Obesity remains a common, serious and costly disease in the United States. According to the Centers for Disease Control and Prevention (CDC), approximately 42.5% of U.S. adults aged 20 years and over were obese in 2018 - a significant increase from the 26.0% obesity rate reported in 2008. By 2030, it’s estimated that half of the U.S. population will be considered obese. However, the way we approach weight management may soon evolve with the FDA approval of semaglutide, a new therapy for weight loss, on June 4.
Semaglutide will require thoughtful strategies to ensure patients experience successful treatment and payers can offer affordable access.
1. What is semaglutide?
Semaglutide is a medication that increases insulin secretion and is currently used as a once-weekly injectable treatment for Type 2 diabetes. Now, researchers are testing it at much higher doses, where it appears to act on centers in the brain to suppress appetite.
Initial clinical trial findings have demonstrated meaningful patient weight loss and suggest that the drug could be an effective treatment for patients struggling with obesity.
2. Why is this approval significant?
The results from semaglutide’s clinical trials show it is more effective than currently available weight loss therapies. These results also confirm an emerging belief among many experts that willpower may not be enough to achieve successful weight loss. Trial participants who received the placebo were unable to see a significant difference in their weight – despite receiving ongoing diet and exercise counseling as part of the study.
An effective treatment for obesity is desperately needed to help lift its immense burden on U.S. health care spending. Estimated annual costs for obesity-related illnesses are $190 billion, or more than 20% of total U.S. medical spend. Obesity is associated with increases in annual medication costs of 77% compared with being of average weight. Patients with common comorbidities, including diabetes (type 2), chronic back pain, and coronary heart disease, account for $45,514 in direct and indirect cost per patient annually.
Obesity’s systemic impact is vast, but it can be mitigated. Researchers project that health improvements and cost reductions are recognized after a 5% reduction in body weight – further putting semaglutide’s potential into context.
3. What challenges are expected once it’s available?
Semaglutide is a significant pharmacological intervention. However, like many new therapies, payers need to prepare for related challenges:
- Affordability: Based on the price of similar therapies that are currently available, and the number of Americans with obesity, the therapy has the potential to become financially burdensome for payers and health plans.
- Adherence: Adherence to therapy is critical for patients to achieve the potential benefits of the medication. Historically, nearly one-third of patients who start out on weight loss medications discontinue use after the first or second fill, meaning payers spend thousands of dollars on initial therapy without seeing any clinical improvements in patient health.
- Access: Obesity is prevalent in the U.S., and many Americans may benefit from semaglutide. However, not all patients will qualify for semaglutide treatment based on its approved indication, and not all patients will have the right support system in place to ensure success with the therapy.
4. How can employers and health plans manage these challenges?
Employers and health plans will require an effective, forward-thinking care management strategy to successfully realize the benefits of semaglutide, including:
- Supply chain innovation that achieves lowest net cost for therapy while creating accountability for outcomes, given the significant investment payers will make in this therapy.
- Access management to ensure only the right patients, who have the right care support and resources, are using this therapy.
- Successful and sustainable weight management with support that combines digital health, virtual care and regular high-touch clinical interventions from physicians and pharmacists. This support will help ensure adherence to therapy, reduce discontinuation and provide ongoing lifestyle and behavioral changes that can lead to prevention of comorbid conditions such as diabetes and heart disease.