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 body mass index (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.
Evernorth 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:
- Some patients experience rapid weight gain after a life event, such as a medical emergency, a physical injury or accident, or an emotional family situation, which becomes a barrier to maintaining a healthy weight.
- Others experience a slower onset. They may have been able to maintain a healthy weight as a teen or young adult, but as life gets busier, their metabolism slows down and their weight becomes harder to control. They may end up with prediabetes and resolve to make lifestyle changes. But a few years down the road, they realize 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 multiple diets and treatments with no success. Now they are turning to what some suggest is a miracle drug, especially those posting in social media and online.
The research also focused on the medication experience. Are patients taking GLP-1s for weight loss as a one-time reset? Or are patients trying to change their lifestyle? 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 hyperfocused on weight loss as the ultimate measure of success. Those with diabetes, hypertension, and/or heart disease were not necessarily focused on controlling their 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 help patients achieve those outcomes. That requires navigating around three distinct decision points: benefit plan design, utilization management, and patient support.
Taking action on GLP-1s for weight loss
The first action plan sponsors can take is benefit design. Based on the desired outcomes, 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 those individuals who will benefit from these drugs – such as people with obesity and diabetes, but with well-controlled blood pressure – can access GLP-1s 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 preferable.
The third action is patient support. We’ve learned that patients undergoing bariatric surgery needed coaching, social support, and behavioral health management. They needed to get their other health conditions under control. Without that support, about 20% gained the weight back. We’re seeing similar patterns among patients using GLP-1 medications only for weight loss.
About 1 in 4 people don’t lose weight on GLP-1s yet continue to take the drug. When people do lose weight, the loss can be precipitous. They 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. They can even exceed their original weight, especially if they haven’t made other lifestyle changes.
We’ve seen more than 30% of people discontinue these medications early due to side effects, costs, or a lack of 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?
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. Plans 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 manage their diabetes, blood pressure, and/or cholesterol and to improve their overall health.
Sign up for our newsletter to get updates when new content is available.
