GLP-1s, and Everything We Haven’t Fixed Already
Skyrocketing demand, unclear coverage criteria, inconsistent outcomes data, escalating costs, and public frustration. These are symptoms of a system that wasn’t built for drug innovation at this scale or speed.
GLP-1s Exposed a System Already Under Strain
GLP-1s didn’t cause the mess. They just showed it to us more clearly.
Employers and plans are asking what to do now. That’s the right question. But the better one is “How did we get here?”
How We Got Here
We’ve had years to build infrastructure for value-based benefit design, to define how we assess clinical value, and to align pricing mechanisms with long-term outcomes. In many places, we didn’t. And GLP-1s filled the vacuum.
They became the test case for every unresolved issue in drug policy: access equity, benefit generosity, PBM incentives, outcomes-based contracting, and member communication.
How GLP-1s are Different
What makes GLP-1s different is how fast the stakes got high. The clinical promise is real. So is the budget impact. And patients, providers, and employers are all responding at once, often with incomplete information. That pressure is forcing uncomfortable conversations about value, sustainability, and what we mean by "coverage."
The First GLP-1 to Enter Price Negotiation
A major policy shift has now arrived: In March 2025, CMS announced that semaglutide (Ozempic/Wegovy) (a leading GLP-1 receptor agonist) will be subject to Medicare price negotiation for 2027 under the Inflation Reduction Act. This marks the first time a GLP-1 is officially on the negotiation list, moving the class from “likely candidate” to active negotiation.
What This Means for Coverage and Innovation Strategy
As these pressures grow, we’re spending time examining how policy, pricing, and benefit structures are interacting in real time, and where systems can adjust. We’re asking how step therapy policies align with emerging evidence, how alternative payment models can incorporate high-cost chronic disease therapies in ways that reflect their clinical promise while protecting sustainability, and how care teams and clinical pathways can evolve to manage rising demand while ensuring appropriate use. These are big, complicated questions that will shape the future of benefit design and innovation policy well beyond GLP-1s.
The Path Forward Requires Collaboration
Health plans, providers, policymakers, and manufacturers each have a role to play in responding to this moment. It will take collaboration across these groups to move beyond the immediate pressure of GLP-1 costs toward building structures that support sustainable access to innovative therapies. This is the moment to clarify value frameworks, update coverage strategies, and align incentives in ways that can last. If stakeholders get it right, the impact will extend far beyond one class of drugs.