GLP-1s are breaking life insurance

Incentives & Insurance Economics

• Thread distinguishes sharply between health and life insurance: health insurers may see near‑term savings from fewer hospitalizations, but US employer‑tied coverage and short member tenure limit incentives for long‑horizon prevention.
• The ACA’s medical loss ratio (80/20 rule) and prevalence of self‑insured employers complicate intuition about insurer profits; some argue insurers actually prefer higher overall spending.
• Life insurers rely on cohort mortality tables, not “98% accurate” individual predictions; commenters say that claim misreads an actuarial report (likely a ChatGPT artifact).
• Several argue GLP‑1‑driven mortality changes are just another actuarial shock (like COVID or accelerated underwriting) that can be repriced away, not an existential threat.

GLP‑1 Costs, Access, and Generics

• US list prices ~$1,000/month are seen as the key barrier; actual out‑of‑pocket costs vary widely by insurance, coupons, compounding pharmacies, and gray‑market imports.
• Outside the US, prices are often a fraction of that; some countries’ public systems are only beginning to cover GLP‑1s, often limited to diabetes or severe obesity.
• Patents on semaglutide and others will expire over the next decade; a Canadian patent lapse and existing generic liraglutide are cited as harbingers of big price drops.
• Debate over whether governments should use tools like compulsory licensing or subsidies, versus preserving strong patent incentives for R&D.

Adherence, Regain, and Long‑Term Safety

• Many users discontinue within 1–2 years, mainly due to cost, GI side effects, or missing the pleasure of eating; refill frequency and pharmacy friction also matter.
• Studies and anecdotes suggest substantial weight regain after stopping, though not always back to baseline; some manage to maintain loss via lifestyle change, many do not.
• Long‑term (>20‑year) safety is unknown, but ~20 years of diabetes data show mostly favorable profiles with limited signals (e.g. possible small thyroid‑cancer risk).

Effects Beyond Weight & Side‑Effect Profile

• Many report dramatic appetite reduction and “food noise” relief; some also see decreases in alcohol, nicotine, and gambling behavior, improved IBS, or better financial habits.
• Others experience severe nausea, diarrhea, sulfur burps, or suspected gastroparesis; experiences range from “barely notice it” to “unlivable side effects.”
• Ongoing concern about muscle loss and “Ozempic face”; several emphasize protein intake, resistance training, and lower maintenance doses.

Moral Framing, Environment, and Life Insurance Impact

• Strong disagreement over whether post‑GLP‑1 regain is mainly “lack of discipline” versus biology and environment (ultra‑processed food, stress, ADHD, emotional eating).
• Some favor making GLP‑1s cheap and ubiquitous; others argue for tackling food systems, education, and soda/“junk food” policy first.
• For life insurers, GLP‑1s create both “mortality slippage” (temporary weight loss at underwriting) and potential long‑term mortality improvement; commenters expect models, underwriting questions (e.g. past max weight), and premium structures to adjust over time.