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Insurance companies often do not cover GLP-1 medications for weight loss, despite evidence that the drugs work and are worth the cost. A University of Mississippi-led study found that insurers would have to offer more services than just the medication to produce long-term cost savings. Graphic by Clara Turnage\/University Marketing and Communications<\/p>\n
For\u00a0patients whose insurance won\u2019t cover GLP-1 medications, lower-cost compounded versions can seem like an attractive alternative, but\u00a0the researchers urge caution.<\/p>\n
Despite growing evidence that GLP-1 medications improve health and are worth their cost, many insurance plans still limit coverage. University of Mississippi researchers are examining why, and where that leaves patients.<\/p>\n
A recent report from the\u00a0Institute for Clinical and Economic Review,<\/a>\u00a0an independent nonprofit that evaluates the value of medical treatments,\u00a0found that GLP-1s such as Ozempic, Wegovy and Zepbound are cost-effective, meaning the medication\u2019s health benefits justify their price.<\/p>\n In a study published in the\u00a0Journal of Managed Care and Specialty Pharmacy<\/a>, Sujith Ramachandran, associate professor of\u00a0pharmacy administration, said that \u201ccost-effective\u201d does not necessarily mean \u201ccost-saving\u201d for insurance companies.<\/p>\n \u201cThe ICER report shows that GLP-1s, at the cost that they are currently being sold, provide tremendous value to society,\u201d he said. \u201cBut the impact they create on the budget is still massive.<\/p>\n \u201cThat is happening because the patient population eligible for this medication is so large. So even if the medications themselves represent good value for society, that does not mean we, as a society, can take the impact of how many individuals would use this.\u201d<\/p>\n According to the Centers for Disease Control and Prevention,\u00a0some 40% of Americans<\/a>\u00a0are obese. Even if only a fraction of those patients sought GLP-1 treatment, insurers could face billions of dollars in\u00a0additional costs.<\/p>\n \u201cICER has a budget impact threshold that estimates whether the uptake of a drug can lead to a budget impact concern,\u201d he said. \u201cThe threshold for this year is $821 million.<\/p>\n \u201cGLP-1s blow way past that threshold, even at lower numbers of uptake.\u201d<\/p>\n A common argument for GLP-1 coverage is that its use could be a preventive measure that leads to long-term savings. But the data doesn\u2019t back up that claim, Ramachandran said.<\/p>\n \u201cWe expect that if we address the obesity issue in this country, then in theory, it should create savings down the road for cardiovascular conditions, liver conditions and kidney conditions,\u201d he said. \u201cBut does that mean it\u00a0actually produces savings? Well, the existing data do not show that.\u201d<\/p>\n Patients often stop using GLP-1s within a year for a\u00a0variety of reasons, including cost, meeting their goal weight or gastrointestinal side effects<\/a>. In many cases, those patients\u00a0regain the weight they lost<\/a>.<\/p>\n To make GLP-1s more cost-saving for insurers, the companies must help patients make the weight loss \u2013 and the associated decrease in risk for diseases associated with obesity \u2013 stick, Ramachandran said. That means not limiting GLP-1 coverage to six months or a year, as many insurers do, and providing the same support that made GLP-1s so effective in clinical testing.<\/p>\n \u201cThe first thing to remember is that all of the clinical trials, GLP-1s were not tested against no treatment; they were tested against lifestyle management interventions,\u201d he said. \u201cIt was not lifestyle management versus GLP-1; it\u2019s lifestyle management versus lifestyle management plus GLP-1.\u201d<\/p>\n This means that health care providers must offer patients more than the drug to deliver the desired benefits, Ramachandran said.<\/p>\n \u201cYou have to provide them access to a registered dietitian, you have to provide them access to a gym membership, you have to provide them access to a fitness instructor or whatever network of services it is that you can provide to make sure that the change is in a lifestyle and not just in taking a medication once a week,\u201d he said.<\/p>\n For\u00a0patients whose insurance won\u2019t cover GLP-1 medications, lower-cost compounded versions can seem like an attractive alternative, but\u00a0the researchers urge caution<\/a>.<\/p>\n Compounded GLP-1 drugs do not go through the same rigorous evaluation that the U.S. Food and Drug Administration-approved medications do, said Liang-Yuan Lin, an Ole Miss doctoral candidate in pharmacy administration who researches compounded drug pharmacies.<\/p>\n