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 is evolving with the FDA approval of Wegovy (semaglutide), a new therapy for weight loss.
Semaglutide will require thoughtful strategies to ensure patients experience successful treatment and payers can offer affordable access.
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.
Why is it significant in weight management?
Obesity costs the U.S. health system roughly $173 billion a year and 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, drive the country’s $4.1 trillion annual health care expenditure, accounting for 90% of costs.
An effective treatment for obesity is desperately needed to help lift its immense burden on U.S. health care spending
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.
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 confirming semaglutide’s effect into context.
What are the challenges associated with it?
Semaglutide is a significant pharmacological intervention. However, like many new therapies, payers need to be aware of related challenges:
- Affordability: Based on the price of similar therapies that are currently available, and the number of Americans with obesity, the therapy has become financially burdensome for payers and health plans.
- Measurement: What parameters are being set to keep the weight off in the first place? Plan sponsors can encourage their members to maintain their weight loss via alternative methods such as coaching, a nutritionist and regular exercise.
- Utilization: Parameters need to also be set to ensure proper drug utilization are being put in place, especially considering a growing number of individuals that are using semaglutide aren’t actually considered obese.
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.
Originally published on 6/2/21 and updated on 8/2/23.
