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CVS Health said employers and other health plan sponsors could break even on GLP-1 drugs if monthly prices fall below $350. Lower medical spending, including reduced hospitalizations and emergency room visits, could then become large enough to offset the prescription costs.

The finding comes from an analysis of claims data from Aetna, the insurance business owned by CVS. Across patients with obesity, diabetes or other conditions, CVS found that current GLP-1 prices still increase total spending because lower medical costs are not sufficient to overcome the drug expense.

The analysis examined patients who had recently begun taking widely used GLP-1 medicines from Eli Lilly and Novo Nordisk. Researchers compared those patients with similar people who were not using the drugs.

GLP-1 medicines mimic the GLP-1 hormone and reduce appetite. The drugs in the analysis included Mounjaro and Ozempic for diabetes, along with Zepbound and Wegovy for obesity.

The analysis covered periods of as long as three years, with patients beginning treatment between 2023 and 2025. CVS did not provide separate figures limited to patients receiving the medicines for obesity.

Coverage for obesity treatment is declining as corporations and other plan sponsors attempt to control premiums expected to rise by more than 9% in 2027. About 14% of companies have already dropped the drugs or intend to remove them from coverage in 2027.

Zepbound and Wegovy can cost approximately $299 and $349 for customers paying cash. Employers and other health plan sponsors pay between $617 and $766 each month, according to a 2025 study from the Employee Benefit Research Institute.

CVS declined to disclose the average prices paid. That leaves a substantial gap between the break even level identified by the company and the amount many plan sponsors currently face.

Dr Amy Compton-Phillips, chief medical officer at CVS Health, said prices offered directly to consumers by drugmakers suggest they can remain profitable while charging less than $350 monthly. She also said such pricing could help reduce overall healthcare costs.

The United States pays more for healthcare than any other country, according to the report. Compton-Phillips said in an interview, “I hope that we can reach that price sooner rather than later,” ahead of the HLTH USA conference in Las Vegas.

CVS planned to present its findings at the conference on November 15. The analysis offers plan sponsors a clearer view of the price needed for reduced medical use to balance the cost of prescriptions.

The US government reached an agreement with Lilly and Novo last year to pay $245 each month for injectable GLP-1 drugs used for weight loss. The arrangement is an 18 month pilot testing cost effectiveness for Medicare beneficiaries who are at least 65 years old or have disabilities.

CVS found that GLP-1 use for obesity, diabetes or other conditions was associated with 10% to 12% fewer emergency room visits during the first and second years of treatment. The company examined records for 60,000 people in the first year and 20,000 people in the second year.

Records for 4,000 people who continued taking the medicine after three years showed hospitalizations falling by 34% to 42%, according to the report. Those reductions produced meaningful medical savings, although prescription spending remained higher.

Across the three years, plan sponsors saved $9,400 per person on medical bills. At the same time, they spent an additional $13,300 per person on prescriptions, producing a net increase of $3,900 per person.

CVS said the price at which GLP-1 medicines begin producing overall savings depends on the health and medical risks of each patient. The company also operates pharmacy benefit manager Caremark and a retail pharmacy network that it plans to spin off.

Compton-Phillips said, “An older person with diabetes is going to have a higher risk for hospitalization than a younger person who is obese without diabetes.” She added, “The higher-risk the person is, the quicker you get to a return on investment.”

DISCLAIMER: GoldInvestors.news is not a registered investment, legal or tax advisor or broker/dealer. All investment/financial opinions expressed by GoldInvestors.news are from the personal research and experience of the owner of the site and are intended as educational material. Although best efforts are made to ensure that all information is accurate and up to date, occasionally unintended errors and misprints may occur.