1. A Wake-Up Call at the HLTH Conference

After attending HLTH, Europe's largest healthtech event in Amsterdam, the author developed a deep interest in the ripple effects of GLP-1 weight-loss drugs on the insurance industry. While most attendees were focused on AI, the author noticed the confusion GLP-1 drugs were causing for insurers.

"Everyone in insurance was asking the same question: 'How do we even deal with this?'"

This question led the author to explore a new challenge for the insurance industry: the breakdown of life insurance risk prediction due to GLP-1 drugs.

2. The Insurer's Predictive Power and the Core of Underwriting

Life insurance companies can predict when a customer will die with 98% accuracy, based on decades of accumulated mortality data. This predictive power is the foundation of premium pricing and profitability.

• Insurers meticulously calculate the premiums they'll collect each year and the amounts they'll pay out in the future.
• Through a process called underwriting, they assess a customer's health status (primarily HbA1c, cholesterol, blood pressure, and BMI) to determine risk levels.

"Underwriters rely on a small number of key health markers to calculate the risk of early death. And those four markers are exactly what GLP-1 drugs improve."

3. The "Health Mirage" Created by GLP-1 Drugs

GLP-1 drugs rapidly improve key health markers: weight, blood pressure, blood sugar, and cholesterol. This can cause insurers to classify customers who appear healthier than they actually are as low-risk.

Example: The Case of a 42-Year-Old Applicant

1. Information submitted to the insurer

   • BMI 25 (normal)
   • No complications
   • No GLP-1 prescription history
   • Normal test results

2. Actual situation

   • BMI was 32 (obese) one year ago
   • Lost 14 kg after taking GLP-1 via direct-to-consumer purchase
   • Metabolic syndrome still present

In this way, insurers are deceived by a "health mirage" and sell long-term policies at low-risk rates.

4. The Risk of GLP-1 Discontinuation and "Mortality Slippage"

The problem is that 65% of GLP-1 users stop taking the drug within a year. Once they stop, most health markers revert to baseline within two years.

• An insurer may have sold a 30-year policy at low-risk rates, but in reality, the customer becomes high-risk again after 3 years.
• The insurance industry calls this phenomenon "mortality slippage."

"Mortality slippage is the mistake of classifying someone as lower risk than they actually are. A single such mistake can cost an insurer millions of dollars."

As the graph below shows, mortality slippage has nearly tripled since 2019, from 5.8% to 15.3%. In other words, 1 in 6 policies is being mispriced.

5. Insurer Response: Changing the Questions and Stopgap Measures

Insurers have started replacing vague questions (e.g., "How much has your weight changed in the past 12 months?") with more specific ones using behavioral science "anchoring" techniques.

"In the last 12 months, has your weight changed by more than 10 kg due to weight-loss medication?"

This approach increases the likelihood of accurate customer responses.

When customers answer honestly, insurers respond by:

1. Declining the application
2. Requiring proof of weight maintenance for 1+ year after GLP-1 use
3. Adding 2-3 points to BMI (risk adjustment)

However, these measures are only stopgap solutions, not fundamental fixes.

6. Retention Is the Key: A New Opportunity for Insurers and Pharma

Insurers view GLP-1 as merely a short-term weight-loss tool, but data already exists showing that long-term use significantly reduces obesity, cardiovascular disease, and mortality.

• Long-term users become much cheaper customers for insurers.
• If insurers, pharmaceutical companies, and healthcare firms form partnerships to improve retention rates, a new market serving hundreds of thousands of customers could open up.

"The company that actually keeps people on the drug will be solving the problem insurers are desperate to throw money at."

7. The Limits of "Wraparound Care" and Practical Solutions

At the conference, insurers claimed that "wraparound care" (comprehensive management) was the solution, but none could offer concrete data or practical plans.

"When I asked for specific data or evidence that anything actually worked, not a single person had a convincing answer."

The author draws a parallel with the statin (cholesterol medication) example, arguing that simple convenience improvements can be more effective than complex strategies.

Lessons from the Statin Example

• Switching from 30-day to 90-day prescriptions immediately increased medication adherence
• This is applicable to GLP-1 as well

Practical Solutions Proposed

• 3-month bundled prescriptions
• Simplified restart procedures after discontinuation
• Text reminders and other behavioral nudges

These simple changes alone could deliver significant benefits for both patients and insurers.

8. Conclusion: The Window of Change and the Importance of First-Mover Advantage

Insurers are currently being deceived by the "health mirage," but they will soon respond with more sophisticated questions and systems. This is a prime opportunity for companies that improve retention rates first to capture the market.

"The statin playbook worked 20 years ago. It'll work today. But only for those who execute first."

Key Concepts Summary

• GLP-1 drugs
• Life insurance underwriting
• Mortality slippage
• Behavioral science questions (anchoring)
• Retention rate
• Wraparound care
• Statin example
• First-mover advantage

Summary in one line: The spread of GLP-1 drugs is causing confusion in insurer health predictions. Rather than short-term stopgaps, practical strategies to encourage long-term adherence will benefit both insurers and patients, and the companies that seize this opportunity first will lead the market.