The surging demand for GLP-1 medications as a weight-loss solution has ignited a fierce debate: could this be the key to solving the global obesity crisis, or is it paving the way for a new set of challenges?
While these drugs have shown promising results in helping people lose weight, their off-label use for weight loss is straining supply, leading to shortages for those who rely on them to manage Type 2 diabetes. Compounding the issue, the high cost of these medications may put them out of reach for the very individuals who need them most, raising critical questions about the balance between addressing obesity and ensuring access to life-saving treatments.
Known as GLP-1 drugs, these medications (glucagon-like peptide-1 receptor agonists) mimic the action of the GLP-1 hormone, which is naturally produced in the gut after eating. This hormone regulates blood sugar levels, slows gastric emptying, and signals fullness to the brain. (An agonist is a substance that mimics the actions of a neurotransmitter or hormone to produce a response when it binds to a specific receptor in the brain.)
Originally developed for managing Type 2 diabetes, these medications started gaining attention in 2021 when studies disclosed their weight-loss benefits. Their popularity surged in 2022 as celebrities and influencers openly discussed their use, sparking a social media buzz and driving demand.
During a recent webinar, Nele Segers, global benefits consultant and principal at Aon, highlighted a notable trend from the 2025 Global Medical Trends Survey: prescription drugs for weight loss are emerging as a key driver of rising medical rates.
The report shows that the increasing demand for GLP-1 drugs is having a significant impact on healthcare costs worldwide.
In the United States, specialty drugs remain the leading contributor to healthcare spending, despite their limited use. The growing popularity of GLP-1 medications alone is expected to push up healthcare costs by 1% in 2025. In Canada, these drugs are projected to add 1.2% to the medical inflation rate.
Rising demand in South Africa
South Africa is not immune to the rising demand for GLP-1 medications.
Margot Brews, the head of health risk management strategy at Momentum Health Solutions, observes a “noticeable increase in claims and prescriptions” for GLP-1 agonists, coupled with a significant rise in their off-label use for weight loss.
Dr Noluthando Nematswerani, the chief clinical officer at Discovery Health, adds: “There is some evidence that certain GLP-1 drugs are being used off-label and for purposes beyond diabetes management.” She says Discovery Health Medical Scheme (DHMS) continues to track and monitor these trends closely.
Providing some background, Brews says the GLP-1 market is almost 20 years old, with at least eight different products available locally for the treatment of Type 2 diabetes.
“Momentum Health Solutions has been funding many of these products as part of our diabetes treatment baskets for several years. However, the newer GLP-1 products like Ozempic (semaglutide), Trulicity (dulaglutide), and Mounjaro (tirzepatide) are blurring the indication lines and are ushering in a local demand for these products as weight-loss agents,” she says.
Brews states that in South Africa, the Health Products Regulatory Authority has registered semaglutide and tirzepatide for use in type 2 diabetes.
Dr Nematswerani adds that other GLP-1 drugs registered in South Africa for diabetes include Trulicity (dulaglutide) and Victoza (liraglutide).
Wegovy is not registered in South Africa.
Saxenda (liraglutide) is the only GLP-1 receptor agonist registered specifically for weight loss.
The surge in demand driven by the weight-loss segment has caused severe stock shortages, making it challenging for diabetes patients to access their medication.
Brews points out that despite the high cost and frequent shortages of GLP-1 products, healthcare providers are increasingly prescribing these newer treatments, largely in response to growing consumer demand.
“The popularity of GLP-1 drugs for weight loss has outpaced supply, exacerbating the issue. The increased demand highlights the need for a balanced approach to medication use, ensuring that those who need these drugs for diabetes management have access to them,” she says.
Medical scheme coverage
Although GLP-1 drugs are not officially approved for weight loss (except for Saxenda) in South Africa, they can be prescribed off-label by medical practitioners. However, medical scheme cover for off-label use is generally not provided.
For instance, at Medihelp, GLP-1 medications are covered under benefit options with non-PMB (Prescribed Minimum Benefits) chronic medicine benefits, in accordance with the scheme’s registered rules for diabetes treatment only.
Johan Viljoen, a pharmacist by profession and Medihelp’s head of Operations, explains that pre-authorisation is required, supported by recent pathology results, to justify the use of GLP-1s according to the scheme’s evidence-based clinical protocol.
