How will weight loss drugs affect health care costs?

A preliminary look at the impact of GLP-1 therapies

The demand for type 2 diabetes medications with weight loss side effects like Ozempic have soared over the last few years. Developed to help patients with type 2 diabetes control their blood sugar, the drug’s side effect of weight loss made it a hot commodity.

The popularity of the drug has been driven by social media influencers, celebrities and other high-profile people and have led to the demand for off-label use of these products for weight loss. Use has become so popular, in fact, that they’ve created shortages, making them unavailable for diabetic patients in need at times.

Blue Cross and Blue Shield of Kansas (Blue Cross) pharmacy and medical staff work closely with our pharmacy benefit manager, Prime Therapeutics, to study the latest data and research about these therapies. In recent years, select drugs in the glucagon-like peptide-1 (GLP-1) class have been FDA approved for weight loss. Prime conducted an analysis to determine the return on investment from a total cost of care perspective when it comes to GLP-1s for weight loss.

Here, we’ve compiled some helpful information about GLP-1s, as well as the preliminary findings from Prime’s analysis.

What are GLP-1s?

Glucagon-like peptide 1 receptor agonists, or GLP-1s, have historically been used to manage type 2 diabetes. In the past, this would include commonly recognized therapies like Ozempic (semaglutide), Trulicty (dulaglutide), and Victoza (liraglutide).  More recently, the FDA has approved select GLP-1 therapies specifically for weight loss, including:

• Wegovy (semaglutide)
• Saxenda (liraglutide)
• Zepbound, a GIP/GLP-1 dual-acting therapy (tirzepatide)

How do they work?

GLP-1 medications treat diabetes by mimicking GLP-1 to signal to the body to release glucose-dependent insulin from the pancreas and slows the speed of stomach emptying, extending the feeling of a full stomach and curbing the appetite. Because of the slowed gastric emptying, many patients have gastrointestinal side effects that can often limit a patient’s ability to take these drugs—especially at the high doses recommended for weight loss. And while many might think of these therapies as an easy fix, in reality, these drugs are not a cure and must be used in conjunction with proper diet and exercise.

What does preliminary data reveal?

Two years ago, Prime began studying data using real-world integrated pharmacy and medical claims data. This is what the initial analysis revealed:

• 68% of individuals who started GLP-1 drugs for weight loss were no longer taking the drug after one year.
• Increasing GLP-1 weight loss utilization by just 1% of an insured population would drive an additional $14.60 per member per month, totaling 5% of a self-insured employer’s drug spend budget.

According to David Lassen, PharmD and Chief Clinical Officer at Prime, “In the first year, it’s pretty conclusive that we’re not seeing any return from a total cost of care perspective. It gives us pause to say –  for an average employer group out there – ‘if you’re investing in this medication for your employees, don’t expect to see a return in year one.’”

According to Joseph Leach, M.D., Senior Vice President and Chief Medical Officer at Prime, “We will need results of ongoing, multi-year studies to see if this treatment has downstream impacts on other health conditions, including cardiovascular events and diabetes development prevention, which are key benefits to weight loss management. Long-term impact on total cost of care also remains to be seen.”

What does Blue Cross and Blue Shield of Kansas cover?

Like most health insurers, Blue Cross and Blue Shield of Kansas covers medications when medically necessary for patients with type 2 diabetes. We have implemented solutions to ensure that patients with type 2 diabetes have access to these medications, while eliminating requests for off-label use. For weight management coverage, Blue Cross has added coverage in 2024 for office visits and consultations, labs, and the cost of radiology and complications from bariatric surgery to support members with lifestyle modifications that are key to a weight loss journey.

How does Blue Cross manage and combat unnecessary costs of GLP-1 drugs?

Without insurance, weight loss drugs like Wegovy cost about $1300 for a one-month supply. This high cost adds yet another layer to the already complex discussion about rising health care costs. It’s no secret that the growing demand for new, brand name medications has long been a major contributor to the high cost of health care, and GLP-1 drugs are no exception. Blue Cross and Prime closely monitor drug costs and effectiveness to determine coverage. As competitors enter the market, costs may shift, so monitoring these changes is a continuous process.

For GLP-1 drugs for diabetes, our utilization management (UM) procedures ensure that members who have type 2 diabetes are the only members who use these products. This includes prior authorization and quantity limits put in place to ensure that members are using the right medications for their condition, as well as the right amount of medication. These efforts prevent incorrect, excessive or unnecessary use of medications. This in turn helps promote member safety and contain costs.

Stay tuned for more insights

As GLP-1 drugs continue to alter the health care landscape, subject matter experts at Blue Cross and Prime will continue keep the pulse on trends with trusted data and insights.

If you would like more information about GLP-1 drugs for diabetes and Prime’s evidence-based approach to managing them, watch this video from Prime, or review their press release. You can also contact your Blue Cross and Blue Shield of Kansas representative.