Ozempic and Wegovy are about to get cheaper. Will employer-sponsored plans benefit?

The White House recently announced a deal with two pharmaceutical manufacturers to lower the price of GLP-1 drugs for weight loss.

Two manufacturers, Eli Lilly and Novo Nordisk, agreed to lower the prices of their drugs from upwards of $1,000 a month to around $350 a month when purchased through TrumpRx, the White House said on Nov. 6. In exchange, the Trump administration said it will allow Medicare to cover the drugs for some patients. This government-funded health plan hasn't previously covered GLP-1s for weight loss. 

While the agreements won’t directly affect most employer-sponsored health plans, they could have secondary effects for companies that are covering the pricey drugs.

Pricing pressure. Doctors have been prescribing GLP-1s to treat type 2 diabetes for two decades, but the drugs were approved for weight loss in 2014. Clinical studies suggest GLP-1s are effective not only at helping patients lose weight, but also at reducing the risk of other conditions, such as cardiovascular and kidney disease.

Recent surveys show more employers are starting to cover GLP-1s for obesity, even as the drugs are driving up health costs.

“The patient population is enormous, fueled by direct-to-consumer advertising, word of mouth, social media,” said Louis Zollo, national pharmacy practice leader and VP at Segal, a benefits consulting firm. “Folks are going to the doctor asking for these drugs by name, which is not something we normally expect to see.”

The White House deal is intended to lower list prices of three popular GLP-1 drugs—Ozempic, Wegovy, and Zepbound. It could eventually spur negotiations to bring down prices on the employer-sponsored insurance side, Zollo said.

Drug companies, health payers, and pharmacy benefit managers (PBMs) might negotiate with one another and “decide that they’re going to match that same direct-to-consumer price and forego, say, a rebate,” Zollo said, referring to referring to the kickbacks PBMs typically receive for negotiating with pharmaceutical companies.

Still, “right now, we’re not getting any signals that that is going to happen anytime soon,” according to Zollo.

Health economists and policy experts similarly told the Washington Post they expect this deal to eventually lower GLP-1 prices overall. “We would expect commercial payers to demand to use these posted prices as ceiling prices,” Rena Conti, a health economist and associate professor at Boston University, told the outlet. 

Wait and see. As employers wait to see whether the Trump administration’s recent efforts have any effect on their health spending, they’re exploring other strategies to contain costs tied to GLP-1s, Zollo said.

In addition to monitoring prior authorization criteria, benefits leaders are also starting to look into point solutions to support employees who are trying to lose weight, “realizing that weight loss is complex and maybe not just a drug-only solution for everybody,” he said. A major challenge with GLP-1s is adherence, and patients may benefit from other services, such as nutrition guidance or health coaching, if they want to maintain weight loss.

Omada Health, a virtual care program, recently launched a GLP-1 prescribing option with these challenges in mind. Omada plans to offer its “lifestyle modification program” alongside clinical expertise about the drugs themselves with the goal of creating “sustainable and lasting results,” Chief Medical Officer Thomas Tsang told HR Brew. When patients stop their GLP-1 and regain the weight they’ve lost, “that’s a huge loss to the investments that they’ve made,” he said.