implications. Until more comprehensive long-term data is available, GLP-1s remain a costly yet potentially valuable option for certain patients—though they have yet to prove themselves as a cost-effective solution for the wider population.
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