March 22, 2024

Glucagon-like peptide-1 (GLP-1) receptor agonists, or GLP-1s, are hailed by some as the magic bullet for obesity. But now that they have been in use for several years and have been subject to more clinical trials, does that claim hold up? Let’s delve into the real-world outcomes of GLP-1s for weight loss, considering both their clinical impact and the financial implications for pharmacy benefit plans.

Efficacy and Side Effects

On the positive side, GLP-1s and GLP-1/GIPs boast impressive weight loss results — especially when compared to previous oral medications for weight loss. The chart below highlights GLP-1/GIPs with a red box. The mean reduction in body weight for these drugs ranges between 7% to a remarkable 21% for Zepbound, which features the GIP component.

These medications are effective for weight loss, but it is important to recognize that not all patients need the level of weight loss these agents provide. The oral agents in the top three rows also provide impactful weight loss results, at a lower price point.

Another element that must be considered with any drug are side effects.  The most common side effects observed in patients using GLP-1s for weight loss are mostly mild — nausea, diarrhea, vomiting and constipation.

However, some more serious issues like pancreatitis, thyroid tumors, and severe gastrointestinal problems have been observed, some of which have led to patients discontinuing GLP-1 use. And this becomes relevant as we examine another emerging concern.

Wasted Spend and Chronic Use

One trend we are tracking as these medications continue to saturate the market is medication discontinuation followed by weight regain. A 2021 PBM assessment by Prime Therapeutics and Magellan revealed that only 27% of patients continued using the medication after a year.

This discontinuation rate is concerning, as studies show that most patients regain weight after stopping GLP-1s — indicating that in practice, GLP-1s are chronic therapies. At costs of over $10,000 per patient per year, those responsible for pharmacy benefits must evaluate the potential impacts of covering these medications for the long haul.

When you combine the high cost of these medications with high discontinuation rates, the result is significant wasted spend — painting a complex picture for employers considering coverage for GLP-1s for weight loss.

Cardiovascular Impact

Another aspect of GLP-1s for weight loss gaining significant traction in the media is the potential to reduce the risk of cardiovascular (CV) events like heart attacks. In recent news, the FDA approved Wegovy as the first treatment to reduce risk of serious heart problems for adults with cardiovascular disease who also have obesity or are overweight.

However, there is more to the story than this headline. While the highlight of the headline was a 20% CV risk reduction — this was a reduction of the relative risk. The reality is that in terms of absolute risk, there was only a 1.5% reduction, lowering risk of cardiovascular events from 8% to 6.5% with the use of Wegovy.

To not get lost in the math — we can turn to the Number Needed to Treat. This benchmark evaluates how many patients must be treated (and for how long) to prevent an event. Studies indicate that for Wegovy, you would need to treat 67 patients for nearly 3 years to prevent a single non-fatal heart attack — which equates to an estimated net cost of $2,000,000. While the cost to prevent one cardiovascular even with GLP-1s in patients with diabetes is still high, it is about a third of the cost when looking at GLP-1s in obesity.

Those responsible for pharmacy benefits must consider that while Wegovy’s cardiovascular indication does reduce risk for those with cardiovascular disease and obesity, it is hard to argue that it is cost-effective at its current price point.

Our Recommendation: A Wait-and-See Approach

Based on the current data, at Innovative Rx Strategies we recommend not covering GLP-1s for weight loss at this time. The clinical benefits are promising, but the long-term financial viability and sustainability for employers require further investigation. As further studies on the additional benefits are released and future agents come from the pipeline which provide pricing pressure, we will continue to review the market and update our recommendations for our clients.

Regardless of your decision to cover or not cover GLP-1s, it’s crucial to implement safeguards like off-label control, prior authorizations, and plan design guardrails to optimize medication use and manage costs effectively. And we would be happy to help and customize a strategy for your needs.  If you want to dive deeper into the data in this article, head to glp1.innovativerxstrategies.com for a recording of a webinar led by our pharmacists that covers everything you need to know about GLP-1s for weight loss. Or simply click the link below to reach out to a member of our team.

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