Experts Weigh in on the Clinical and Business Impact of GLP-1s

GLP-1s have been growing in popularity, in part because of their effective applications for weight loss. That popularity, though, has also led to increased demand, higher pharmacy spend, and inventory shortages. 

With GLP-1s being a high priority for many members, brokers and plan sponsors will need to weigh the benefits of covering these drugs against potentially high costs. That’s where our experts come in. We recently spoke with Avantika Waring, an endocrinologist with a focus on diabetes care and the Chief Medical Officer at 9amHealth, and Alissa Johnson, a pharmacist by training and the Clinical Strategy Director at SmithRx, to answer some common questions about GLP-1s. 

Let’s start with the basics — what are GLP-1s and are they new? 

Avantika: GLP-1s are a class of medications that have been around for over 15 years. They’re used primarily for diabetes and now we’re also seeing them used for weight management as well. They work in a variety of ways — they have an impact on appetite, they slow down digestion, and they lower blood sugars, which is why they’ve been very impactful in the treatment of type 2 diabetes. 

Let’s first dive into the clinical considerations from the patient’s point of view. Everyone’s health backgrounds are different. How can one best advocate for their diabetes and weight loss journey and outcomes with providers and pharmacists?

Avantika: GLP-1s are great drugs, but everybody’s body is different. Depending on what your history is, what other conditions you might live with, etc., these drugs may not be right for you. The best way to advocate for yourself with your clinical team if you’re interested or have heard about these drugs is to speak with your provider so they can understand the full picture and have a conversation about whether GLP-1s are the right medication for you. 

Alissa: Another consideration is that coverage may vary based on what your employer selects. The FDA has approved GLP-1s for different indications, like diabetes and weight loss, with many more being studied. Additionally, other therapies may be required first or you may need a prior authorization saying this is the right drug for you before your employer will cover the GLP-1. 

There’s a lot of information and confusion around how effective these medications are for diabetes and weight loss management. What questions do you recommend patients ask their doctor when it comes to GLP-1s?

Avantika: When people are seeking information about GLP-1s, it’s important to talk about what your goals are — where do you want to be at the end of this treatment or health journey? It’s especially important to talk about what you’ve tried before for weight loss, what struggles and barriers you’ve dealt with, and so on. It’s crucial to talk about your full history with your provider — in particular, what’s worked and what hasn’t. 

‍Plus, there are many other medications out there that work well for metabolic health. Drugs like metformin are effective and safe medications, which have been around for a long time, as well as newer ones like SGLT2 inhibitors. These are also options that your provider should be bringing up with you depending on your unique health conditions. 

What about side effects? What are the most common ones for people taking GLP-1s?

Avantika: The most common side effects are stomach symptoms like nausea and vomiting, with nausea happening in up to 30% of patients. The goal is to work with your team to ensure you’re taking the right dose and taking a very, very slow approach to increasing the dose over time.

There are also some other side effects to be aware of. For example, people with a history of pancreatitis or gallbladder conditions may want to avoid taking GLP-1s as they can worsen some of the symptoms. There are also other risks that you’ll want to discuss with your provider before starting. 

In addition to side effects, people want to know if these drugs are truly effective. What are some of the outcomes you’ve seen with GLP-1s and how long does it usually take to see the benefits? 

Avantika: GLP-1s can be very effective for certain people in the right circumstances. Studies show anywhere from 10-20% body weight loss, but that does take time. It can take 12 months to get to the right dosage, and data shows that most of the weight loss occurs in the first 12-18 months before people enter a maintenance phase. It’s also critical to note that the most positive outcomes are with patients who also participate in a lifestyle program. The medications need to be taken in conjunction with healthy eating and physical activity to see the best impact. Even if you’re a good candidate for the medication, the first and most important thing to do is to build in those lifestyle habits so that you’ll see the effect you want when you do start the medication. 

‍With the drug shortages, there’s also been talk about “compounded” GLP-1s. Can you explain when they’re suitable for patients? 

Alissa: If you’re interested in exploring compounds as an option, you’ll want to speak with your provider. The most important thing, though, is the safety of the products — you’ll want to get them from a reputable pharmacy and ensure the dosing is correct. 

Avantika: The most important thing from a physician's perspective is you want to make sure the medication is coming from a clinician who really understands how the medication works, can support you, can check that your labs are safe, and can ensure you’re getting the right dose. After all, most of the side effects are going to occur if you don’t start low and go slow with the dosing. 

Let’s get into coverage and costs — after all, plan sponsors are at a crossroads when it comes to GLP-1 coverage for weight loss. What’s your advice for employer plan sponsors on how to decide whether to cover GLP-1s for weight loss? 

Alissa: For employer groups who are considering covering weight loss, it’s important to note that while it can initially increase drug spend, it can have a lot of favorable impacts down the line to reduce medical spend. Many employer groups didn’t previously cover weight loss drugs as a whole because they weren’t always effective or safe, but that was before the long-term benefits and outcomes that we’re seeing with GLP-1s. 

