The ever-expanding demand for blockbuster glucagon-like peptide 1 (GLP-1) agonists medications have led all of us in healthcare to face an important question: Can we work together to overcome the unsustainable status quo to make this once-in-a-generation innovation available to everyone who needs it?
Make no mistake: we’re facing an inflection point when it comes to GLP-1medications. The GLP-1 market has evolved rapidly over the past decade and a half since the first medication was approved for the treatment of Type 2 diabetes. When GLP-1s were approved for weight-loss, we faced the first major challenge to market stability. Estimates predict that half of the U.S. population will have obesity by 2030, standing as one of the greatest health threats America faces as a nation.
The demand for GLP-1s has become unprecedented—but so is the price set by their manufacturers. Despite these medications being relatively cheap to produce, Americans are facing prices that are multiples higher compared to other countries, paying upwards of $11,000 annually for a year supply. Even with the discounts and rebates pharmacy benefit managers can negotiate with manufacturers, prices are still high compared to others around the globe; this is not acceptable and not sustainable.
As FDA-approved indications continue to grow—including kidney disease, sleep apnea and risk reduction of cardiovascular death, heart attack and stroke—and with anticipated label expansions on the way, demand will only continue to increase. At the same time, employers and other plan sponsors are facing impossible decisions about how to cover these medicines without bankrupting their plan or dramatically increasing the cost of health coverage for everyone.
A combination of challenges such as high drug costs, alternative reimbursement models in large and small pharmacies, waste due to non-adherence, and the important need for a high-touch management of the clinical care journey have put the healthcare industry on the brink of a perfect storm.
Among these challenges are the complexity of GLP-1 drugs, which require close patient monitoring and customized dosing to reach the desired needs of the patient while minimizing side effects. We know the first several weeks are the most difficult for patients, from learning to administer injections to managing adverse side effects. Studies estimate that as many as 70% of patients taking GLP-1s may experience gastrointestinal issues during the first several weeks of beginning a GLP-1 regimen. But the current system is wrought with clinical care gaps and studies indicate that 35% of patients taking GLP-1s for obesity discontinue use within three months (growing to 50% by twelve months). Patients need more help achieving their maintenance dose and we must provide them with a clinical ecosystem that includes dose optimization guidance, side effect management, monitoring, nutrition counseling and overall wellness support.
The current model for GLP-1 access and care is not efficient or beneficial to pharmacies, patients and plan sponsors. We need to reimagine a clinical structure that better addresses the complexities medications like GLP-1s bring to the market while also reimaging a reimbursement structure that allows pharmacies to dispense medications to patients.
Pharmacies are making difficult decisions to stop stocking GLP-1s as they face supply fluctuations and a high cost that doesn’t align with their business model. I’ve seen this firsthand with independent pharmacies in the Express Scripts network, with more than 1,600 discontinuing GLP-1 dispensing for patients in the fourth quarter of 2024 alone. Additionally, a recent survey found that only about a quarter of independent pharmacies will stock GLP-1 weight-loss drugs and 14% of pharmacies responding are no longer carrying them.
But independent pharmacies aren’t the only ones feeling the GLP-1 pressure. In addition to supply issues, high list prices and the lack of generics for the most prescribed GLP-1s, are also straining large retail pharmacies—we see this pressure already in 2025 during conversations with a large retail pharmacy showcasing the inability to sustain dispensing GLP-1s in traditional arrangements—putting additional stress on health plan sponsors and patients. Further exacerbating challenges, pharmaceutical companies are taking inflation increases on these already expensive drugs.
In response to these pressures, pharmacies ranging from large retailers to smaller independents are seeking disruptive changes to the way that GLP-1s are reimbursed to enable a sustainable path to patient access.
All in all, these challenges combine to form the reality facing our healthcare system: the existing GLP-1 approach is unsustainable, it’s failing patients, pharmacies and health plan sponsors. As an industry, we must overhaul our approach to care and reimbursement by establishing a comprehensive ecosystem designed for medications like GLP-1s that prevents high costs, lack of access and fragmented outcomes.
Ashley Holzworth-Nash is a vice president at Express Scripts by Evernorth.