GLP-1s are constantly being advertised for weight loss, whether on TV or on public transit. But are they actually worth the hype?
That question was posed by Harrison Newman, vice president of consulting company Corporate Synergies, during a Tuesday panel discussion at the MedCity INVEST conference held in Chicago. Newman moderated the session.
And according to one panelist, GLP-1s are proving extremely effective for patients with obesity. However, when the drugs are portrayed on social media, the emphasis is on the “vanity aspect,” said Disha Narang, endocrinologist and director of obesity medicine at Endeavor Health. This is what’s creating shortages and coverage difficulties because demand has become so significant, she added.
“Most patients that come to see me have tried everything under the sun to get weight off,” she said. “They’re not there to try to get into a fancy dress that’s 10 or 15 pounds away from their goal. It’s not necessarily something of vanity that we talk about. We talk about metabolic disease. When I’m seeing patients, they’re having issues with heart disease, liver disease, diabetes.”
She added that GLP-1s have been around for longer than many people realize. GLP-1s have been used to treat diabetes for nearly two decades. Around six to eight years ago, they also began receiving regulatory approval for weight management, Narang added. In addition, the side effects are typically gastrointestinal-related, such as upset stomach, indigestion and nausea. And studies show that about 95% of patients can tolerate the medication, she said.
“We’re not seeing long-term complications from this. And in fact, we’re seeing long-term benefits. … What’s been more difficult, obviously, has been the landscape of shortages, and of course, now insurance coverage,” Narang said.
Another panelist, AJ Loiacono, CEO of pharmacy benefits company Capital Rx, noted that this conversation around the coverage of GLP-1s wouldn’t even be happening if the drugs were reasonably priced.
He said that the strategy for covering GLP-1s depends on the profile of the company. Coverage may not be a problem for wealthy employers, but it’s a major challenge for the vast majority who are struggling with cost trend.
“Based upon the data, there’s certainly efficacy of this drug and benefits to it,” he said. “But the question is, who pays?”
He added that the average employee cycle is three to four years before moving on to the next employer, but the long-term value of GLP-1s may not show up until seven to nine years. In which case, “most people, if you’re just doing the math, you don’t want to cover this because you never see the benefit.”
These comments on the cost challenges were echoed by Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, an advocacy organization for employers.
“When you’re talking about something that can increase your medical spend significantly, you have to have these conversations. And it’s frustrating from the employer perspective to feel like now we have to be the bad guys because the drugmakers and PBMs are being greedy, and we have to be the ones who say no. … I just think employers have to be really thoughtful about how they want to do this,” he said.
While the high price tag of GLP-1s is causing some employers to pull back on coverage, Newman, the moderator, argued that covering them could actually save employers in other ways.
“The fact that these medications are working is creating a healthier workforce,” Newman said. “A healthier workforce is a more productive workforce. … When you’re trying to attract and retain and one employer is offering them and another is not, it’s a huge selling point. You could possibly find ways to fund this based on increased productivity, increased health, lack of taking days off, so on and so forth.”
Narang agreed with this, noting that diabetes and obesity cost the U.S. about $2.4 trillion a year in absenteeism and presenteeism.
Gremminger, however, argued that the individuals who would benefit most from GLP-1 coverage are not typically employed by companies like Amazon and Google, which can afford it. Instead, they often work for organizations with tighter budgets, such as school districts and manufacturers.
He noted that one strategy some employers have implemented is setting a higher body mass index (BMI) threshold for GLP-1 coverage than what the drugs are officially approved for. Additionally, he emphasized the importance of pairing these medications with lifestyle support to help ensure sustainable weight loss.