“Although diabetes is a CDL (Chronic Disease List) and qualifies for PMB, GLP-1 is not included in the treatment algorithm for diabetes,” says Viljoen.
He adds that at Medihelp, obesity treatment is considered an exclusion.
“We do allow funding for exclusions from members’ savings accounts (options that offer this benefit),” he says.
For members on all DHMS plan types (excluding the KeyCare series) who are registered for Type 2 Diabetes Mellitus, GLP-1 agonists are funded by the scheme from the chronic illness benefit when the scheme’s clinical criteria for GLP-1s are met. If the criteria are not met, these medicines are funded from the member’s available day-to-day benefits (medical savings account and above-threshold benefit, and up to the prescribed medication benefit limit, where applicable).
Saxenda is funded from the member’s day-to-day benefits, subject to the rules of their chosen plan type (that is, medical savings account and above-threshold benefit, and up to the prescribed medication benefit limit, where applicable).
DHMS has not made provisions in its policies for the off-label use of GLP-1 drugs.
Nematswerani shares that DHMS claims data shows an 83% increase in claims for GLP-1 drugs from the chronic illness benefit (registered for Type 2 diabetes) and a four-fold increase for claims paid from day-to-day benefits between January 2021 and October 2024.
For liraglutide (Saxenda), DHMS claims data shows a 69% decrease in claims from the chronic illness benefit and a 47% decrease in claims paid from day-to-day benefits between January 2021 and October 2024.
“This may be that the daily injections make this product less ideal for patients,” says Nematswerani.
For Ozempic, a semaglutide product, DHMS claims data shows an 80% increase in claims for this GLP-1 drug from the chronic illness benefit and a 150% increase in claims paid from day-to-day benefits between January 2021 and October 2024.
The high cost of GLP-1 medications: a pricey path
These drugs come with a hefty price tag.
According to Brews, many patients opt to self-fund newer GLP-1 agents if their health funders have declined coverage, either based on clinical criteria or off-label use for weight loss.
She notes that the cost of GLP-1 drugs in South Africa can range from R1 200 to R1 800 per injection, with monthly treatment packages costing between R4 500 and R7 000. The regimen for weight loss can vary from three months to long-term use, depending on individual needs and medical advice.
“It is important to consider the financial implications and ensure that these medications are used judiciously,” says Brews.
Viljoen adds that the cost of Victoza (registered for diabetes) is about R2 800 for three pens, while Saxenda (registered for weight loss) costs about R2 765 for three pens.
“The cost of treatment will depend on the dosage required. At the maximum dose of 3mg per day, you will need five pens per month, costing R4 600 per month. Typically, the duration of treatment should be reviewed after 12 weeks (three months),” explains Viljoen.
Nematswerani states that the single exit price (SEP) of an Ozempic pre-filled 4mg/3ml pen is R2 692.59.
The Ozempic pre-filled 2mg/1.5ml pen is R1 346.29. The average monthly cost is R8 100, and the average annual cost is R97 200.
The cost of the Saxenda 6mg/1ml pen is R2 726.80. The average monthly cost is R4 600, and the average annual cost is R55 200.
Pressure on medical schemes to cover GLP-1 drugs for weight loss
Both Brews and Nematswerani confirm there has been growing interest in and requests for the inclusion of GLP-1 drugs in medical scheme benefits for weight loss.
Brews says: “This reflects the increasing awareness and demand for effective weight management solutions. However, it is crucial to balance this demand with the need to ensure that these medications are available for their approved indications.”
It remains to be seen whether mounting pressure from members will prompt medical schemes to reconsider their coverage policies. But in the meantime, Brews says that Momentum Health Solutions is monitoring the rising use cases and treatment pathways of members prescribed GLP-1 drugs.
“The primary focus remains on ensuring these medications are available for their approved indications, such as diabetes management,” she says.
She adds that any policy changes would need to weigh the benefits against the financial implications and potential impact on drug availability.
“It is essential to prioritise comprehensive health strategies that promote long-term well-being,” Brews says.
Also, affordability constraints will play a significant role in determining whether broader coverage for GLP-1 drugs is feasible. Brews highlights that high costs may limit access to these medications to members on premium plans, making it challenging to provide equitable access across all member tiers.
“It is important to explore cost-effective alternatives and ensure that all members have access to safe and effective weight management solutions that require medical intervention, as prescribed by a medical practitioner,” she says.
