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The weight-loss drug storm now swamping employers' health benefits budgets could level off between 2028 and 2030, according to analysts at Milliman.
Roughly 7.9% to 12.7% of the participants in a typical employer health plan could be taking Wegovy, Zepbound or similar drugs by then, with costs averaging roughly $3.17 to $22.88 for every plan participant per month, the analysts predict in a new weight-loss drug spending forecast.
Originally, patients with diabetes took GLP-1 agonists like semaglutide and GIP/GLP-1 agonists like tirzepatide mainly to control their blood sugar. If the Milliman analysts are correct, an employer plan with 1,000 participants will have 79 to 127 enrollees taking a GLP-1 agonist or similar new-generation weight-loss drug for reasons other than diabetes management.
The analysts assume in their calculations that the average cost per patient using the weight-loss drugs will range from $50 to $140 per month, or from $600 to $1,680 per year.
For a 1,000-participant plan with 79 to 127 enrollees using the GLP-1 agonists, the total cost of the drugs would be $47,400 to $213,360 per year.
Related: PBM reform, drug prices rank as top policy priorities for employers
John Rogers, an actuarial consultant at Milliman, led the five-person team that created the forecast.
The analysts fed in-house Milliman employer plan spending data into a specific kind of forecasting tool — a Markov model — to come up with the forecast.
The analysts based their work on the assumption that the GLP-1 agonists will follow a path similar to antidepressants like Prozac and anti-inflammation drugs like Humira.
"As these drugs launched, their associated costs attracted tremendous attention from plan sponsors," the analysts write in a discussion of their calculations. " At the time, many plan sponsors had reservations about formulary placement for these medications. Today, these drugs are generally widely available."
Milliman: Milliman is one of the biggest actuarial consulting firms in the world.
Its predictions about GLP-1 agonist costs could affect how pharmaceutical manufacturers develop, price, distribute and launch GLP-1 agonists, as well as how employers and their benefits advisors make GLP-1 agonist coverage decisions.
A wildcard: The analysts emphasize that many factors could cause actual GLP-1 spending to differ from the forecast.
One source of uncertainty is researchers' hope that GLP-1 agonists could do more than control blood sugar and obesity.
"Many speculate that these medications may also be used to treat diseases such as alcohol misuse disorder and Parkinson's disease," the researchers note. "Further, drug trials are underway to investigate the use of tirzepatide for a weight-related indication for those with comorbid methamphetamine use disorders. Generally speaking, the greater the number of indications for GLP-1s, the more likely those drugs are to be prescribed—both for individuals with a history of diabetes and those without."
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