Weight Loss Drugs Tilt Scales Toward Higher Pharmacy Benefit Plan Costs
How weight loss and diabetes drugs
drive increased pharmacy benefit plan costs
June 2, 2023
Pharmacy benefit plan costs are on the rise with increased utilization of medications for members seeking weight management and treatment for type 2 diabetes with products such as Ozempic, Wegovy, and Mounjaro. There has been a surge in prescribing of a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists that mimic a natural gut hormone causing blood glucose lowering and appetite suppressive effects. Such endpoints are appealing to a growing population of people being diagnosed with diabetes and obesity and are reflected in an uptick of attention on social media.
These medications are costing plans about $1,000 per utilizing member per month. Also adding to the total cost, treatment is typically long-term as benefits have been shown to reverse after discontinuation. To date, the available branded products are either indicated for type 2 diabetes (i.e., Mounjaro, Ozempic, and Trulicity) or chronic weight management (Wegovy, Saxenda), but dual indications are anticipated to be on the horizon. Mounjaro has been granted a fast-track designation by the FDA to expedite the review for chronic weight management and is expected to be approved for that indication later this year.
The CDC estimates that over 70 percent of adult Americans are obese or overweight, as defined by BMI (body mass index).
#Ozempic gaining social media buzz
companies invest to meet growing demand
Hashtags like #ozempic and #ozempicweightloss have taken social media by storm as users document their weight loss journeys across platforms. This buzz further impacts prescription sales as more people become aware of the potential weight loss effects. The surge in demand has led to worldwide medication shortages and actions to increase supply. Eli Lilly is investing $450 million to create a manufacturing plant in North Carolina to expand production capacity to meet the growing need.
GLP-1 agonists are changing the landscape of weight loss management with their potential to help patients lose a clinically significant percentage of body weight and their potential to increase industry revenue. WeightWatchers plans to capitalize on the market with their recently announced acquisition of a telehealth platform known as Sequence. The addition of the telehealth platform will allow WeightWatchers to expand its existing programs by providing access to these blockbuster drugs. Launched in 2021, Sequence is a niche company that offers a subscription service to patients who want to lose weight with the assistance of GLP-1s such as Ozempic, Wegovy, and Mounjaro.
WeightWatchers’ CEO Sima Sistani stated that drugs like Ozempic are “the biggest innovation in our industry today.”
“Over a million prescriptions were written for Ozempic alone in December 2022, according to IQVIA, a rise of 64 percent over the previous December,” Sistani said.
While the benefits are encouraging, an extension phase trial has shown participants regain the majority of weight lost as the feeling of fullness subsides once the medication is discontinued. Ongoing treatment is required to maintain improvement in weight and health. Treatment also does not come without the risk of adverse reactions. Most commonly, utilizers experience gastrointestinal events and there are manufacturer warnings of more serious events including, but not limited to, thyroid tumors, pancreatitis, and acute kidney injury.