Weight Loss Drug Demand Must Be Addressed With New Solutions & Strategies

Ozempic, Wegovy, and other medications part of a class of drugs known as glucagon-like peptide-1 (GLP-1) agonists have garnered a lot of attention in recent years thanks in large part to social media influencers and celebrities like Elon Musk,¹ Chelsea Handler², and Amy Schumer.³

These medications were originally approved to treat diabetes, however, some of them, such as Wegovy, have now been approved by the FDA for weight management⁴ due to their remarkable ability to induce weight loss, which in some individuals can result in a 15% reduction in body weight.⁵

Although these drugs aren’t all that new—they date back to 2005 when the FDA approved Exenatide⁶—they are very expensive. With this recent soaring demand has also come a debate about how and when to prescribe these drugs and how health plans and employers can take steps to curb the high costs. 

As obesity sits at the center of so much metabolic morbidity, there’s no doubt that GLP-1 agonists have the potential to improve outcomes and overall health. Studies have demonstrated their ability to reduce the risk of type-2 diabetes, cardiovascular risks and outcomes, and hypertension to name a few—all leading healthcare cost drivers.⁷ But striking a balance between clinical appropriateness and financial responsibility will prove critical this year and beyond. 

GLP-1 Medications: Gaps and Barriers

Over the last decade, obesity rates in the U.S. have steadily increased⁸, and the trend shows no sign of slowing down.
Recent estimates find that 41.9% of U.S. adults have obesity.⁹ And by 2030, experts predict that number will rise to 1 in 2 adults, with nearly 1 in 4 who will have severe obesity. ¹⁰

Obesity is increasingly being recognized as a chronic disease, not a lifestyle, although there are certainly psychosocial and other factors. 

Further, obesity typically leads to a host of other chronic conditions such as type-2 diabetes, hypertension, high cholesterol, and stroke. Obesity is also among the top 10 most expensive chronic diseases for payers,¹¹ costing the healthcare system nearly $173 billion a year.¹² And for 25% of employers, obesity is the number one driver of overall healthcare costs.¹³
Leading healthcare organizations including the American Heart Association,¹⁴ American Diabetes Association,¹⁵ and American Gastroenterology Association¹⁶ have set forth clinical guidelines for the use of GLP-1 medications. Yet experts think these recommendations are overly permissive and recommend they are better used in patients with a higher BMI and/or metabolic disease load.

While GLP-1s have opened up more options for patients, they have also created a slew of challenges. 
For starters, like any test or treatment, providers lack transparency into individual health plan coverage so they can’t possibly know what’s covered, what’s not, and how much a patient will have to pay out of pocket. As a result, these prescriptions are driving a lot of prior authorization requests, with only 25% that are being approved. 

Also, considering the average doctor’s visit is only 18 minutes,¹⁷ providers don’t have the capacity to provide coaching around diet, behavior, and lifestyle. Not only are patients on their own to manage side effects, but they lack the support that’s necessary for lasting weight loss. Coaching is also important for the long haul since research shows¹⁸ most people who stop taking GLP-1s gain the weight back.

The cost of GLP-1s is also nothing to sneeze at—running as high as $20,000 a year.¹⁹ And for a typical employer, estimates show drug spending could increase by more than 50% if half of its employees who were eligible for Wegovy took it. ²⁰

Up to two-thirds of companies have been covering weight loss drugs for at least three years,²¹ but the high costs are leading health plans to rethink their strategies. 

In fact, many payers are allowing only select patients to access the weight loss drugs, and many more are requiring members to complete coaching and behavior change programming, or demonstrate that a trial of lower-cost drugs is ineffective before agreeing to pay for Wegovy, according to an analysis in Modern Healthcare. ²²‍

The Move Toward GLP-1s

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How to Manage The High Costs of GLP-1 Medications

As the demand for GLP-1 medications continues to soar, health plans and employers must develop a weight management strategy that balances the clinical indications with the financial implications.

For a member who is overweight and has pre-diabetes, for example, coaching and support for behavior and lifestyle modifications can be an effective way to improve outcomes and reduce spend. 

For at-risk members who are obese and have other comorbidities, they are likely good candidates for medication evaluation, but medication on its own isn’t enough. In fact, weight loss medication combined with intensive behavioral therapy (IBT) significantly increases initial weight loss compared to IBT alone, a 2019 study in the journal Obesity (Silver Spring) found. 

When evaluating a weight management solution, health plans and employers should consider these strategies:

Prioritize risk stratification: responsible partners are those that can identify members who are at high risk for poor outcomes, need a medical evaluation, and may be appropriate for GLP-1 evaluation. Patients who have less risk and disease burden can then be offered personalized health coaching. 

Innovation on medication adherence: patients prescribed a GLP-1 medication by a known provider rarely get the coaching and side effect management needed to be successful. These medications must be managed carefully in order to minimize gastrointestinal side effects. 

