GLP-1 Coverage Gaps and Real-World Evidence Shape Access Trends: Ben Urick, PharmD, PhD

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) utilization has grown rapidly in recent years and has contributed to increases in overall prescription drug spending. However, varied coverage remains a persistent barrier, and strategies to overcome such were highlighted during a pivotal conversation at the 2026 Academy of Managed Care Pharmacy annual meeting from April 13 to 16, 2026, in Nashville.

The education session titled “Unpacking the Data: The Application and Interpretation of Real-World Evidence in GLP-1 Obesity Treatment” featured an array of managed care specialists, one of whom was Ben Urick, PharmD, PhD, the senior director of health outcomes at Prime Therapeutics.

In an interview with The American Journal of Managed Care^®, Urick emphasized the role of Prime Therapeutics, a pharmacy benefit manager, as pivotal to providing timely consumer data and evidence to payers to influence updated coverage policies, thus expanding access for patients.

Urick noted that often when patients access therapies outside of the pharmacy benefit, they’re often miscategorized in studies as a control—those who were not exposed to the drug—when they actually did receive it.

“From a research perspective, we have to be very precise in how we create these matches and try to account for access and benefit design when designing a control group,” Urick said.

Yet, real-world evidence isn’t easy to produce. Variation in study designs and overlapping patient population demographics may complicate the task of drawing conclusions. Urick described the results of 10 different studies that assessed all the study populations for adherence to a high-potency product and reaching the maximum dose.

“You can see from that data that selecting for that population that has diabetes in addition to obesity and is most adherent to these treatments, you tend to see essentially flat medical spending with year 3 within that population,” he explained.

However, when looking only at patients with obesity, the data showed a $900 increase per patient, per year, which is essential from a benefits perspective, he said.