Key facts
- CVS Health said plan sponsors saved $9,400 per person on medical bills over three years but spent $13,300 more on prescriptions.
- CVS Health said GLP-1 use was associated with 10-12% lower emergency room visits in the first and second year.
- Records for 4,000 people still taking the drugs after three years showed a 34-42% decrease in hospitalizations, CVS said.
- About 14% of companies have dropped or plan to drop GLP-1 coverage in 2027, CVS said.
- Employers and plan sponsors pay $617 to $766 monthly for the drugs, per a 2025 Employee Benefit Research Institute study.
CVS Health said on November 14 that employers and other health plan sponsors could break even on GLP-1 drugs if they are priced below $350 per month, because reduced use of medical services such as hospitalizations and emergency room visits lowers spending enough to offset drug costs.
The company said an analysis of claims data from its Aetna insurance unit found that across patients with obesity, diabetes or other conditions, current prices for GLP-1 drugs add to spending because they are too high for lower medical costs to offset. The analysis compared patients newly taking the medicines from Eli Lilly and Novo Nordisk with similar patients not taking them. The drugs included Mounjaro and Ozempic for diabetes and Zepbound and Wegovy for obesity, with patients starting between 2023 and 2025 and periods of up to three years. The analysis did not break out figures for obesity patients alone.
CVS said GLP-1 use was associated with 10-12% lower emergency room visits in the first and second year of use, based on records for 60,000 people in the first year and 20,000 in the second. Records for 4,000 people still taking the drug after three years showed a 34-42% decrease in hospitalizations, according to the report. Across the three years, plan sponsors saved $9,400 per person on medical bills but spent $13,300 more on prescriptions, adding $3,900 per person.
Coverage of GLP-1 drugs for obesity is falling as corporations and other plan sponsors try to bring down premiums expected to be up by over 9% in 2027, and about 14% of companies have already dropped or plan to drop the drugs in 2027, CVS said. Zepbound and Wegovy can cost about $299 and $349 for cash-pay customers, while employers and plan sponsors pay between $617 and $766 monthly, according to a 2025 study by the Employee Benefit Research Institute. CVS declined to comment on the average prices paid.
Dr Amy Compton-Phillips, chief medical officer at CVS Health, said the drugmakers' direct-to-consumer prices suggest they can still profit by charging less than $350 a month while helping lower overall healthcare costs. "I hope that we can reach that price sooner rather than later," she said in an interview ahead of the HLTH USA conference in Las Vegas, where CVS will present the findings on November 15.
The US government agreed a deal with Lilly and Novo last year to pay $245 per month for injectable GLP-1 weight-loss drugs in an 18-month pilot testing their cost-effectiveness for Medicare beneficiaries aged 65 and older or with disabilities. CVS, which also operates pharmacy benefit manager Caremark and a network of retail pharmacies it plans to spin off, said the price at which GLP-1s start saving money overall depends on how healthy or sick a patient is.