Insurers seek to wean patients off GLP-1 drugs

Introduction

After losing 50 pounds on the injectable weight loss medication Zepbound, Kyra Wensley received a surprising letter from her pharmacy benefit manager in April. Her request for coverage had been denied, the letter said, because she’d had a body mass index of less than 35 when she started Zepbound. The 25-year-old who lives in New York had been taking Zepbound without incident for months, so she was confused: Why was her BMI, which had been around 32 when she started, becoming an issue only now?

The Struggle with GLP-1 Drug Costs

Lots of research suggests such medications must be used indefinitely to maintain weight loss and related health benefits. But with list prices of roughly $1,000 a month, public and private payers are struggling to keep up with ballooning demand for GLP-1 weight loss drugs and in some cases are eliminating or restricting their coverage as a result. North Carolina Medicaid plans to end GLP-1 coverage for weight loss on Oct. 1, just over a year after starting the coverage. Pennsylvania is planning to limit Medicaid coverage to beneficiaries at the highest risk of complications from obesity.

Deliberate Deprescription

Already, many GLP-1 users quit within a year, studies suggest — often due to side effects, high costs, or insurance issues. Now a growing number of researchers, payers, and providers are exploring deliberate “deprescription,” which aims to taper some patients off their medication after they have taken it for a certain amount of time or lost a certain amount of weight. The U.K.’s National Institute for Health and Care Excellence, which creates guidance for the National Health Service, recommends two-year limits on the use of some weight loss medications, such as Wegovy.

The Concept of Deprescription

A. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan, has argued that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them. “If you’re going to spend $1 billion or $100 billion, you could either spend it on fewer people for a long period of time, or you can spend it on a lot more people for a shorter period of time,” he said. Fendrick’s employer, the University of Michigan, indeed does that. Its prescription drug plan caps coverage of GLP-1 drugs at two years if they’re used solely for weight loss.

Challenges and Limitations

Studies have shown that people typically regain a substantial amount of weight within a year of stopping GLP-1 medications, and that many people who quit ultimately go back on the drugs. “There’s no standard of care or gold standard on how to wean right now,” said Allison Adams, an obesity and internal medicine doctor with UK HealthCare in Kentucky. But the math shows why time-limited coverage is appealing to payers that struggle to pay for beneficiaries’ GLP-1 prescriptions, said Michelle Gourdine, chief medical officer for the pharmacy benefit manager CVS Caremark.

Alternative Solutions

Plenty of companies are eager to sell insurers, employers, and individuals on behavioral alternatives. One is Virta Health, which advertises its nutrition-focused weight management program as “a proven approach for deprescribing GLP-1s when clinically appropriate.” A Virta-funded study assessed 154 people with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta’s program, concluding that their weight did not significantly increase after a year. Researchers affiliated with a European weight management company also recently reported that slowly tapering off the medications may help maintain weight loss.

Conclusion

The issue of GLP-1 drug costs and the concept of deprescription is complex and multifaceted. While some researchers and payers are exploring alternative solutions, others are concerned about the potential consequences of limiting access to these medications. As the demand for GLP-1 weight loss drugs continues to grow, it is essential to find a balance between providing effective treatment and managing costs.

FAQs

1. What are GLP-1 drugs, and how do they work?
   GLP-1 drugs, such as Ozempic, Wegovy, Mounjaro, and Zepbound, are injectable medications that help with weight loss and are also used to treat Type 2 diabetes. They work by mimicking a natural hormone that helps regulate blood sugar levels and appetite.
2. Why are insurers struggling with GLP-1 drug costs?
   The list price of GLP-1 drugs is roughly $1,000 a month, making them expensive for public and private payers to cover. The growing demand for these medications has led! to a significant increase in costs, which is a challenge for insurers to manage.
3. What is deliberate deprescription, and how does it work?
   Deliberate deprescription is the practice of tapering patients off their GLP-1 medication after a certain period or weight loss milestone. The goal is to transition patients to alternative treatments or lifestyle changes to maintain weight loss while reducing costs.
4. Are there alternative solutions to GLP-1 drugs for weight loss?
   Yes, companies like Virta Health offer behavioral alternatives, such as nutrition-focused weight management programs, that can help patients maintain weight loss after stopping GLP-1 medications. Researchers are also exploring other options, such as slowly tapering off the medications, to help patients maintain weight loss.
   

   By Jamie Ducharme, KFF Health News

   Kyra Wensley’s doctor fought to keep her on the injectable weight loss medication Zepbound, but Wensley ultimately had to switch to Wegovy, a different GLP-1 agonist, to meet her health plan’s requirements. ((Lori Wensley)/KFF HEALTH/TNS)