Evaluating GLP-1s Beyond Cost: A Case for Value-Based Pharmacy

As benefits teams increasingly pursue value-based care models with medical providers—paying for quality and outcomes rather than volume of services—there’s growing momentum to apply the same principles to pharmacy benefits. One effective starting point is your own data: by creating matched cohorts within your database, you can compare downstream medical claims and utilization between individuals taking a drug and those who are not. For example, while GLP-1 medications like semaglutide carry high pharmacy costs, their total value may emerge when evaluated holistically. If users of semaglutide show lower total cost of care—including reduced incidence of conditions like osteoporosis and gout—these medications may prove more valuable than initially assumed. Indeed, recent research supports this approach: semaglutide demonstrated significant protective effects against osteoporosis and gout in patients with obesity and type 2 diabetes when compared to traditional glucose-lowering medications (Chen et al. 2025). Such insights can inform smarter, data-driven pharmacy benefit and formulary decisions that align with value-based care goals.

Chen J-C, Huang Y-N, Tsou M-Y, Chen S-C, Yang S-F, Liu Y-L & Su P-H 2025 Comparative analysis of GLP-1 receptor agonists, traditional glucose-lowering medications and traditional anti-obesity medications on skeletal outcomes in obese individuals with and without type 2 diabetes: a five-year propensity-score matched cohort study. Endocrine Abstracts 110 P684. https://doi.org/10.1530/endoabs.110.P684