If you want to cover GLP-1s for weight loss, it can offer really rich benefits for your employees. Plus, studies are showing that people will stay in their jobs or switch jobs to pursue this weight loss coverage in their benefits. 9amHealth commissioned a consumer survey in which 67% of respondents would be “likely” or “very likely”
 to stay at a job they didn’t like to sustain coverage for
 weight loss medication.

Avantika: If you think about weight as a condition that should be managed by experts, then you can ensure that the right people are getting the medications they need. As a result, down the road, they’ll see fewer complications and other diseases.

One great approach is if an employer partners with a company like 9amHealth through their partnership with SmithRx, they’ll get access to not only GLP-1 prescriptions but also a comprehensive weight management program. After all, we don’t treat a condition like diabetes with just one solution or one medication. Similarly, when it comes to weight management, 9amHealth has programs with a variety of options, including lifestyle change interventions, GLP-1 alternatives, and more. This allows us to identify who would really benefit from GLP-1s and see those short- to medium-term positive outcomes. 

‍What about additional costs, such as extra testing or treatments for side effects? What can employers do to better prepare themselves? 

Avantika: When starting a new medication, there may be additional services people need to get access, which can drive up other costs (like needing lab tests or managing side effects with additional visits). The most important factor is how the drug is being prescribed and who’s managing that. If you have a thorough and comprehensive care team like at 9amHealth, managing these patients, you won’t see an increase in labs drawn because they’ll be following standard clinical criteria. And, when it comes to side effects, working with an experienced team means you’re much less likely to see side effects that are unexpected or that drive people to the emergency room. 

Employers may be wondering what the risks are down the line if they don’t cover GLP-1s for obesity today (i.e., need for bariatric surgery, disabilities, other costs of care later, etc.). Are these valid comparisons? What advice would you give plan sponsors when they’re analyzing cost factors? 

Avantika: It’s important to consider prevention vs. treatment. While using a GLP-1 is essentially a treatment for obesity, you’re also using it to prevent future events related to weight. For example, if you reduce someone’s BMI by just one unit (like going from 34 to 33), it doesn’t seem like a huge change, but you see an average cost savings of $700 per year on medical spend for someone living with diabetes by reducing that weight. 

Also, even with a modest amount of weight loss, which we can achieve without even going to a GLP-1, that weight management model can reduce your body weight enough to prevent developing type 2 diabetes over the next 10-20 years. So, you’re really investing in your employees and helping them be healthier in the medium to long term as well. 

Alissa: To add to that, for most plan sponsors, the top spend category in the traditional drug space is diabetes. Being able to control weight loss or diabetes with these very effective medications can decrease the utilization of other products (like insulin). While there is an initial cost for medications like GLP-1s, it can help lower the spend of other products in the category as well.

SmithRx + 9amHealth = Better Outcomes at Lower Costs

As demand for GLP-1 medications continues to rise, it's crucial to implement strategies that meet member needs while maintaining cost-effectiveness. We at SmithRx offer innovative solutions to address weight loss and diabetes care management efficiently.

Our Connect Care program, powered by 9amHealth, a virtual diabetes and cardiometabolic care provider, offers a comprehensive suite of options including:

• Insulin therapies
• Non-insulin treatments
• GLP-1 medications
• Lifestyle intervention programs

This partnership combines SmithRx's PBM expertise with 9amHealth's specialized virtual care platform, enabling an integrated approach for tailored, cost-effective care management. By leveraging 9amHealth's focus on diabetes and cardiometabolic conditions, we can provide more targeted and efficient support to our members.

For more detailed information about GLP-1 medications and their impact on healthcare management, please visit our Learning Center.

^{About 9amHealth}

^{‍9amHealth offers complete cardiometabolic care—a first-of-its-kind, whole-body approach to preventing and treating diabetes, obesity, high cholesterol, and hypertension. They partner with businesses to provide effective health benefits for those living with chronic conditions. Their members receive personalized care plans, prescription delivery, at-home lab tests, and unlimited specialist access. 9amHealth was founded in 2021 by the team behind mySugr and is backed by 7Wire Ventures, Human Capital, Founders Fund, and Define Ventures. More at www.join9am.com.}

^{‍About SmithRx}

^{‍SmithRx is working to reduce the complexity and cost of pharmacy benefits by building a new type of pharmacy benefits manager (PBM) committed to transparency and aligned with employers and patients. By combining advanced technology, a member-centric approach, and innovative cost savings programs through our Connect 360 offering, we're making prescriptions more affordable and delivering valuable transparency and savings to main street businesses. With features like real-time prescription pricing comparisons, seamless online access, and detailed savings reporting, SmithRx empowers both employers and individuals to make cost-informed decisions about their medications. SmithRx is at the forefront of reshaping the pharmacy benefits landscape, delivering a new level of simplicity and value to small employers across the United States.}