With various studies predicting the global market for GLP-1s exceeding a staggering $471 billion (opens a new window) by 2032, employers should be asking: What is my strategy for achieving an ROI for the spend on these expensive weight loss medications?
In the U.S. alone, the number of people using GLP-1s is projected to exceed 30 million (opens a new window) by 2030. And, as these medications are approved for additional uses, they may cease to be constrained by limited use in the treatment of type 2 diabetes and weight loss and may merit coverage consideration for several other directly and indirectly related FDA-approved indications.
So, how do employers paying for, or considering covering these medications, infuse an element of control to affect the growing problem of obesity in the workplace and its associated health issues?
Lifestyle modification programs could be the answer, but it’s too early to know their potential effectiveness in clinical results – and, to put it bluntly – the companies mandating adjunct programs are essentially acting as guinea pigs for the future direction of GLP-1s.
The fact is, the FDA-approved indication language combining GLP-1 drugs, calorie reduction and increased exercise isn’t just optional but crucial for long-term success. The clinical trials that led to FDA approval provide the strongest evidence supporting this “three-legged stool” approach.
Encouragingly, we are seeing some data in several lifestyle modification programs that align with the trifecta foundation of any effective weight loss program entailing healthy eating, physical activity and behavioral modification.
However, employers should be wary of vendors touting behavioral and/or dietary modification tactics that lead to de-prescribing within a predetermined timeframe as their big differentiator, as these medications are intended for ongoing use to maintain associated 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. This is confirmed by the Tufts Specialty Drug Evidence and Coverage Database, which tracks insurance and healthcare trends.
QUANTIFYING LIFESTYLE MODIFICATIONS
In a recent report (opens a new window), Tufts’ data showed that, of the 18 commercial insurers with the highest memberships, only Blue Cross Blue Shield of Michigan and Centene were specific in their requirements for the companion programs.
Practically speaking, the specter of setting up a significant number of workers, dependent on costly weight loss medication, for a lifetime annuity is not sustainable for most employers, and that should never be the program.
The goal should be to transition people off the medications, which should serve only as a bridge to permanent lifestyle modifications that will equip long-term success. This approach aligns with the FDA’s original intention to see GLP-1s prescribed as an adjunct to lifestyle and behavioral modification.
DISCONTINUATION RATES ARE HIGH
Employers must be mindful of the lost investment should their employees discontinue the medications. Drug manufacturers’ own research shows that when someone stops these medications, their weight quickly returns to the unhealthy range.
A recent study, (opens a new window) released by Prime Therapeutics LLC/Magellan Rx Management, LLC, showed that after two years of injecting GLP-1s for weight loss, 85 percent of patients discontinued them. That’s up 14 percent over a 2023 Prime/MRx study, showing a 71 percent discontinuation rate after one year. The study doesn’t offer an explanation for this stark absence of persistence, but it is plausible that the absence of effective and accountable lifestyle modification support is a contributing factor.
Lockton’s data has shown 60-75 percent discontinuance within a year and confirms that counsel to clients and the public since the FDA first began approving the drugs for weight management after strict, controlled clinical trials that incorporated lifestyle management into the therapy.
As David Lassen, Prime/MRs’s chief clinical officer, rightly asserts: “GLP-1s are unlikely to deliver therapeutic value when so many individuals stop treatment after two years, but the findings also illustrate the need for obesity care management programs to improve adherence.”
This is at odds with the commercial and internet hype of a magic injection that melts away pounds on celebrities and influencers, along with a wide range of adjunct lifestyle modification programs that you can do online with little or no real accountability.
Newsflash: There are no magic, stand-alone shortcuts to weight loss. Rather, ensuring some measure of success requires an integrated approach to shift the long-term goal away from weight loss induced by GLP-1s to a commitment to behavior and lifestyle modification.
This is a continuation of our series on the rapidly evolving GLP-1 landscape and strategies on how employers can navigate it. Next: Implementing a lifestyle management strategy around GLP-1s.
