GLP-1 medications are FDA-approved specifically for weight loss for more than half the adult population in the United States. Plan sponsors can take action to manage weight and other cardiodiabesity-related health challenges within their member population.
GLP-1 medication research for weight management
GLP-1s are a category of medications that have been used to treat diabetes since 2005. In 2014, the FDA approved the first GLP-1 specifically for weight loss for people with a BMI of 30 and above or a BMI of at least 27 with one weight-related comorbid disease, which affects more than half the U.S. adult population.
Related: Fighting the obesity epidemic calls for a multifaceted approach
Recently, we commissioned a third-party research initiative to understand the patient journeys of those seeking weight management therapy with GLP-1 medications. We discovered three common pathways that lead people to this point.
- Some experience rapid weight gain after a life event, such as a medical emergency, a physical injury or accident, or an emotional family situation that becomes a barrier to maintaining a healthy weight.
- Others experience slow onset. They may have been able to maintain a healthy weight as a teen or young adult. But as life gets busier, they age, their metabolism slows, their weight becomes harder to control. They may end up with prediabetes and resolve to make lifestyle changes. But then a few years down the road, they find they’re unable to return to a healthy weight.
- Some struggle with weight their entire life going back to childhood or even birth. They may have tried every diet and treatment under the sun with no success. Now, they are turning to what some suggest is a miracle drug, especially in social media and online.
The research also focused on the medication experience. Are patients taking the medication only as a one-time reset? Or are they trying to change their lifestyle? And what type of support do the patients have? Is it minimal, moderate or significant intervention?
GLP-1 medication challenges
A revealing insight from the study is that participants were hyper-focused on weight loss as the ultimate measure of success. They had diabetes, hypertension and/or heart disease. But they were not necessarily focused on controlling blood glucose, blood pressure, or cholesterol even though that could give them the greatest chance of preventing limb loss or heart attack and extending their life.
Rather than looking solely at weight loss, plans must define the values and outcomes that they’re seeking for the populations they manage and then help patients achieve them. That requires navigating around three distinct decision points.
Taking action on GLP-1 for weight loss
The first action plan sponsors can take is benefit design. Based on the outcomes they’re looking to achieve, does it make sense for their plan to include coverage for GLP-1 weight loss medications in a member’s benefit?
The second is utilization management. Making sure that those individuals who will benefit from these drugs —such as people with obesity and diabetes, but well-controlled blood pressure — can access them without cost-share being a barrier. At the same time, for those individuals with a BMI of 27 who do not have diabetes or cardiovascular disease, driving to alternate treatments may be preferred.
The third action is patient support. Ten years ago, individuals undergoing bariatric surgery needed coaching, social support and behavioral health management. They needed to get their other conditions under control. Without that, about 20% gained the weight back. In our early data, we're seeing similar patterns with using GLP-1 medications specifically and only for weight loss.
Consider that about one in four people don't lose weight yet continue to take the drug. Also, in people who do lose weight, the loss can be precipitous. People lose not just fat, but also muscle mass, which can negatively impact physical activity. That means when a person stops taking the medication, the weight comes back on and can even exceed their original weight, especially if they haven't made other lifestyle changes.
In 2022, we saw more than 30% of people discontinue these medications early due to side effects, costs, or lack of a response to therapy. How do plans identify adherence issues and make sure that they're reaching out to engage and connect patients with the appropriate level of service?
Related: Three of the biggest drivers of health care costs
There's no one-size-fits-all strategy. Plans must consider upstream access, which involves benefit design and utilization management. However, access is just a starting point. They also need to look at downstream support, such as making clinical tools and resources available to patients to help them achieve their desired outcomes beyond weight loss alone. That’s critical for helping patients to manage their diabetes, blood pressure and/or cholesterol and ultimately to improve their overall health.
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EncircleRxSM: Cardiodiabesity
Evernorth’s EncircleRx is a data-driven solution portfolio that helps plan sponsors reduce costs and enhance outcomes. The EncircleRx: Cardiodiabesity solution gives clients optionality and predictability in managing cardiodiabesity – obesity, diabetes and cardiovascular disease with the first-ever GLP-1 financial guarantee from a PBM.