Insights on GLP-1s: Costs and coverage

Researchers and clinicians have been warning about the tremendous costs from obesity for many years. Yet, the upward trend in prevalence and spending for obesity seemed unstoppable. In 2010, approximately 36% of U.S. adults were obese.¹ By 2020, the proportion who were obese had risen to 42%.²

Today it is estimated that obesity is generating $426 billion in annual costs to U.S. businesses and employees. These include direct medical costs and costs for disability, workers comp, and lost productivity.³  

But, seemingly overnight, GLP-1s have changed how we think about treating and managing obesity. Some of the brand names include Ozempic®, Wegovy®, Mounjaro® and ZepBound®. Suddenly there's huge awareness, whether on social media, talking to neighbors or watching TV. The odds are good that you know someone who has taken a GLP-1 or other weight loss medication. 

The main reason for all the excitement is simple: These drugs work. Patients routinely achieve double-digit percentage reductions in body fat when taking them.⁴  

Not only are GLP-1 and similar drugs highly effective at their original purpose of controlling blood sugar for diabetes, they are also much more effective than any previous weight loss medications.

The Optum Rx Strategic Insights area recently completed a deep dive into how GLP-1 drugs are affecting the prescription drug market. They found a complex web of interrelated factors that will influence the shape of this drug class going forward. 

In short, they found that while consumers, employers and physicians are optimistic about the effectiveness of GLP-1s to treat obesity, cost and coverage are significant hurdles for consumer access. Employers are craving leadership to help make coverage decisions, while physicians want help navigating barriers for patient access. 

Consumers and physicians are leading the way when it comes to spreading awareness and acceptance of these new drugs. Here are a few of the key insights:

• One in ten U.S. consumers say they are most interested in trying prescription medications for weight loss, with 7% currently taking Ozempic or a similar GLP-1 medication.  
• 77% of physicians surveyed said they had prescribed a GLP-1 in the past year, while 93% said they expect to prescribe more GLP-1s for weight loss going forward.

The Optum Rx Weight Engage solution is a suite of behavior modification programs that provide education and support for the members who use GLP-1 type drugs. This support ranges from understanding the drug to checking in on them and educating them about the effects of the drug so that they can have better persistency and can realize the long-term benefits.