The rising cost of obesity medications, especially GLP-1 receptor agonists like semaglutide and tirzepatide, is dominating conversations among healthcare stakeholders.A recent analysis of insurance claims from 2018 to 2023 revealed a sharp increase in prescriptions for these drugs,even among individuals without diabetes,but access remains a meaningful hurdle for many who could benefit.
Trends in Glucagon-Like Peptide 1 Receptor Agonist Prescribing Patterns
Table of Contents
- Trends in Glucagon-Like Peptide 1 Receptor Agonist Prescribing Patterns
- Evernorth Launches Co-Pay Cap for Weight Loss Drugs Amid Affordability Concerns
- Real-World Use of GLP-1s Yields Less Weight Loss Than Clinical Trials
- Contributor: how Can the US health Care System Affordably and Fairly Expand GLP-1 Access for the Millions of People Who Need It?
A study analyzing US insurance claims from 2018 to 2023 found that prescribing of GLP-1 RAs has risen sharply, especially for semaglutide, while use of older agents like dulaglutide, liraglutide, and exenatide has declined. The increase in GLP‑1 RA use occurred across individuals with and without diabetes, with a significant rise in prescriptions among nondiabetic patients who are obese or overweight. Semaglutide, including formulations approved for weight management, now makes up the majority of GLP‑1 RA prescriptions, reflecting its growing role in treating obesity alongside diabetes.Despite these trends, high costs and variable insurance coverage remain barriers to broader access.
Evernorth Launches Co-Pay Cap for Weight Loss Drugs Amid Affordability Concerns
Evernorth, the health benefits arm of The Cigna Group, announced a $100 monthly co-pay cap for certain weight loss drugs, including GLP-1 RAs, for its members. This move aims to improve affordability and access to these medications, which have demonstrated significant clinical benefits but often come with substantial out-of-pocket costs. However, experts caution that co-pay caps alone may not fully address the issue of affordability, and broader policy changes are needed to lower list prices and improve equity in obesity treatment. Without policy changes, disparities in access and patient outcomes may persist despite the clinical benefits of these medications.
Real-World Use of GLP-1s Yields Less Weight Loss Than Clinical Trials
Real-world results with GLP-1 RAs appear less dramatic than those seen in clinical trials,largely due to early discontinuation and suboptimal maintenance dosing,according to a retrospective study published in Obesity. The study, which observed 7881 adults with obesity, found that while these medications can aid weight loss and improve glycemic control, the weight loss achieved in real-world settings was less pronounced than in randomized clinical trials. Hamlet Gasoyan, PhD, a researcher at Cleveland Clinic’s Center for Value-Based Care research, noted that high discontinuation rates, potentially linked to cost or insurance barriers, were also observed in a forthcoming study.
Contributor: how Can the US health Care System Affordably and Fairly Expand GLP-1 Access for the Millions of People Who Need It?
Despite the potential benefits of GLP-1 RA medications for obesity and related chronic diseases, significant challenges remain in expanding access due to high costs and limited insurance coverage.Employers providing health insurance have struggled to cover GLP-1 RAs for weight loss, and pharmacy benefit managers (PBMs) have faced difficulties negotiating broader access due to cost and scale issues. Wei-Li Shao,MBA,president of Omada Health,suggested collaboration between pharmaceutical companies,employers,and PBMs to support long-term,affordable access. Shao also emphasized the importance of lifestyle intervention support to improve adherence and justify continued investment in these therapies.