From hype to evidence: What real-world GLP-1 data means for insurers

Swiss Re's analysis of Milliman IntelliScript's Irix® data examines real-world GLP-1 drug usage patterns, using prescription and medical claims records across the US insurance applicant population between 2020-2025. GLP-1 drug uptake is accelerating, with a growing share of non-diabetic users increasing year-on-year. High adherence is associated with a lower modeled mortality Risk Score, while treatment duration alone does not yet show an independent mortality risk reduction. This suggests that adherence, underlying disease burden and behavioral engagement are more important than exposure alone. Long-term health outcomes, and any corresponding insurance impacts, will also depend on sustained, successful lifestyle change.

Key messages:

• Since 2020, Milliman's data shows that GLP-1 drug use and prescriptions have increased fivefold across adult age groups and both sexes, with the highest uptake among those aged 50–69.
• While diabetes use remains predominant, in 2025, nearly one third of users in the Milliman IntelliScript's Irix® cohort did not have a prescription code for diabetes.
• In their cohort, nearly half of applicants with a GLP-1 drug use history, were active users at the time of application.
• Patients being prescribed GLP-1 drugs commonly present with cardiometabolic comorbidities indicative of metabolic ill-health, including cardiovascular disease, high blood pressure and high total cholesterol.
• Milliman IntelliScript's Irix® Risk Score combines prescription histories and medical claims data to indicate mortality risk.
• The average Risk Score among GLP-1 users is 1.48 (vs 1.0 for 'average' health risk) indicating an elevated baseline mortality risk; users who have signals of weight loss treatment show a lower mortality risk than those who have diabetes.
• Medication Possession Ratio (MPR), a proxy for adherence, shows a clear relationship with the modeled mortality Risk Score; better adherence is associated with lower predicted risk.
• Our analysis suggests that treatment duration alone does not independently reduce modeled risk. Medication adherence, underlying disease burden and lifestyle engagement may be more influential than exposure alone.
• Swiss Re continues to monitor emerging drug compliance trends, including potential shifts in uptake and duration associated with newly approved drugs or formulations such as tablets.
• These developments may potentially influence long-term morbidity, mortality and insurance risk dynamics, although outcomes remain subject to significant uncertainty and evolving evidence.