How pharmacies, members & patients can think about accessibility & cost of these treatments
Glucagon-like peptide-1 (GLP-1) drugs have taken the country—and the world—by storm, due to their efficacy for some people as a weight loss treatment. While originally formulated and still used as a treatment for type 2 diabetes, the positive weight loss results associated with GLP-1s led manufacturers to seek U.S. Food & Drug Administration (FDA) approval for the treatment of obesity and market the drugs under a different name. Patients are clamoring for these medications, and due to this off-label use of GLP-1s for weight loss, there have been widespread shortages, leaving individuals with diabetes searching for available supply. Payors, meanwhile, are challenged with balancing coverage of GLP-1s for obesity with their overall plan costs.
Members and patients confront these issues daily. “GLP-1s are an important topic among all of our members,” says Katie Hess, PharmD, Senior Director, Pharmacy Benefit Strategy at HealthTrust. Some members want to provide GLP-1s as a weight loss benefit to their colleagues, while others are trying to tighten up their healthcare spending, taking a more conservative approach by excluding weight loss coverage. Members are also questioning whether GLP-1s will yield positive returns on the investment, in terms of improvements in overall patient health and long-term healthcare savings.
The supply shortage
The market is currently volatile from a supply perspective. “Growth and utilization of these products is outpacing manufacturing,” says Jason Braithwaite, PharmD, MS, BCPS, AVP of Clinical Pharmacy Operations at HealthTrust. It’s not just a U.S. problem, but one that is worldwide. “Right now, several of these drugs are on back order, and some patients have started on them or have a prescription but are unable to get them.” This is due to a shortage of manufacturing lines to produce the drug as well as its active pharmaceutical ingredient (API).
Shortages can cause treatment disruptions where a patient has to stop taking one GLP-1 and move to a different strength or formulation, based on supply and availability. Each has its own dosing and side-effect profile, so changing medications can be difficult for the patient and expensive for the healthcare payor.
Some patients are choosing to get GLP-1s from compounding pharmacies instead of through the manufacturer and traditional supply chain. While insurers are not part of these cash-only acquisitions, using a compounder can create a visibility difficulty for clinicians charged with monitoring a patient’s medication history. The compounders are also using the same API as the manufacturers, further contributing to the shortage, explains Braithwaite.
HealthTrust members can reach out to Optum Rx to help navigate some of the challenges associated with locating available supply and obtaining their prescribed GLP-1. As the shortage continues, Optum Rx remains focused on ensuring patients receive the medications they need and is committed to ensuring continuity of care for all members. Optum Home Delivery is actively collaborating with suppliers to maintain adequate inventory and has options available for patients such as waitlists for out-of-stock products, working with a patient’s prescriber to switch to an in-stock product, or transferring a prescription to a different pharmacy that may have the medication in stock.
How to manage spend
There’s immense financial pressure in this category given the amount of money being spent. “A lot of the focus is on how to appropriately manage it based on the member’s philosophy,” says Kevin Carter, AVP Pharmacy Benefit Strategy at HealthTrust. “Our members will be challenged long term. It’s not a flash in the pan. It will continue for the next few years, if not longer.”
Hess says that HealthTrust can provide members with custom prior authorization criteria for weight loss GLP-1s. Members can choose to cover GLP-1s for obesity but be more aggressive in coverage criteria or quantity limits. “There are high discontinuation rates due to intolerable side effects and a need to start on a low dose and titrate up,” Hess explains. Members also have the option to exclude GLP-1s for obesity. “Right now, about 60% of our clients are completely excluding GLP-1s for weight loss, which is telling, as companies are not able to keep up with the high cost.”
Working in partnership with Optum Rx as its Pharmacy Benefit Manager (PBM) partner, HealthTrust helps members manage their pharmacy spend and trends. “We can provide custom strategies to help members achieve their financial and clinical goals for their pharmacy benefit,” Hess says.
HealthTrust is developing additional trend management options for 2025 and beyond. “In partnership with our GPO colleagues, we’re working directly with manufacturers on supply and staying updated on pipeline drugs and indications,” adds Carter.
Connect with the Pharmacy Team today through kevin.carter@healthtrustpg.com to learn how HealthTrust can help your organization with GLP-1 trend management.
Share Email Drugs, Q4 2024, Weight Loss