Nematswerani says Discovery Health has conducted extensive health economic and clinical analysis on GLP-1 drugs. She says although the GLP-1 medications offer some clinical benefits for managing diabetes and promoting weight loss, the current pricing of certain GLP-1 medications makes them neither cost-effective nor affordable from a health economics perspective.
“The high cost of GLP-1 medications for weight loss, in particular, are not yet offset by the long-term healthcare benefits at a population level. Consequently, medical scheme benefits will initially focus on higher-risk populations where there is better health economic benefit and across medical scheme plans with more comprehensive benefits,” says Nematswerani.
Viljoen highlights the potential ripple effect of including GLP-1 medications in medical scheme benefits for weight loss. He notes that the high cost of these treatments would inevitably influence premiums across all beneficiaries.
“If the utilisation of such treatment increases, it will definitely impact the benefit option’s overall performance, which will, in turn, affect all beneficiaries’ premiums,” he explains.
Long-term outlook
Segers said Aon will be closely monitoring the impact of GLP-1 medications in the coming years, given their significant effect on projected medical inflation. The hope is that, in the long term, these drugs may help reduce overall medical costs.
“If a significant group of people who are likely to be in ill health due to obesity are taking this medication to successfully lose weight, then we may expect that this can or will positively impact medical trends going forward, because we should be seeing a reduction in obesity-related conditions such as diabetes, cardiovascular hypertension, possibly even musculoskeletal conditions,” Segers said.
However, she noted, “we’re not there yet”.
Brews says studies have shown GLP-1 drugs can reduce long-term healthcare costs by improving outcomes for conditions such as diabetes and cardiovascular disease.
“These medications have been associated with significant reductions in HbA1c [a blood test that measures average blood sugar level], weight loss, and improved cardiovascular outcomes, which can lead to lower healthcare costs over time,” she says.
She further notes that there is evidence suggesting GLP-1 drugs can improve health outcomes, which may offset their high costs in the long run for those who medically require them.
“These benefits include better glycaemic control, weight loss, and reduced cardiovascular risks,” Brews adds.
However, she emphasises the importance of considering overall cost-effectiveness and ensuring that these medications are used appropriately to maximise their benefits.
Despite their potential, she points out that the high cost of these medications remains a barrier to their widespread use for weight management alone.
“It is also crucial to emphasise that the prescribing of GLP-1 medications needs to be done responsibly, with the necessary protocols in place to identify other underlying conditions that may be contributing to challenges in weight loss and maintaining a healthy weight.”
Brews says conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), and certain psychological factors can significantly impact a patient’s ability to lose weight.
“Proper diagnosis and management of these conditions are essential to ensure that patients receive the most appropriate and effective treatment.”
And it is early days yet.
Brews says there are still many unanswered questions surrounding the use and long-term effects of glucagon-like peptide 1 agonists in both diabetic and non-diabetic patients.
“Local health funders, like Momentum Health Solutions, are responding with tighter funding policies, therapeutic substitution, and reference pricing co-payments to manage costs, counter demand, and ensure that we only fund safe and effective treatments,” she says.
GLP-1 for weight loss: experts urge caution and holistic health approaches
Brews says the off-label use of GLP-1 medications for weight loss is concerning. She emphasises it is important for those considering the use of GLP-1 treatment for weight loss to understand and discuss the risks and side effects with their medical practitioners.
“We encourage our members to focus on long-term health strategies rather than relying solely on medications that are effective in the short term but have long-term side effects and implications”
She notes that when GLP-1 treatment is prescribed for weight management, it is crucial to investigate possible underlying causes, and to analyse lifestyle factors that can be changed in terms of exercise and nutrition.
“Focusing on comprehensive health and well-being should be first priority as it is possible to achieve sustainable weight management through balanced nutrition, regular physical activity, and lifestyle changes, rather than relying on GLP-1 medications that may have adverse effects and contribute to medication shortages,” she says.
Momentum Health Solutions advocates for a comprehensive and sustainable approach to health and wellness. This includes thorough medical evaluations to identify any underlying health issues that may affect weight management.
“By addressing these conditions, we can provide more targeted and effective interventions, reducing the reliance on medications alone. This approach not only benefits individual health but also contributes to the long-term sustainability of our healthcare system,” says Brews.
