Optimizing pharmacy benefits: GLP-1s, obesity, and diabetes
The impact of obesity and diabetes in healthcare spending is vast – but employers can make a difference by carefully considering weight management drugs and a patient-centric approach in their pharmacy benefits solutions.
By: Prescryptive Health
The challenge: Obesity is a health crisis
The numbers speak for themselves: 43% of adults in the United States currently battle obesity, and this number is expected to rise to 50% by 2030. Due to associated comorbidities, obesity in the U.S. is calculated to be at least a $1.7 trillion disease, including $1.24 trillion in lost productivity and $480.7 billion in direct healthcare costs. A person with obesity averages $1,861 in higher healthcare costs per year, compared to those with a healthy body weight.
For these reasons and more, obesity should be treated as a health crisis, as it strains healthcare systems, impacts productivity, and fuels chronic diseases.
The obesity-diabetes relationship and what it means for pharmacy benefits
Obesity is linked to several downstream health conditions caused by excess weight: cardiovascular disease, heart attacks, Type 2 diabetes and strokes. Among these, diabetes stands out: Up to 53% of new diabetes cases in the US are linked to obesity. For an adult who is overweight, the likelihood of developing diabetes is 1.52 times greater than an individual with a weight in a normal range – and for an individual with obesity, the likelihood increases to 3.43 times greater.
What does that mean for pharmacy benefits? Likely, higher costs for those with diabetes: people with diabetes have medical expenditures 2.6 times higher than those who don’t, averaging $19,736 a year.
It’s here where GLP-1-based therapies can offer support and solutions by addressing both conditions – obesity and diabetes – simultaneously.
53%
of new diabetes cases in the US
are linked to obesity
$19,736
more is paid in medical costs a year
for those with diabetes
Could GLP-1s make an impact?
GLP-1 (glucagon-like peptide 1) is an incretin hormone that plays a pivotal role in glucose homeostasis. Its effects include enhancing insulin secretion, slowing gastric emptying, and reducing postprandial glucagon levels. In simpler terms, GLP-1s can help regulate blood sugar and promote weight loss.
The popularity of GLP-1s has exploded. With social media and influencer attention, employers have already seen a 90% increase in the utilization of the drug class since 2020. Current estimates for employers covering GLP-1s for weight loss range from 43% to 49% in 2024; another report says GLP-1 coverage could double in 2024.
And employers and their consultants have every reason to look into covering the weight management drugs and related solutions: Access to weight loss treatment is important to employees, and 44% of people with obesity say they would change jobs to an employer that covers obesity care. Many employers do recognize the demand, with 81% of HR decision-makers saying their employees would be interested in this benefit, and 79% agreeing that GLP-1 coverage would help employee health long term.
In any pharmacy benefit plan, the costs of these drugs must be considered. Though complex to calculate, GLP-1s are estimated to be about $1,000 per patient per month. This and other factors have led some researchers to estimate that weight-loss drugs could add 50% to overall healthcare spending.
Employers as advocates for a holistic, patient-centric approach
Forward-thinking employers recognize that healthy employees are productive employees. Because of the complexity and impact in positive outcomes available, weight loss management is a place where employers can impact the health of their members through holistic pharmacy benefits.
Where to start? Obesity. It’s a condition to take seriously given the utilization and demand as well as the downstream consequences obesity can have on an employer’s population. A patient-centric approach to weight health management can drive down costs and empower patients at the point of prescribing.
There are best practices and lessons we can learn from specialty pharmacy, or categories like cancer – other complex, chronic conditions where patients have vastly different needs but outcomes can be improved through holistic solutions.
And as in many things in healthcare, member engagement is the key to weight management initiatives. In addition to covering GLP-1s and other related prescription drugs, employers should look at a whole-person approach that could include wellness challenges, educational campaigns, and personalized support through related clinical services.
Member engagement can start at the point of prescribing, when a member-patient might be prescribed a drug that’s new to them like those in the weight management category. The prescription is an opportunity to put members and patients on a sustainable, more affordable medication journey toward weight management – and control costs and adherence at the same time.