GLP-1s help patients but expansion is expensive

An examination of nearly 1.5 million medical records sheds new light on one of the key questions about GLP-1s: Do they lower a patient’s overall medical costs?

New research suggests that when it comes to patients with diabetes, the answer is yes. But patients using the medications to combat obesity drove up health care costs.

Two studies released by the Blue Cross Blue Shield Association (BCBSA) and conducted by Blue Health Intelligence (BHI) also suggest significant clinical benefits for patients with diabetes. The two studies are based on de-identified national claims data from 2017 to 2024.

Strong results for diabetes

Patients with diabetes who used GLP-1s for two years or more saw a 45% lower risk of kidney failure, a 34% lower risk of liver failure, and fewer hospital admissions for strokes and heart failure.

• 45% drop in end-stage renal disease (dialysis/transplant delayed by 2.7 years)
• 34% drop in end-stage liver disease (transplant delayed by 2.3 years)
• 26% reduction in hospitalizations for heart failure

Because of those clinical benefits, costs tied to the medication were offset by fewer hospital stays and less dialysis.

Costs rise for patients without diabetes

People without diabetes, who take GLP-1s, typically for weight loss, did see some modest reduction in conditions like kidney and liver disease but the amount of overall annual health care spending rose by 9–10%, even before factoring in the drug’s price. This is due to increased use of health care.

This real-world retrospective research, one of the largest of its kind, was co-authored by leaders from Blue Cross Blue Shield Massachusetts and Hawaii Medical Service Association. As part of a broader collaboration between BHI and the Blue Cross Blue Shield Association (BCBSA), the research enables a deeper understanding of GLP-1 use and effects among members with and without diabetes.

A recent study from the Employee Benefits Research Institute (EBRI) provided insight on the impact these medications can have on premiums. EBRI found that expanding GLP-1 eligibility beyond people with diabetes and obesity to those who are overweight could raise employer-sponsored premiums by up to 14%. Even with copays, broader eligibility increases costs.

The takeaway is GLP-1s work and they’re cost-effective for people with diabetes. But broader use, especially for obesity, brings major cost concerns. GLP-1 coverage decisions should allow flexibility to balance access, affordability and sustainability.