New survey finds rising out-of-pocket costs and affordability are primary barriers to GLP-1 access

Nearly seven in 10 Americans who have taken a GLP-1 medication say the drug’s cost influenced their decision to start or continue treatment, according to a new nationwide Navitus Health Solutions Pulse Survey released today.

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“GLP-1 medications offer meaningful health benefits, but this survey highlights trends and concerns related to medication cost and long-term accessibility to these drugs,” said Sharon Faust, Chief Pharmacy Officer at Navitus Health Solutions, which commissioned the survey. “Difficult tradeoffs exist for patients and plan sponsors alike.”

Faust added: “We anticipate demand for GLP-1s will continue to increase in coming years. This trend increases the need to make sure that the appropriate patients can get the medications they need while ensuring financial stability within the U.S. health-care system.”

The Pulse Survey questioned 2,000 Americans who are taking or have taken GLP-1 medications in the last two years. GLP-1s include popular brand names Ozempic, Wegovy, Mounjaro and Zepbound. The medications are indicated for managing Type 2 diabetes and chronic weight management, among other conditions.

In recent years, GLP-1 use has grown as a result of proven clinical effectiveness, expanded indications and direct-to-consumer advertising. But their high cost has made them a topic of conversation, especially as indications expand to cover more potential utilizers and amid concerns about reversing beneficial effects with discontinuation of use.

The Pulse Survey found many individuals reported paying significant amounts out of pocket for GLP-1s, including:

• 24% said they pay more than $250 per prescription fill, including nearly 8% who pay $500 or more. The percentage paying $250 or more per fill is nearly twice as high for individuals using these medications for weight management compared with diabetes patients.
• 44% said their GLP-1 cost was higher than expected.
• 60% know someone who wants to take a GLP-1 but cannot afford it.
• Among respondents who stopped taking a GLP-1, cost was the reason cited most frequently, surpassing side effects and achieving a desired weight.

With cost becoming a significant barrier for GLP-1 access, users reported exploring direct-to-consumer programs and other channels to reduce their out-of-pocket cost. The survey found:

• Nearly 40% have used discount programs or manufacturer coupons to help offset their out-of-pocket costs.
• More than 83% think individuals are turning to direct-to-consumer GLP-1 programs because traditional health care access is too difficult or too expensive.

At the same time, respondents expressed concern about possible risks associated with lower-cost, compounded GLP-1 products often available through alternative programs but not approved by the U.S. Food and Drug Administration (FDA). Nearly 60% said they are aware of potential safety risks, and more than 86% said they would be willing to pay more for FDA-approved options.

Considering the affordability challenges associated with GLP-1s, the survey suggests that Americans recognize the need for some management of access to these medications. More than 70% said they support minimum requirements such as prior authorization, thresholds for body mass index or participation in supportive wellness programs for coverage of GLP-1 prescriptions.

“Without thoughtful benefit strategies, affordability challenges will continue to grow,” Faust said. “Employers, health plans and manufacturers must work together to manage costs responsibly while protecting access for patients who need these medications most.”

She added: “This isn’t simply a question of access or restriction. It’s about designing options that are clinically appropriate and financially sustainable for everyone involved.”

For more information about the Pulse Survey, visit: Navitus Health Solutions Research: Americans Feel the Pressure of Expensive GLP-1s.

About the survey:
The Navitus Health Solutions Pulse Survey questioned 2,000 U.S. adults who are taking or have taken GLP-1 medication in the last two years, including for diabetes treatment and weight management. The survey, conducted in January by Pollfish, has an error margin of plus or minus 2.2 percentage points. Error margins are higher for subgroups within the overall sample. Navitus Health Solutions commissions regular Pulse Surveys on health-related topics important to Americans to provide useful data and insights into issues shaping healthcare access, affordability and benefit design.

About Navitus Health Solutions:
Navitus Health Solutions is a pioneering pharmacy solutions provider that first launched a transparent pharmacy benefit manager (PBM) to pass through 100% of negotiated drug rebates and discounts to health plans and plan sponsors. The Navitus PBM is an alternative to traditional PBMs, which divert rebates and discounts for profit. It leads the way in driving meaningful cost savings to help make medications more affordable. Now, more than 20 years later, the organization delivers a range of solutions through portfolio brands, including Navitus, Lumicera and Archimedes. Owned by SSM Health and Costco Wholesale, Navitus Health Solutions serves more than 18 million lives across 800 clients including employers, unions, government plans, payers and health systems. For more information, please visit www.navitus.com.

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