The Financial Barrier to GLP-1s

In a video interview with Pharma Commerce, Colin Banas, MD, DrFirst’s chief medical officer, describes have many Americans face significant challenges in accessing GLP-1 drugs due to their high cost. Despite the growing popularity and usage of these medications, which were originally developed for diabetes treatment, the price remains largely unchanged. Even with insurance coverage, patients often encounter co-pays or out-of-pocket expenses upwards of $500 to $600, making the medications unaffordable for many. Research indicates that once out-of-pocket costs exceed $100, medication adherence drops dramatically, further limiting access.

Additionally, insurance companies frequently require patients to try other medications first, a process known as step therapy, which can delay access to GLP-1 drugs. The drugs' weight loss benefits have garnered attention, but insurance companies still primarily cover them for diabetes treatment, leaving individuals seeking them for weight loss without coverage options. Moreover, as ongoing research uncovers more potential benefits of GLP-1 drugs—such as their positive effects on cardiovascular disease, Alzheimer's, and chronic kidney disease—insurance policies have not yet adapted to these expanded uses. As a result, many Americans who could benefit from these drugs for conditions beyond diabetes find that coverage is not available.

Banas also comments on patients turning to direct-to consumer (DTC) platforms following insurance denials; rumors of DTC advertising being banned; and much more.

A transcript of his conversation with PC can be found below.

PC: What challenges do many Americans face regarding the affordability of GLP-1 drugs?

Banas: Affordability is the biggie, I would say, and it's two-fold. These drugs still are quite expensive. We’re probably two years into what I would call the GLP-1 run, and the usage—by our own data and by any other metric—is continuing to increase almost at an exponential rate. But the cost has really not fluctuated too much. For a lot of folks, even with insurance, you're facing co-pays or out of pockets (OOPs) that are upwards of $500, $600, which is a lot. There's actually data out there that shows that once you get to the OOP around $100, the first-fill adherence for a drug drops precipitously. I'm not surprised at all that if you're in the hundreds of dollars for a GLP-1, most folks might find that to be simply unattainable.

Even with insurance, there's often a lot of what we step therapy, a lot of hoops or prior medications that you have to attempt first, and then I would say the third thing is, these drugs really were brought around for diabetes, and the weight loss aspect of it was a nice byproduct, and now we're continuing—as we research them—to find more and more benefit, whether it's cardiovascular disease or Alzheimer's.

Chronic kidney disease is the latest one that I've seen in the literature, but the primary indication was diabetes. The insurance companies still haven't quite shifted to the outside of diabetes use cases, so a lot of folks who feel like they want to access these medications for weight loss are finding that it's simply just not covered for weight loss yet.