Understanding GLP-1s
Glucagon-like peptide-1 drugs, or GLP-1s, have risen in prominence due to their effectiveness in treating diabetes, managing obesity and reducing the risk of cardiovascular events.
Read on to better understand the potential impact GLP-1s have on your member population and how you can support them while controlling costs and providing affordable GLP-1 coverage.
Cardiodiabesity is a hybrid term that describes the relationship between obesity, diabetes and cardiovascular disease. Because these diseases are interconnected, treating one can have a positive impact on overall health and improve the status of the other diseases.
With the unprecedented rise of the obesity rate in the U.S., weight loss is a key factor in treating and preventing complications related to cardiodiabesity.
50% of the U.S. population is estimated to be obese by 20301
Obesity substantially increases one’s risk of developing type 2 diabetes, coronary heart disease and hypertension.
Meaning that over half of diabetes cases could be prevented by more effective obesity treatment.
Patients with diabetes are 2x more likely to experience heart disease or stroke4
Many Americans who struggle with obesity are seeking effective ways to lose weight to improve their overall health, including using GLP-1s off-label. This off-label use can potentially impact the availability of GLP-1s for diabetes patients who need them.
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GLP-1s explained
For the first time in years, traditional spend (55%) outpaced specialty (45%)5 with the growth in popularity of GLP-1s. GLP-1s effectiveness in treating diabetes and obesity is driving increased utilization and demand.
In addition, the costs of these drugs have the potential to negatively impact clients’ ability to continue providing health care benefits for their members. Clients are looking for ways to expand coverage and affordability of GLP-1s to ensure their members have access to the medications they need.
J.P. Morgan Research forecasts that the GLP-1 market is expected to exceed $100B by 2030, driven equally by diabetes and obesity usage.6
Cardiodiabesity is one of the most expensive condition categories to treat.
$173B
in annual medical costs for obesity7
$413B
the cost of diagnosed diabetes yearly7
77%
of patients with diabetes have high cholesterol and/or high blood pressure8
Understanding the basics of cardiodiabesity and GLP-1s
Addressing the importance of cardiodiabesity prevention
Part one of the Evernorth Research Institute's cardiodiabesity report studies the three phases of the disease states and how prevention can reduce the burden.
The resource and economic impact of disease progression
Part two of the cardiodiabesity report tackles the importance of preventing disease progression to reduce the cost of care.
GLP-1s work best with behavior change support
A recent analysis determined that using GLP-1s and enrollment in a lifestyle modification program can be effective in helping members lose more weight.
EncircleRx: Cardiodiabesity financial guarantee for GLP-1
Cardiodiabesity is the first solution from the EncircleRx portfolio. EncircleRx: Cardiodiabesity provides clients with predictable and affordable options in managing GLP-1 trend by offering the industry’s first GLP-1 financial guarantee.
Depending on client type, clients can implement either a 15% cost cap or a 3:1 savings guarantee* for weight loss and/or diabetes.
The program is designed to cover GLP-1s for the right patients, support their wellness journey with enrollment in a lifestyle modification program and prevent fraud, waste and abuse.
Sources
*Clients are eligible for financial guarantees for a flat PMPM fee. The savings guarantee is available for both the weight loss and diabetes packages with no previous GLP-1 coverage necessary. Cost Cap eligibility: For existing ESI clients only. Clients must have previous GLP-1 coverage and >1,000 lives. Cost cap is only applicable for Year 1 of program enrollment.
Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity, New England Journal of Medicine, December 19. 2019.
American Heart Association, 2021.
CDC, 2024, Adult Obesity Facts
American Diabetes Association, Diabetes Complications: Cardiovascular Disease
Evernorth Health Services, Emerging Trends and Growth Drivers in Health Care, 2023.
J.P. Morgan, 2023.
CDC, 2024, Diabetes Basics
2023 Drug Trend Report data.