Offer personalized virtual care: solutions should focus on behavior and lifestyle interventions through remote patient monitoring and connected devices, nutrition counseling, and personalized coaching for weight loss, medication adherence, side effects, and eventual titration off medications depending on the member’s needs.

Demonstrate proven outcomes: a potential partner should provide data insights and show proven results. 

Want to learn more about how Lark Health partners with health plans and employers to develop a weight management strategy that balances clinical outcomes and cost-effectiveness? Learn more. 

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Sources:

1. Musk, E. [@elonmusk] (2022, October 1) And Wegovy. [Tweet] Twitter.com. 
https://tinyurl.com/5y3bjneh.
2. Cardoza, R. (2023, January 25). Chelsea Handler ‘didn’t know’ she was on Ozempic: My doctor ‘hands it out.’ Page Six. https://pagesix.com/2023/01/25/chelsea-handler-i-didnt-know-i-was-on-ozempic/
3. Etienne, V. (2023, June 9). Amy Schumer Says She Tried Ozempic, Tells Others 'Lying' About It to Be 'Be Real' About Their Weight Loss. People. https://people.com/amy-schumer-tried-ozempic-tells-others-to-be-real-about-their-weight-loss-7510462.
4. U.S. Food and Drug Administration. (2021, June 4). FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014 [Press release]. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
5. Wilding, J. P. H., et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine. 384:989-1002

DOI: 10.1056/NEJMoa2032183
6. Latif, W., Lambrinos, K.J., Rodriguez, R. (2023). Compare And Contrast the Glucagon-like Peptide-1 Receptor Agonists (GLP1RAs). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK572151/
7. Business Group on Health. (2022, August 23). 2023 Large Employers’ Health Care Strategy and Plan Design Survey. https://tinyurl.com/4fe5ym8v
8. Advisory Board. (2023, March 20). Obesity in America, in 4 charts. https://www.advisory.com/daily-briefing/2020/12/17/obesity
9. CDC. (2022, May 17). Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html
10. Ward, Z.J., et al. (2019). Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. The New England Journal of Medicine. 381:2440-2450. DOI: 10.1056/NEJMsa1909301.
11. Schmidt, Hayden. (2022, February 22). Top 10 Most Expensive Chronic Diseases for Healthcare Payers. https://healthpayerintelligence.com/news/top-10-most-expensive-chronic-diseases-for-healthcare-payers
12. Ward, Z. J., Bleich, S. N., Long, M. W., & Gortmaker, S. L. (2021). Association of body mass index with health care expenditures in the United States by age and sex. PLOS ONE, 16(3), e0247307. https://doi.org/10.1371/journal.pone.0247307
13. International Foundation of Employee Benefit Plans. (n.d.). 22% of U.S. Employers Cover Prescription Drugs for Weight Loss. https://tinyurl.com/yc4ra6ja
14. Marx, N. et al. (2022). GLP-1 Receptor Agonists for the Reduction of Atherosclerotic Cardiovascular Risk in Patients With Type 2 Diabetes. Circulation. 146:1882–1894. https://doi.org/10.1161/CIRCULATIONAHA.122.059595 
15. Anderson, J., et al. (2022). Optimizing the Use of Glucagon-Like Peptide 1 Receptor Agonists in Type 2 Diabetes. Clinical Diabetes. 40(3):265–269. https://doi.org/10.2337/cd22-0020
16. Grunvald, E. et al. (2022). AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. Volume 163, Issue 5, P1198-1225.https://doi.org/10.1053/j.gastro.2022.08.045 
17. Neprash, H. T., et al. (2021). Measuring Primary Care Exam Length Using Electronic Health Record Data. Medical Care DOI: 10.1097/MLR.0000000000001450
18. Wilding, JPH, et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. doi:10.1111/dom.14725.
19. Brett, A.S. (2021, December 27). Another GLP-1 Receptor Agonist for Weight Management. NEJM Journal Watch. https://www.jwatch.org/na54359/2021/12/27/another-glp-1-receptor-agonist-weight-management
20. Iskowitz, M. (2023, June 19). More payers could stanch off-label use of Ozempic. Medical Marketing and Media. https://www.mmm-online.com/home/channel/7-day-supply/more-payers-could-stanch-off-label-use-of-ozempic/
21. Wingrove, P. (2023, June 27). Focus: Obesity drug Wegovy's popularity has US employers rethinking insurance coverage. https://www.reuters.com/business/healthcare-pharmaceuticals/obesity-drug-wegovys-popularity-has-us-employers-rethinking-insurance-coverage-2023-06-27/
22. Pepper, N. (2023, March 16) Insurers, PBMs restrict access to weight loss drugs as demand soars. Modern Healthcare. https://tinyurl.com/2s6wbuzz