eHealth recently released a survey finding that 33% of Americans intend to begin taking GLP-1 medications for weight loss when discounted pricing becomes available in 2026. This impending demand is one that provider network executives must prepare for to ensure cost management and future MLR stability.
Cost and Capacity Planning for Health Care Provider Network Executives
The sheer scale of this projected demand creates a dual threat for the payer. The first threat is aggregate pharmaceutical spend, which will increase dramatically. The second, and more subtle, threat is capacity. To responsibly manage GLP-1 prescriptions, members require specialized care and monitoring from providers, including endocrinologists, weight management specialists, and primary care physicians proficient in chronic weight management. The existing health care provider network is likely not scaled to handle a 33% surge in demand for these specific services.
Strategic Imperatives for Provider Network Management
To effectively manage increased utilization and mitigate rising costs, provider network strategy must pivot. TOG Network Solutions recommends a three-step plan to prepare to meet member demand for GLP-1 prescriptions.:
- Assure network adequacy. The health care provider network must be pressure-tested to identify critical gaps in specialty capacity. Payers must use provider network access and adequacy data to quantify how many members will compete for appointments with limited specialists. Strategy should focus on proactively recruiting high-value providers in endocrinology and behavioral health care to meet the anticipated demand surge.
- Use network intelligence to merge utilization data from pharmacy benefits with physician prescribing patterns. This analysis determines which providers are prescribing GLP-1s and whether those decisions align with appropriate clinical pathways. The goal is to enforce clinically sound management while maintaining cost-effectiveness for the payer.
- Given the high cost of pharmaceuticals, traditional fee-for-service contracts are unsustainable. Provider network strategy must implement value-based or performance-based contracts with key providers and integrated health systems. This ensures reimbursement is tied directly to patient adherence, weight loss milestones, and overall health improvement, making the spend an investment rather than a runaway cost.
The GLP-1 market disruption requires a proactive and precise response. Health care provider network intelligence is the only tool that can merge clinical utilization data with financial metrics, allowing the payer to transform this major challenge into a strategically managed opportunity for both improved member outcomes and MLR stability.
To learn more about TOG’s network intelligence services and how payers can optimize network adequacy, competitiveness, and performance while managing adequacy, competitiveness, and performance with analytics, benchmarking, and automation, schedule your consultation today.