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What plan sponsors need to know about new weight loss medications
February 23, 2023
For decades, researchers have tried to bring safe, effective weight loss drugs to market, but they’ve had little success. Now it seems they’ve done it, with glucagon-like peptide 1 agonists (GLP-1s) such as the repurposed diabetes drug semaglutide, marketed under the brand names Ozempic for the treatment of diabetes and Wegovy for weight loss.
GLP-1s produce significant weight loss and are well-tolerated in many people. These drugs and similar agents could be life-changing for plan members whose obesity is jeopardizing their health and quality of life. While GLP-1s come with a high price tag, used appropriately, they could potentially offset health care costs associated with obesity and weight-related comorbidities.
Semaglutide is now approved for use in patients as young as age 12. Both the American Gastroenterological Association and the American Academy of Pediatrics have issued updated guidance including pharmacotherapy as part of their treatment protocols for obesity.1,2
Demand for weight loss medications is growing rapidly. Analysts expect as many as 55 percent of patients who seek treatment for obesity will be prescribed weight-loss drugs.3 So it’s imperative for plan sponsors to be proactive about making coverage decisions, implementing utilization management strategies, and offering the right support for members who might benefit from these drugs.
Thinking around obesity is changing
Obesity has long been linked to conditions such as type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, osteoarthritis, various cancers, sleep apnea, depression, and anxiety, among others.4,5 Yet it wasn’t until 2013 that the American Medical Association officially identified obesity as a chronic condition in and of itself.6
associated with obesity10
excess annual medical costs per person with obesity11
|13 types of cancer have been linked to obesity12|
Traditional thinking that overweight and obesity are a matter of willpower has persisted. Meanwhile, obesity rates in the United States have surged – from 31 percent to 42 percent over the past 20 years7 – with staggering impacts on individuals, communities, and the health care system.
Traditional approaches to weight management have largely focused on lifestyle changes, with bariatric surgery as an option, though invasive, for those who meet certain criteria. Previous generations of weight-loss drugs were not particularly effective and had concerning side effects. GLP-1s broaden the array of effective approaches available for combating obesity, particularly for those for whom lifestyle changes don’t seem to be enough.
Crafting a comprehensive weight loss drug strategy
To get the most value out of these medications, it’s crucial for plan sponsors to have strategies in place to manage access, while supporting members and their prescribers. A comprehensive program might include the following components:
- Comprehensive coverage guidelines. GLP-1s aren’t for everyone. They are currently indicated for people who have a body mass index (BMI) of 27 or higher who also have weight-related conditions, or for those with a BMI of 30 or higher, regardless of comorbidities. Some patients don’t have success with these drugs, and many experience unpleasant side effects. GLP-1s may be contraindicated for some people, depending on health history, medications they may be taking, and other factors.
The choice to use weight-loss medication should be based on the clinical profile and needs of the individual, including, but not limited to, comorbidities, patient preferences, costs, and access to therapy.13
- Health care provider education. Providers historically have been reluctant to prescribe the previous generation of FDA-approved weight loss medications.14 Supporting them with guidance on when to prescribe GLP-1s and other agents, as well as information on what to do if intolerance develops or a patient chooses to discontinue medication, can help promote appropriate usage.
Appropriately discontinuing medication in patients who do not respond with weight loss of at least 5 percent after six months can reduce patients’ exposure to potential side effects and high costs of drug treatment when there is minimal long-term benefit.15
- Support for members. Members who are living with obesity may benefit from support to determine if pharmacotherapy is appropriate for them, or if there are other interventions that make sense to try first. Member education should include information on how these medications work, what to expect, and what signs or symptoms to report to their care providers.
If they begin pharmacotherapy, they also may benefit from programs to support lifestyle changes to complement drug therapy, and monitoring of effectiveness, side effects, and adherence. GLP-1s are significantly more effective when combined with lifestyle interventions and counseling, as well as adhering to recommended dosing.16 Medication nonadherence for patients with chronic diseases can reach as high as 40 to 50 percent.17
February 23, 2023
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.
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