HIALEAH, Fla. — A growing number of patients are choosing to pay cash for GLP-1 medications even when their insurance covers a less expensive alternative, creating new challenges for pharmacies, health plans and pharmacy benefit managers (PBMs), according to a new survey from Buzz Health.
The survey of 256 U.S. pharmacists found that 54% have seen patients pay out of pocket for a GLP-1 prescription despite having access to a cheaper covered option through their insurance plan.
"Cash pay continues to be a routine part of GLP-1 access. Sixty-one percent of pharmacists see patients pay cash for a GLP-1 every week while continuing to use insurance for their other prescriptions. That creates a growing visibility challenge for health plans and PBMs, because important information about utilization, spending and adherence falls outside the traditional claims record," said Joseph Kleiman, president of Buzz Health.
The trend reflects the rapidly evolving GLP-1 marketplace, where patients have more avenues than ever to access medications used for weight management and diabetes treatment. With cash-pay options starting around $149 and programs such as Medicare's GLP-1 BRIDGE initiative offering copays as low as $50, consumers are increasingly evaluating factors beyond traditional insurance coverage when choosing how to obtain their prescriptions.
"GLP-1s are creating a parallel prescription pathway. More than half of pharmacists (54%) have seen patients pay cash even when a cheaper covered option was available, and 43% point to manufacturer direct-to-consumer programs and telehealth pricing as drivers. Those channels offer what insurance often doesn't: a known price, no prior authorization and a faster path to the medication," he said.
Pharmacists working across chain, independent, hospital outpatient, grocery and mail-order settings report seeing the shift firsthand.
According to the survey, 68% of pharmacists have observed an increase in cash-pay GLP-1 purchases over the past year. More than six in 10 respondents (61%) said they encounter patients who pay cash for GLP-1 medications on a weekly basis while continuing to use insurance for most of their other prescriptions.
Respondents pointed to several factors driving the trend. Forty-three percent cited direct-to-consumer offerings from manufacturers and telehealth-based pricing models as key influences on patient behavior. Meanwhile, 36% said the emergence of oral GLP-1 therapies is further accelerating movement toward cash-pay purchasing.
While the shift may offer patients additional flexibility and convenience, it also introduces potential blind spots for healthcare stakeholders. Every cash transaction represents a prescription fill that may not be fully captured within traditional insurance systems, limiting visibility into medication utilization and adherence patterns.
Those gaps could have broader implications for one of the fastest-growing drug categories in healthcare. Without complete data, pharmacies, PBMs and health plans may struggle to accurately measure patient outcomes, monitor adherence or assess the full impact of GLP-1 utilization trends.
Kleiman said the findings highlight a changing prescription landscape in which patients are increasingly making purchasing decisions outside of their standard pharmacy benefits. He noted that the trend raises important questions about why patients are opting for cash-pay alternatives, what stakeholders lose when those transactions go untracked and how initiatives such as Medicare's GLP-1 BRIDGE program may shape the future of prescription access.
"Medicare's GLP-1 BRIDGE program is a test case worth watching. Sixty-eight percent of pharmacists have seen cash-pay GLP-1 transactions increase over the past year, and BRIDGE will show whether a predictable $50 monthly copay can bring patients back to their coverage. If it does, that's a signal for commercial plans. If patients still go elsewhere, it tells us convenience and access matter as much as cost.”
As competition intensifies among manufacturers, telehealth providers and insurers, the survey suggests that cash-pay GLP-1 purchasing is becoming an increasingly significant part of the market, with implications that extend beyond patient costs to the broader healthcare data ecosystem.
