Expert insight from Lockton's Chief Medical
Officer and Chief Clinical Officer
DALLAS, May 16, 2024 /PRNewswire/ -- Early
discontinuation of medications happens for various reasons – and
for the increasingly popular GLP-1 medications, they include supply
chain issues, cost and intolerable side effects ranging from nausea
and diarrhea to more severe complications like gastroparesis
(stomach paralysis), among others.
The medications, broadly referred to as "GLP-1 agonists," are
used to treat type 2 diabetes or as a co-therapy with diet and
exercise for sustained weight loss in people who are overweight or
struggling with obesity. Known under their brand names of
Wegovy®, Saxenda® and Zepbound™, demand for
the medications continue to rise.
Growing evidence indicates roughly two-thirds of patients
discontinue these expensive medications within one year, and with
approximately 75 percent of the total addressable market (TAM)
for the GLP-1 pipeline existing within the commercially insured
space, this should signal to employers to plan ahead.
GLP-1 medications can cost as much as $1,200 per month, and discontinuing treatment can
mean lost investment for employers and regained weight for
employees. Drug manufacturers' own FDA-approved package insert
shows that discontinuing treatment will result in a rapid return of
the weight.
Employers that already opted to cover the medications saw them
quickly rise to their top-five most expensive health plan costs
within 90 days of initiating coverage, according to internal
Lockton data.
J.P. Morgan Research predicts the GLP-1 market will exceed
$100 billion by 2030, with roughly 30
million users in the U.S. alone. As more indication approvals
happen, coupled with mounting pressure from clinicians and advocacy
groups, employer health plan coverage of weight loss medications,
for at least some indications, will soon become standard.
With almost 50 percent of working-age Americans being obese, the
calculus of employers that opted in early on these medications was
understandable. They promised a smooth and rapid path to a
healthier employee population with fewer chronic conditions, and a
reduced healthcare spend.
However, evidence to the contrary, including our own, continues
to mount. Consider these findings:
- In 2020, Merck published a study that concluded,
"over half of (type 2 diabetes) patients initiating GLP-1
(drugs) were non-adherent, and the majority (70.1%) discontinued
therapy by 24 months..." While not specifically related to
GLP-1s launched later, the conclusions proved startlingly
prophetic.
- A Prime Therapeutics study released in July 2023 found that "…Wegovy or Saxenda
treatment persistency was poor, with only one-third on therapy at
one year. Among [Wegovy or Saxenda]-adherent individuals, the
increase in costs was even higher, double the prior year…"
- In November 2023, our Data
Science team reviewed a subset of our nationwide client database of
combined pharmacy and medical claims and found that: Nearly
two-thirds of claimants were observed to stop taking [Wegovy or
Saxenda] before 12 months. Those who used the drugs longer were
observed to drive more inflation and experience more frequent side
effects.
Clearly, GLP-1s have transcended fad. Manufacturers are winning
expanded uses of the medications from the FDA, which recently
granted Wegovy approval as a treatment to reduce subsequent
cardiovascular risk among adults without diabetes who are
overweight and who previously suffered a major cardiovascular
event, including heart attack and stroke. It was the first approval
of its kind.
Employers not currently covering GLP-1s beyond diabetes
treatment should be planning now to ensure responsible utilization
and cost-effectiveness when broader coverage is required. To
prepare, here are some considerations:
- Implement a fully integrated utilization management and
lifestyle intervention program to ensure appropriate
medication use and successful, sustained weight loss for the
employees who will benefit most.
- Engage your PBM to learn what options are available to
medically manage the medications. Also, ask your PBM to
provide the percentage of patients still using the medications
after a year. This insight will signal if it's time for a course
correction on coverage.
- Be wary of vendors touting behavioral and/or dietary
modification tactics that lead to de-prescribing as their big
differentiator as these medications are intended for ongoing use to
maintain weight loss benefits. To our knowledge, there are no
long-term studies – beyond two years – specific to these
medications that support de-prescribing as a broad-brush approach
to weight management.
- As these products gain additional indications, they may cease
to be considered for weight loss only and may merit coverage
consideration as their potential list of FDA-approved treatments
grows.
Healthy weight loss is a journey, not a destination. These
medications are neither a primary nor a solitary therapy. Lifestyle
intervention programs are critical to successful adherence. One
without the other will invariably lead to more discontinuation, and
lost investment for employers.
Dr. Shealynn Buck, MD is
the Chief Medical Officer for Lockton Companies. Robert Kordella, RPh is Chief Clinical Officer
for Lockton Pharmacy Consulting.
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SOURCE Lockton Dunning