It’s no surprise that demand for weight loss solutions has surged.
Americans are struggling with their health. Six in 10 have at least one chronic condition. A growing number suffer from multiple chronic – or “polychronic” – conditions. Prominent among them is “cardiodiabesity,” the triple diagnosis of obesity, type 2 diabetes and cardiovascular disease.
Amid this public health crisis, Ozempic has become a household name. It’s part of a group of medications called glucagon-like peptide 1 (GLP-1) agonists. GLP-1s have become a popular weight loss solution. But widespread misuse has left plan sponsors struggling to maintain their bottom line.
Related: GLP-1s Medications 101
Doctors have used GLP-1s to treat type 2 diabetes for nearly 20 years.
In 2017, the Food and Drug Administration (FDA) approved Ozempic for diabetes treatment. In 2021, the FDA approved the GLP-1 Wegovy for weight management. and more recently, the FDA approved Zepbound for weight management. These treatments are intended to treat people with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher and at least one co-morbid condition.
But people have been seeking GLP-1s for uses not approved by the FDA. Social media and celebrity backings have fueled off-label prescriptions for weight loss.
Between early 2020 and the end of 2022, GLP-1 prescriptions increased 300%, a study by data analytics company Trillian Health found. Ozempic accounted for two-thirds of GLP-1 prescriptions.
In 2023, the GLP-1 trend showed no sign of slowing. In September, JPMorgan estimated GLP-1 annual sales will surpass $100 billion over time. Use of GLP-1s for diabetes and obesity will drive sales “fairly equally,” JPMorgan said in a research report.
The GLP-1 trend has strained supply. Both Ozempic and Wegovy have appeared in the FDA Drug Shortages database.
The cost of the medications creates additional tension. Consider the expense of a one month-supply of Ozempic. A box can run nearly $1,200 without insurance, a Houston pharmacist told WebMD. The newly approved Zepbound will be priced at around $1,060 per month without insurance. These price tags make clear the need for more cost-effective options.
With costs high and supply worn thin, plan sponsors have seen their business plans unravel. They need to gain control over their plans. Managing the medications is a necessary place to start.
To navigate GLP-1 challenges, plan sponsors should build upon existing strategies. Here are key steps they can take:
- Implementing a cost cap or savings guarantee: Offering financial guarantees can make expenses more predictable and make sudden cost burdens less likely.
- Engaging the right patient population: Validating patients with a higher BMI and a requirement for ongoing engagement and enrollment in a lifestyle modification program. .
- Ensuring fraud, waste, and abuse (FWA) support: Aligning prescriber/pharmacy with patient outcomes to ensure appropriate prescribing, filling and adherence.
The question remains: How will plan sponsors adjust to the GLP-1 trend? The way they respond will likely affect how individuals use GLP-1s.
Plan sponsors could, for example, tighten access to GLP-1s for immediate cost control. Or they could loosen restrictions for certain patients, such as those with medically documented obesity struggles.
The potential for health cost savings associated with weight loss, especially for members with diabetes, is undeniable. But plan sponsors must protect their bottom line.
Having a deliberate pharmacy benefit strategy and getting the tools needed to better control growth and expand access is necessary for this effort. By staying informed and adaptable, plan sponsors can navigate the current challenges but also prepare for a more predictable future.