Current Market Access to GLP-1s

Apr 18
Apr 18, 2024

In March, the FDA approved Novo Nordisk’s Wegovy (semaglutide) for cardiovascular risk reduction, which could further boost the already-strong sales for the GLP-1 weight-loss medication.

Specifically, Wegovy is now approved to reduce risk of “major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal heart attack (myocardial infarction) or non-fatal stroke” in adults who are either overweight or obese and have established cardiovascular disease, per a Novo press release.

Data from MMIT Analytics shows that all GLP-1s are available for the majority of commercial-plan enrollees for the treatment of diabetes, as of April 2024 (MMIT is the parent company of AIS Health.) Almost all enrollees under commercial formularies have plans that put Eli Lilly and Co.’s Trulicity (dulaglutide) — a GLP-1 that hit the market in 2014 — under the preferred/preferred (prior authorization and/or step therapy) tier and covered/covered (PA/ST) tiers.

Eli Lilly’s weight loss drug Zepbound (tirzepatide) was the latest medication that joined fellow GLP-1s — Wegovy (semaglutide) and Saxenda (liraglutide) — in the burgeoning obesity drug market. (It is likely, per news reports, that a substantial amount of diabetes-coded utilization of GLP-1s is actually off-label weight loss utilization.) As of April 2024, over 60% of commercial-plan enrollees have access to Zepbound with utilization management restrictions (such as prior authorization and/or step therapy), a 10% increase compared to February, according to MMIT Analytics.

The weight loss medication market is currently dominated by Wegovy. In 31 states, pharmacy formularies that cover more than half of commercial-plan enrollees categorize Wegovy as “preferred” or “preferred with utilization management restrictions,” while only Massachusetts and the District of Columbia put Saxenda on those tiers.

This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.
© 2024 MMIT

Jinghong Chen

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.