2025 SOA Health Meeting: Session 8B: An Actuarial Perspective on GLP-1s - What Have We Learned and Where Are We Going? -06.24.25- Recording

Pharmacy trends have been an evergreen topic on the minds of health actuaries for the better part of two decades due to both the volume of new products and therapies coming to market and the rapid evolution the rules and regulations that apply to prescription drugs. And yet, the introduction of GLP-1 receptor agonists, primarily for the management of obesity and type 2 diabetes, stand apart in terms of the issues that they pose for actuaries projecting pharmacy costs.
Private and public plan sponsors alike have been grappling with coverage decisions regarding Wegovy, Ozempic, and other GLP-1 receptor agonists were approved for weight loss due to the potential ramifications on healthcare budgets. Indeed, challenges in forecasting prescribing patterns, demographic factors influencing utilization, and the impact of marketing and clinical guidelines on patient access, combined with the costs and complex reimbursement structures associated with these drugs, have made it exceedingly difficult for plan sponsors to find a balanced, sustainable set of coverage decisions.
The first part of the session will focus on a review of the current coverage landscape of GLP-1's in both commercial and Medicaid programs. We will review what we have learned from the emerging experience over the past few years and how that experience has informed the themes we are seeing in terms of clinical protocols, utilization management controls, and risk mitigation.
Next, we will cover new and anticipated changes in market dynamics in the GLP-1 space, including new products that are expected to be approved, changes that may occur with respect to approved indications, and what (if anything) we expect to happen to drug prices as this space becomes more competitive.
Finally, the panel will provide its thoughts on how future pharmacy utilization and cost trends will be influenced by GLP-1's and how anticipated changes may alter the thinking of plan sponsors going forward.