GLP-1 Drugs Force Insurers to Weigh Today’s Pharmacy Bill Against Tomorrow’s Health Savings

Rapid adoption of GLP-1 therapies has pushed health insurers to balance rising near-term pharmacy costs against uncertain long-term reductions in medical spending, according to AM Best.
By: | October 2, 2026
GLP-1 medication

GLP-1 therapies have become one of the most significant drivers of pharmacy spending across the health care industry, and their surging use is forcing insurers to reconsider how coverage decisions today will affect medical costs for years to come, according to AM Best.

The rating agency pointed to the January 2026 launch of Wegovy’s oral pill as a marker of how quickly demand has grown: the drug reached 1 million prescriptions in 12 weeks and an additional 2 million over the following 10 weeks, through June 1. By August 2026, Novo Nordisk said prescriptions for the Wegovy pill in the U.S. had topped 5 million since launch, with weekly prescriptions exceeding 265,000.

AM Best said manufacturer-reported data suggests most of those prescriptions went to patients new to GLP-1s, and because most employer-sponsored health insurance does not cover the drugs for weight loss, many of those patients are likely paying out of pocket.

Coverage Narrows Even as Demand Climbs

While coverage for diabetes indications has generally remained intact, AM Best said many employer-sponsored health plans offered by commercial insurers have reassessed, narrowed or eliminated coverage for obesity indications as they try to balance affordability with growing demand. Most insurers now require prior authorization even for non-obesity prescriptions, AM Best said.

Even with lower prices for some GLP-1 therapies, the sheer number of people who could be eligible for weight-loss drugs has left insurers and employers grappling with the affordability implications, according to the report. AM Best noted that the uptick in prescriptions could be far higher if GLP-1s were broadly covered specifically for weight loss.

The report described a structural mismatch at the heart of the issue: pharmacy costs are immediate and measurable, while anticipated benefits, including fewer diabetes complications, reduced hospitalizations and improved management of obesity-related chronic disease, may not materialize for years.

AM Best also noted that because members frequently switch employers and health plans, the payer funding treatment today may not be the one that eventually captures any medical savings.

Morbidity Gains Are Emerging, but Mortality Answers Remain Years Away

From a population health standpoint, AM Best said the most immediate impact of GLP-1 therapies is likely to be on morbidity rather than mortality. Emerging clinical evidence points to improvements across several co-morbidities tied to weight reduction, including lower BMIs, improved cardiovascular disease outcomes, hypertension, lipid profiles, reduced severity of joint pain, sleep apnea and chronic kidney disease, according to the report.

AM Best said these therapies are generally considered most effective when paired with dietary modification, physical activity and sustained lifestyle changes, meaning long-term success likely depends on broader chronic disease management strategies rather than medication alone.

Whether those morbidity improvements will eventually translate into measurable mortality reductions remains an open question, AM Best said, adding that the full impact on population health and its economic benefits will require longer-term study and real-world experience. The report framed the central unresolved issue as whether future reductions in medical costs will be sufficient to offset today’s elevated pharmacy expenditures, an answer that will shape coverage decisions, premium development and long-term health care financing.

AM Best raised several related questions facing the health insurance industry, including how much employers and individuals are willing to absorb in higher premiums, how benefit structures should be redesigned as new evidence emerges, and how stakeholders should evaluate therapies whose costs land today while benefits may accrue to a different payer down the road.

AM Best said the industry conversation is shifting from the medications themselves to how health care financing should adapt to innovations capable of reshaping population health. The report noted that increased market competition, product innovation and evolving pricing dynamics may improve affordability over time, though the timing and magnitude of such changes remain uncertain.

Given elevated medical cost trends generally, AM Best said the added spending from GLP-1 weight-loss use has proven difficult for insurers and employers to absorb, a dynamic that may require evaluating GLP-1 utilization as a longer-term investment, similar to other care management initiatives aimed at improving health outcomes over time. Future coverage decisions for obesity indications will likely hinge on continued clinical evidence, pricing trends and the overall value proposition of the therapies, according to the report.

Obtain the full report here. &

The R&I Editorial Team can be reached at [email protected].

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