In posters presented at AMCP Nexus, researchers determined that glucagon-like peptide 1 (GLP-1) receptor agonists are not a cost-effective treatment option for patients without diabetes looking to treat their obesity.1 Furthermore, persistent use of the medication was only identified in patients with high or low copays,2 while specific GLP-1s like semaglutide and tirzepatide were most often prescribed alongside lifestyle interventions, as opposed to solely a GLP-1 prescription.3
GLP-1 demand has noticeably taken over the prescription drug market despite high out-of-pocket costs that typically surpass $1000 a month for patients in the US.1-2 However, with these medications showing significantly improved outcomes for patients with obesity, cardiovascular disease, and diabetes, experts are giving “blockbuster status” to these so-called miracle drugs.3 But with the prevalence of obesity in the US, the weight-loss aspect of GLP-1 medications is what patients are seemingly taking the most advantage of, despite varied results.
Put It Into Practice
Incorporate these strategies into your pharmacy practice to improve patient outcomes.
- Advise patients to seek out further understanding of their insurance benefits to have a more knowledgeable idea of what medications they can be prescribed.
- Help patients understand the importance of being medically adherent as well as taking prescription drugs on a persistent basis as directed by their providers.
- Highlight the importance of lifestyle interventions in tandem with GLP-1 treatment for patients seeking weight loss.
“Many patients that start weight management GLP-1s do not continue them long-term, with a recent study finding that more than half of individuals that start GLP-1s do not continue beyond 12 weeks, when clinically meaningful weight loss is likely to occur. Poor persistence may be driven by a range of factors, including access and cost, and barriers to long-term use need to be described,” wrote authors of a poster.2
Before exploring the cost-effectiveness of these medications, researchers aimed to understand how cost translates to GLP-1 adherence and persistence. They identified pharmacy and medical claims of 70,491 individuals aged 18 to 64 prescribed semaglutide or liraglutide from January 1, 2021, to June 30, 2023. Study participants were defined as nonpersistent if there was a gap following the most recent prescription of at least 2 times the duration of that prescription.
READ MORE: Benefits of GLP-1s Transcend Simple Weight Loss for Individuals With Overweight, Obesity, and Comorbidities
Individuals spent a mean of $97.77 in monthly copays for GLP-1 medications, which fell into the “moderate payment” threshold of between $60 and $100. Among those in the “high” and “low” copayment groups, 29.7% paid over $100 a month and 20% paid less than $30 a month. However, the more unlikely finding was regarding patient persistence of GLP-1s, where those who paid either high or low copays used the medications significantly longer than patients who paid moderate copays.2
“Although high copayments were associated with better persistence than moderate, potentially because of financial buy-in, the most optimal persistence remains in the lowest quartile of costs to patients. Payers and providers alike should consider cost sharing when considering the effective use of GLP-1s for weight management,” concluded authors of the poster.2
While it’s important to understand appropriate GLP-1 costs that will drive adherence, it’s also important to understand the overall cost-effectiveness for these types of medications. In a systematic review and meta-analysis, researchers identified the cost-effective uses of GLP-1s for patients with obesity and without diabetes compared with other treatments or no treatment.1
“Cost-effectiveness studies were included if they reported economic outcomes of any GLP-1s (semaglutide and liraglutide) in the treatment of obesity in patients without diabetes for a minimum time horizon of 5 years,” wrote the authors.1 The comparator treatments that researchers used to measure against GLP-1s included semaglutide, liraglutide, phentermine plus topiramate, lifestyle intervention, naltrexone plus bupropion, and no treatment.
A total of 8 studies with 23 comparisons were included in the review. Compared with lifestyle and pharmacotherapy interventions, GLP-1s were not cost-effective for the treatment of obesity in patients without diabetes. They did find that semaglutide was cost-effective compared with liraglutide, but no statistical significance was identified.1
Finally, after assessing the association of GLP-1 use with their costs, researchers identified how large US commercial health plans cover GLP-1s (specifically semaglutide and tirzepatide).3 They explored coverage policies for these medications issued by 18 commercial health plans as of April 2024 and examined 6 different coverage requirements: weight restrictions, step therapy protocols, diet and exercise, enrollment in a lifestyle modification program, approval duration, and continuation criteria.
Of the 18 health plans included in the study, 13 issued policies for semaglutide and 10 issued policies for tirzepatide, with all plans featuring diet and exercise requirements for both prescriptions. All plans also required documented weight loss for individuals looking to continue their coverage of GLP-1s.
“Health plans in our sample often implemented requirements for diet and exercise and enrollment in lifestyle modification programs for access to semaglutide and tirzepatide. Variation in coverage requirements across health plans may result in inconsistent access to semaglutide and tirzepatide for patients,” concluded authors of the study.3
According to the aforementioned studies, demand for GLP-1s as key drivers in obesity management seems to be rising at a similar rate as the costs these medications require for a prescription. As health care providers continue to search for the most appropriate use of these medications for treating all approved complications, researchers are simultaneously exploring how to make these blockbuster drugs more accessible and cost-effective.
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References
1. Meraz M, Dhippayom T, Lee H, et al. Unlocking value: The cost-effectiveness of glucagon-like peptide 1 agonists for obesity treatment in patients without diabetes—A comprehensive meta-analysis. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, NV. Poster E-38.
2. Coetzer H, Pigoga J, Swami S, et al. Association of prescription copayments and persistence on weight management glucagonlike peptide-1 receptor agonists: A real-world evidence study of commercially insured individuals, 2021-2023. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, NV. Poster E-31.
3. Enright D, Beinfeld M, Chambers J. US commercial health plan coverage of semaglutide and tirzepatide for obesity management. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, NV. Poster E-33.
