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Impact of Anti-Obesity GLP-1 RA Medication Policy Restrictiveness on Net Per Member Per Month Spending
By An Dang, PharmD; Alan Fou, PharmD; Jeffrey He, PharmD, APh; Mark Shinmoto, PharmD
Rapid growth in anti-obesity glucagon-like peptide-1 receptor agonist (GLP-1 RA) use has prompted plans to reassess how coverage criteria influence utilization and pharmacy spending. An analysis of real-world pharmacy claims across employer-sponsored health plans demonstrates that utilization management (UM) design plays a meaningful role in shaping both utilization and net per-member per-month (PMPM) costs for these therapies.
This retrospective analysis evaluated how varying levels of UM design influence net plan-paid PMPM spending for anti-obesity GLP-1 RAs. The findings highlight how UM policy design can impact net plan paid PMPM costs. Understanding the relationship between eligibility criteria, utilization, and PMPM outcomes may help plans evaluate coverage strategies that balance access to therapy with budget predictability.
This analysis was presented by Ventegra’s 2025–2026 Managed Care Fellow,An Dang, PharmD, in collaboration with the clinical team, and examines the impact of different utilization management policies on net plan paid PMPM spending for anti-obesity GLP-1 RA therapies.
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