Insurance Curator ZURICH — The global life insurance industry is beginning to recalibrate long-term mortality models and premium structures in response to a surge in metabolic therapies, as new data suggests GLP-1 medications could reduce U.S. all-cause mortality by as much as 6.4% over the next two decades.
Reinsurance giants Swiss Re and Munich Re released landmark studies in late 2025 and early 2026, signaling a fundamental shift in how underwriters assess metabolic risk. The reports indicate that drugs such as semaglutide (Wegovy) and tirzepatide (Zepbound) are no longer viewed merely as lifestyle treatments but as critical tools for cardiovascular risk reduction that could mirror the impact statins had on longevity in the 1990s.
"GLP-1 drugs hold significant promise to help us beat the obesity epidemic," said Paul Murray, CEO of Life & Health Reinsurance at Swiss Re, in a statement accompanying the firm’s September 2025 analysis. "As insurers, we are in a position to build partnerships, support policy, and encourage people to make meaningful lifestyle changes. If we get this right, we can strengthen the insurance safety net and contribute to people living longer, healthier lives."
Redefining Mortality Projections
The shift in the insurance sector follows robust clinical evidence from the SELECT trial, which demonstrated that semaglutide reduced major adverse cardiovascular events (MACE)—including heart attack and stroke—by 20% in non-diabetic patients with overweight or obesity.
According to a February 2026 report from Munich Re, which analyzed 41 million insured lives in the United States, users of GLP-1 agonist drugs showed lower all-cause mortality compared to non-users across both diabetic and non-diabetic populations. The reinsurance firm forecasted that these therapies could drive an annual mortality improvement of 0.2% to 0.5% through 2045.
Swiss Re’s modeling presented even more aggressive figures. In an "optimistic scenario" where drug adoption is high and supported by lifestyle changes, the firm projects a 6.4% cumulative reduction in U.S. mortality by 2045. For the United Kingdom, the projected reduction stands at 5.1%.
"GLP-1 drugs could be the medical innovation we’ve been waiting for to reshape mortality trends," said Natalie Kelly, Head of Global Underwriting, Claims and R&D at Swiss Re. "The flow-on effect for underwriting assumptions and claims patterns could therefore be significant."
The Underwriting "Add-Back" Rule
Despite the promising data, current life insurance applicants may not see immediate premium discounts. Historically, rapid weight loss has been viewed by underwriters as a "red flag" for underlying illnesses like cancer or depression.
Industry data shows that many carriers currently employ a "50% add-back" rule. If an applicant has lost 50 pounds on a GLP-1 medication within the last 12 months, underwriters typically credit them for only 25 pounds of that loss when calculating their Body Mass Index (BMI) for premium pricing.
The hesitation stems from what actuaries call "mortality slippage"—the risk of misclassifying a high-risk individual as low-risk. Industry research indicates that mortality slippage has nearly tripled since 2019, rising from 5.8% to 15.3%, meaning roughly one in six life insurance policies is currently mispriced.
"Insurers see GLP-1s as short-term tools because that’s exactly how many patients treat them," noted Dr. Ashwin Sharma, a medical analyst focusing on metabolic trends. "When someone stops the medication, most health markers—BMI, blood pressure, and cholesterol—bounce back to their starting point within two years. If an insurer locks in a 30-year policy at a preferred rate based on a temporary weight drop, they face a massive financial liability."
The Adherence Crisis
The primary obstacle to permanent premium adjustments remains the high rate of discontinuation. Real-world data shows that roughly two-thirds of patients stop taking GLP-1 therapies within the first year.
According to Munich Re’s February 2026 data, the discontinuation rates are even more pronounced in younger demographics. Among non-diabetic individuals aged 30 to 40, fewer than 30% continued medication use beyond one year. Overall adherence dropped to 47.7% at 12 months and plummeted to 70.1% after 24 months.
Reasons for discontinuation include gastrointestinal side effects—with 64.4% of patients reporting nausea—and the high out-of-pocket cost of the drugs, which often ranges from $500 to $1,000 per month in the U.S. as insurance coverage for weight-loss indications fluctuated throughout 2025.
"Achieving the full potential of GLP-1 drugs is strongly dependent on availability, adoption rates, and lifestyle changes," Murray said. Without these factors, Swiss Re’s "pessimistic" model suggests mortality gains could shrink to just 2.3% by 2045.
Beyond Weight Loss: Direct Cardiovascular Benefits
Newer analyses of the SELECT trial published in late 2025 suggest that the cardiovascular benefits of GLP-1s may be independent of weight loss. Researchers found that heart health markers began to improve as early as three weeks after the first dose, well before significant pounds were shed.
Mediation analyses indicated that only about 33% of the drug's cardioprotective benefit was explained by a reduction in waist circumference. This suggests that the medications may have direct anti-inflammatory or metabolic effects on the heart and blood vessels.
For insurers, this "disease modification" is the key to moving beyond BMI-based underwriting. As more carriers gain access to Electronic Health Records (EHRs), they are beginning to look at sustained metabolic health rather than just the number on a scale.
The Statin Precedent
Industry experts compare the current moment to the introduction of statins in the 1980s and 90s. Initially, insurers were skeptical of the long-term impact of cholesterol-lowering medication. Today, underwriters view statin use as a sign of "proactive health management," often offering better rates to individuals who use the medication to keep their cholesterol in check.
"It is essential that insurers keep ahead of the GLP-1 evolution and maintain a robust, evidence-based approach to assessing the risks," Kelly said.
As metabolic therapies continue to evolve—including the recent approval of tirzepatide for obstructive sleep apnea and ongoing trials for Alzheimer's and Parkinson's disease—the life insurance industry is moving toward a more dynamic pricing model.
For now, the message to policyholders is one of "wait and see." While the long-term potential for lower premiums is clear, insurers say they will require evidence of long-term adherence—typically two years of stable weight and metabolic markers—before the "GLP-1 discount" becomes a standard feature of life insurance underwriting.