The rapid rise in prescriptions for GLP-1 weight loss drugs had a muted effect on Delaware health insurers’ spending thanks to significant manufacturer rebates, according to a new report from the state’s Department of Insurance.
The study found that from 2020 to 2023, use of GLP-1 medications among Delaware’s fully insured commercial population increased 127%. During the same period, net spending - after rebates - rose 137%. Despite the surge in demand, the average prescription cost remained stable at about $400 over the four years. Without rebates, the average cost per prescription reached $952 in 2023, up 17% from 2020.
On average, patients paid about 22% of prescription costs out of pocket but received less than 1% of the rebates at the point of sale. Health insurers retained about 90% of rebates, the department said.
GLP-1s accounted for 6% of all pharmacy spending in Delaware last year, a figure in line with national trends, according to a BestWire report.
“It’s long been suggested that the cost of GLP-1s has been a primary contributor to rising health insurance costs, but this data shows that simply is not the case,” insurance commissioner Trinidad Navarro said in a statement. “Considering the rebates from drug manufacturers and other entities, even with increased utilization, they are not a substantive cost driver.”
The findings come amid heightened scrutiny of GLP-1 coverage decisions. In July, CVS Health Corp. said it would stop covering the weight loss drug Zepbound due to cost concerns, while expanding access to Novo Nordisk’s Wegovy under a rebate agreement. CVS now faces a potential class action lawsuit in New York, alleging it prioritized rebate-backed drugs over patient needs.
Navarro added that beyond stable spending, GLP-1s may provide long-term cost savings by helping manage chronic conditions such as diabetes and obesity, though he noted those savings are difficult to measure.
The report was mandated under a 2019 state law requiring the insurance department to identify health care cost drivers and recommend strategies for affordability. The regulator said it plans to broaden its review to include overall pharmacy spending in the coming months.
The analysis covered data from CVS Caremark, Express Scripts, and Optum Rx, the state’s largest pharmacy benefit managers.
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