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Results of two-year study show limited adherence, savings for GLP-1 obesity drugs

Pharmacy

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A doctor adjusts balances on a scale

In recent history, there have been fewer drugs that have made such a meteoric rise than those classified as GLP-1s. From first being prescribed for diabetes management to now being used for weight loss, GLP-1s have caused health care providers and insurers to examine the long-term effects of the drug and the costs associated with their use. Many would assume a drug being hailed as a modern miracle would result in cost-savings for the patient, provider, and insurer, but recent real-world studies are proving that isn’t the case. 

The Study

Prime Therapeutics conducted a two-year, real-world study examining the clinical outcomes and cost when patients were using a GLP -1 for obesity treatment. The study, GLP-1 Obesity Treatment without Diabetes: Clinical Outcomes and Cost Offsets, analyzed data from 16 million commercially insured members to evaluate the impact of GLP-1 drugs on obesity-related health outcomes. Researchers focused on members who had a GLP-1 drug claim between Jan. 1, 2021, and Dec. 31, 2021, and who met specific conditions:

  1. They had continuous insurance enrollment for a year before starting the GLP-1 drug and two years after.
  2. They had no previous GLP-1 drug claims and a diagnosis of obesity (BMI ≥ 30) but no diabetes.
  3. Members with serious conditions like cancer or end-stage renal disease were excluded.

Researchers tracked total health costs (medical and pharmacy) and noted various obesity-related outcomes, including surgeries, cardiovascular events, diabetes development, and changes in medication use. Negative health events such as thyroid cancer, nonarteritic ischemic optic neuropathy, or acute pancreatitis were also tracked.

The Results

In this study, 3,346 people with obesity, meaning a BMI over 30, but without diabetes started GLP-1 therapy and were compared to 8,343 similar people not using GLP-1 drugs. The results are broken out into three parts: cost of treatment, health outcomes, and adherence to therapy. 

  1. Cost of Treatment:
    • For GLP-1 users, total health care costs (TCC) were $12,695 before starting, then rose to $20,165 in year one and $18,507 in year two.
    • In the control group, TCCs were lower, averaging $11,406, $11,882, and $13,012 for the same periods.
    • GLP-1 therapy raised yearly health care costs by about $7,000 in the first year and $4,200 in the second year compared to the control group.
  2. Health Outcomes:
    • There was no reduction in obesity-related medical events for GLP-1 users versus controls.
    • The rate of acute pancreatitis was 0.4% higher among GLP-1 users, in year one, which translates to one additional case for every 250 GLP-1 users.
  3. Adherence to Therapy:
    • Only 32% of GLP-1 users remained on therapy at the end of year one, dropping to 15% by year two.
    • About 27% were consistently adherent in year one (meaning they took the drug regularly), which fell to 17% in year two.

For individuals with obesity but no diabetes, GLP-1 therapy increased health care costs with no significant reduction in obesity-related health issues over two years. Many patients did not stick with the treatment, and there was a small but notable increase in risk for acute pancreatitis. The study suggests that GLP-1 therapy in this group led to increased costs without clear health benefits over the observed period.

Covering What Matters

Blue Cross and Blue Shield of Kansas is committed to providing members with the prescription drugs that are the safest and most effective. Current pharmacy coverage does not include GLP-1s for weight loss, unless your group has elected the benefit, for the many of the reasons outlined in the study. It is the hope of Blue Cross and Blue Shield that patients can access weight loss and diabetes management via proven, effective and cost-conscious options that medical providers feel confident prescribing. 

“As we experience new therapies that come to market at continuously rising costs, we must be good stewards of our member premium dollars that are used to pay for these therapies,” explains Tiffany Liesmann, Chief Pharmacist at Blue Cross and Blue Shield of Kansas. “The data in the study reinforces the significant costs associated with weight loss products. Understanding the long-term outcomes is critical for groups who are considering adding these therapies to coverage for weight loss so they can assess whether covering the cost of these therapies for their employees is affordable when long-term adherence and reduction in medical spend has yet to be established.”

Blue Cross and Blue Shield of Kansas continuously monitors the pharmacy landscape to determine the best course of care for members. Looking at treatments, in conjunction with pharmacy solutions can offer options for segments of our member population. The chance of treatment success with GLP-1s is improved considerably when used in conjunction with diet and exercise, which is included in the FDA labeled indication for GLP-1 products. To improve the chance for any return on investment with GLP-1 use, there is an increased importance on the need for meaningful lifestyle changes alongside medication use. 

In Pharmacy, we are committed to helping members access and use medications effectively, while combating the rising costs of products.