How Ozempic Is Disrupting a $1.4 Trillion Industry

GLP-1 weight-loss drugs like Ozempic and Wegovy are revolutionizing obesity treatment—and quietly wreaking havoc on the U.S. life insurance industry, which wrote roughly $1.4 trillion in premiums last year. So what’s the problem? It isn’t that the drugs don’t work. In fact, it’s that most people quit taking them.

When patients stop these drugs, key health markers like blood pressure and weight often shoot back up within months. But unwittingly, life insurance underwriters—working off outdated forms—still rate these applicants as low-risk. That gap between perceived and actual risk is called “mortality slippage,” and it’s more than doubled since 2019. It now affects about one in six policies.

Mortality slippage refers to insurers mistakenly assigning someone a lower-risk insurance profile than is appropriate, and it can be costly due to subsequent unexpected payouts.

“It’s a complicated problem,” says Dr. Ashwin Sharma, a researcher who’s studied the phenomenon. In essence, your markers of cardiovascular health seem fine on paper, but the underwriting risk is much higher than insurers expect. That’s because they might not know you’ve been using GLP-1s, and many patients end up quitting the medication. Meanwhile, finding a solution to mortality slippage is proving to be complicated, too.

How a Weight-Loss Shot Threatens Life Insurance Companies’ Bottom Line

Underwriting hinges on accurately estimating an applicant’s mortality risk. But as Sharma explains, very few underwriting forms include any questions about GLP-1 use. That means someone on these drugs might show dramatically improved labs—lower blood sugar, better blood pressure—without needing to disclose the medication behind them.

If they quit, which recent data suggests more than half of patients do within a year, those improvements can reverse quickly. The insurer, however, has already locked in a low premium based on an artificially healthy profile—potentially for decades. “It just takes a couple thousand policies, and then you realize you may have a huge collapse,” Sharma cautions.

Quitting GLP-1s Is the Problem

Why They Quit

A key reason people stop GLP-1s is their cost, researchers have noted. In the United States, patients can pay roughly $700 to $800 each month for the shots, which very quickly adds up. Plus, Sharma notes that most patients pay out of pocket because employers either don’t cover them or require a long prior-authorization process.

The second big driver: “side effects,” Sharma says, noting that nausea and vomiting can become more common as doses increase. In fact, up to 50% of patients experience nausea as a side effect, with vomiting, constipation, and abdominal pain also being relatively common (affecting up to 10% of patients).

What Happens When They Quit

Both factors feed into a dangerous cycle for insurers. When patients quit, the long-term health gains that the underwriting assumed disappear, and insurers then face higher-than-expected payouts.

The Industry’s Search for Solutions and What This Means for Your Policy

Some insurers have started adding GLP-1 questions or requiring proof of a year’s continuous use before approving coverage, Sharma notes, though he adds that it’s still not a widespread practice.

As for a longer-term fix, the bigger play is maintenance. According to Sharma, while insurers look to adjust underwriting, they’ll also be throwing money at solutions that can help ensure patients actually stick to GLP-1s. Ideas include longer prescription intervals and proactive side-effect medications. However, it could take years before any solution gets traction.

For policyholders, the implications are mixed. Sharma predicts more denials as GLP-1 penetration rates increase, at least until underwriting catches up. Meanwhile, premiums could rise for high-BMI or diabetic applicants, even if they’re not on a GLP-1, as insurers hedge against undisclosed use.

The Bottom Line

GLP-1 drugs may be a medical breakthrough, but they’re also forcing life insurers into uncharted territory. Until underwriting adapts, expect stricter applications, more denials, and potentially higher premiums in high-risk categories.

If you’re on a GLP-1, Sharma shares his advice: “These are lifelong medications. We need to start treating them and viewing them as such.”