GLP-1s Outpace Specialty, Novo’s Pharm To Table Play, and AI Prior Auth Run Amok

Hey all,

happy hump day! Every time insurers claim that 50% of patients stop taking GLP-1s within a year, you have to wonder—are people really choosing to quit, or are they just hitting the usual wall of prior auth headaches and denied coverage? A study looking at cash-pay or compounding patients could be pretty revealing because let’s be honest—skipping the insurance maze is 50% of the reason people stop taking GLP-1s. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Fierce Healthcare) Evernorth Reports GLP-1 Spending Growth

A new Evernorth report reveals that spending on GLP-1 drugs, primarily used for weight loss and diabetes, has surged, with annual pharmaceutical spending growth rising from 2.1% in 2021 to 12.8% in 2024—outpacing specialty drug spending for the first time. This rapid increase followed the approval of semaglutide for chronic weight management, particularly with the success of weekly options like Ozempic and Wegovy. However, concerns remain over cost, long-term effects, and high discontinuation rates, as more than 50% of patients stop using these drugs within a year. Full Article.

(Cost Curve) Novo’s “Pharm to Table” Expansion and Launch Price Challenges

Brian Reid explores how Novo Nordisk is expanding its “pharm to table” approach by making its cash-pay option available at all pharmacies, but the program remains more of a copay assistance model than a true direct-to-consumer platform like LillyDirect. The price drop from $650 to $499 is an improvement, yet restrictions for Medicare beneficiaries and certain insurance plans still apply. Meanwhile, a new AJMC commentary highlights the challenges of interpreting drug launch prices, emphasizing that list prices don’t reflect final costs due to statutory discounts and market shifts. Full Article.

(STAT) Health Insurers’ Rapid AI Adoption Outpaces Regulation

Insurers like UnitedHealth, Elevance, and Centene are rapidly deploying AI for tasks like coding and prior authorizations, but regulators lag behind. While insurers tout efficiency, watchdogs warn of transparency issues and rising AI-driven care denials. Soon, AI will deny claims as fast as AI files them—without fixing the system. Full Article