GLP-1 Demand and Price Surge Reshape Health Plan Strategies to Contain Costs and Protect Your Bottom Line

Accelerating demand for GLP-1 drugs like Ozempic, Wegovy and Zepbound are impacting the financial stability of employer-sponsored health plans. It is simply becoming impossible to ignore these medications which are now widely prescribed for obesity and other emerging conditions—and the costs are stacking up fast.

Originally developed for diabetes management, utilization of GLP-1 prescriptions has skyrocketed in recent years, with demand showing no signs of slowing. The market, valued at $46.7 billion in 2024, is projected to surge past $470 billion by 2032. For payors, self-insured employers and TPAs, that spells a new era of pharmacy-driven cost pressure and the need for smarter, more comprehensive cost-containment strategies.

What's Driving the GLP-1 Surge?

• Expanded Indications: The FDA has approved GLP-1s for additional conditions like sleep apnea and kidney disease. More are coming.
• High Patient Demand: Driven by celebrity use, direct-to-consumer ads and social media, GLP-1s have become the latest must-have medication.
• Circumvented Plan Designs: Comorbidities allow some members to qualify under diagnoses like Type 2 diabetes, even if the goal is weight loss.

In response to these trends, plan sponsors are reshaping their pharmacy plan spending and triggering downstream medical claim challenges that could affect everything from stop-loss premiums to fiduciary liability.

How H.H.C. Group Helps Mitigate the Impact

H.H.C. Group is a critical partner in helping plans balance rising costs driven by drugs like GLP-1s with effective medical claim control strategies. Here's how:

1. Independent Medical Reviews (IMRs) for Clinical Oversight

With the rapid expansion of GLP-1 use for weight loss and other emerging indications, ensuring clinical appropriateness has become more important than ever. H.H.C. Group's URAC-accredited Independent Review services provide:

• Clinical validation for high-cost care plans
• Documentation-based assessments to support or deny claims
• Protection against unnecessary spend and liability

2. High-Dollar Claim Negotiation

As GLP-1 use increases, so does the potential for follow-up services, side effects and related care episodes—especially when used outside traditional indications.

H.H.C. Group's expert negotiators work directly with providers to reduce high-cost inpatient and outpatient claims, achieving savings of up to 90% in some cases. This helps mitigate the ripple effects of rising pharmacy costs across medical spend.

3. Line-Item Medical Bill Review

GLP-1-related care often comes bundled with labs, consults and other procedures. H.H.C. Group's coders and clinical reviewers:

• Identify billing errors, duplicates and inflated charges
• Compare to UCR and Medicare benchmarks
• Deliver savings and accurate reimbursements

Why This Matters Now

Many plans focus on pharmacy cost trends in isolation. However, the real financial impact hits when high-cost prescriptions create a cascade of downstream utilization, more doctor visits, more diagnostics and potentially more comorbid care.

By controlling what you can—medical claims, compliance and appropriateness—plan sponsors can reduce the overall exposure created by high-cost pharmacy trends like GLP-1s.

Be Proactive, Not Reactive

We are still in the early stages of the GLP-1 cost wave. With new approvals pending and legislative changes in motion, it's clear that 2025 will be a turning point. Plan sponsors that take proactive steps now will be better positioned to safeguard assets, stay compliant and support members effectively.

Partnering with H.H.C. Group gives you the tools to:

• Validate and control claims tied to GLP-1 use
• Ensure medical necessity and documentation alignment
• Protect against balance billing and unnecessary overpayments
• Strengthen fiduciary compliance under ERISA

Take Control Before Costs Spiral Further

While GLP-1 drug use continues to grow, plan sponsors don't have to accept unchecked cost increases as inevitable. By reinforcing your medical claims strategy, you can stay ahead of the financial pressure these drugs bring and protect your plan participants and bottom line.

Contact H.H.C. Group today to learn how we can help your organization navigate the GLP-1 surge with confidence, compliance and real savings.