CVS Health says GLP-1 drugs like Ozempic, Wegovy, Mounjaro and Zepbound only break even for employers and health plans once their price falls below $350 a month. Above that threshold, the company says, the drugs add net costs rather than save money, even after accounting for fewer hospitalizations and emergency room visits.
The findings come from an analysis of Aetna insurance claims, comparing patients newly started on the drugs between 2023 and 2025 against similar patients who weren’t taking them. The study tracked people for up to three years and covered patients with obesity, diabetes, and other conditions, though it did not break out results for obesity patients specifically.
CVS medical officer Dr. Amy Compton-Phillips presented the data ahead of the HLTH USA conference in Las Vegas, Nevada, where the company is scheduled to share the findings publicly on Sunday.
Right now, the math doesn’t work in employers’ favor. Zepbound and Wegovy run about $299 to $349 a month for cash-paying customers, but a 2025 Employee Benefit Research Institute study found employers and health plans actually pay between $617 and $766 a month for the same drugs. CVS declined to say what average price its own clients pay.
Compton-Phillips said drugmakers’ own direct-to-consumer prices show they could still profit while charging under $350 a month, and that doing so would lower overall health costs across the system.
“I hope that we can reach that price sooner rather than later,” Compton-Phillips said.
The numbers behind the break-even math: CVS found GLP-1 use was tied to 10% to 12% fewer emergency room visits in the first and second years, based on records for 60,000 people in year one and 20,000 in year two. Among roughly 4,000 people still on the drugs after three years, hospitalizations dropped 34% to 42%.
But over three years, those medical savings totaled $9,400 per person, while prescription spending rose by $13,300 per person — a net cost increase of $3,900 per person once drug spending is factored in.
Employers are already pulling back. With premiums expected to rise more than 9% in 2027, about 14% of companies have dropped or plan to drop GLP-1 coverage next year.
Compton-Phillips said the break-even price depends on how sick the patient already is. “An older person with diabetes is going to have a higher risk for hospitalization than a younger person who is obese without diabetes,” she said. “The higher-risk the person is, the quicker you get to a return on investment.”
The federal government has already struck its own deal with Eli Lilly and Novo Nordisk, agreeing to pay $245 a month for injectable GLP-1 weight-loss drugs under an 18-month pilot for Medicare beneficiaries 65 and older or with disabilities.
