By Amina Niasse
NEW YORK, Nov 14 (Reuters) - CVS Health said employers and other health plan sponsors could break even on GLP-1 drugs if they are priced below $350 per month as reduced use of medical services, such as hospitalizations and emergency room visits, lower spending enough to offset drug costs.
CVS said that an analysis of its Aetna insurance claims data found that across patients with obesity, diabetes or other conditions, the current prices for GLP-1 drugs add to spending because they are
too high to be impacted by lower medical costs.
The analysis looked at patients who were newly taking highly popular GLP-1 medicines — which mimic the GLP-1 hormone and reduce appetite — from Eli Lilly and Novo Nordisk, and compared them to similar patients who were not taking the drugs.
The drugs included Mounjaro and Ozempic for diabetes and Zepbound and Wegovy for obesity. The analysis covered periods of up to three years, with patients starting the medicines between 2023 and 2025.
The analysis did not break out figures for obesity patients alone.
GLP-1 COVERAGE FALLS OVER COST
Coverage of GLP-1 drugs for obesity is falling as corporations and other health plan sponsors try to bring down premiums expected to be up by over 9% in 2027. About 14% of companies have already dropped or plan to drop the drugs in 2027.
Zepbound and Wegovy can cost about $299 and $349 for cash-pay customers. Employers and other health plan sponsors pay between $617 and $766 monthly for the drugs, according to a 2025 study by the Employee Benefit Research Institute. CVS declined to comment on the average prices paid.
Dr Amy Compton-Phillips, chief medical officer at CVS Health, said that the drugmakers' direct-to-consumer prices suggest they can still profit by charging less than $350 a month, while also helping to lower overall healthcare costs. The United States pays more for healthcare than any other country.
“I hope that we can reach that price sooner rather than later,” she said in an interview ahead of the HLTH USA conference in Las Vegas, where CVS will present the findings on November 15.
The US government agreed on a deal with Lilly and Novo last year to pay $245 per month for injectable GLP-1 weight-loss drugs in an 18-month pilot testing their cost-effectiveness for Medicare beneficiaries aged 65 and older or with disabilities.
HOSPITALIZATIONS FALL
CVS said GLP-1 use for obesity, diabetes or other conditions was associated with 10-12% lower emergency room visits in the first and second year of use. It examined records for 60,000 people during the first year and 20,000 people for a second year.
An analysis of records for 4,000 people still taking the drug after three years showed a decrease in hospitalizations of 34-42%, according to the report.
When looking at spending and savings across those three years, plan sponsors saved $9,400 per person on medical bills, but spent $13,300 more on prescriptions, adding costs of $3,900 per person.
The company, which also operates pharmacy benefit manager Caremark and a network of retail pharmacies it plans to spin off, said the price at which GLP-1s start saving money overall depends on how healthy or sick a patient is.
"An older person with diabetes is going to have a higher risk for hospitalization than a younger person who is obese without diabetes," said Compton-Phillips. "The higher-risk the person is, the quicker you get to a return on investment."
(Reporting by Amina Niasse; editing by Caroline Humer)
