The Cost of Discontinuing GLP-1s: Mitigating Financial Impact

Krissy Vann | Host, All Things Fitness and Wellness

The rise of GLP-1 medications like Wegovy®, Saxenda®, and Zepbound™ has marked a significant advancement in treating type 2 diabetes and aiding weight loss in individuals struggling with obesity. These medications, known as GLP-1 agonists, are used in conjunction with diet and exercise for sustained weight loss. However, the journey with these medications is far from straightforward.

Early discontinuation of GLP-1 medications occurs for various reasons, including supply chain issues, high costs, and side effects such as nausea, diarrhea, and severe complications like gastroparesis. Studies show that nearly two-thirds of patients stop these medications within one year, which can lead to significant financial implications for both individuals and employers.

Dr. Shealynn Buck, MD, Chief Medical Officer for Lockton Companies, highlights that the World Health Organization’s data indicates that discontinuing treatment leads to rapid weight regain, underscoring the importance of sustained medication use. Employers covering these medications often see them quickly rise to the top five most expensive health plan costs within 90 days.

J.P. Morgan Research predicts that the GLP-1 market will exceed $100 billion by 2030, with approximately 30 million users in the U.S. alone. The increasing demand and subsequent pressure from clinicians and advocacy groups mean that employer health plan coverage of these weight loss medications will soon become standard.

With almost 50% of working-age Americans being obese, employers initially covering GLP-1 medications hoped for a healthier employee population and reduced healthcare costs. However, mounting evidence, including studies from Merck and Prime Therapeutics, reveals a high discontinuation rate and increasing costs, challenging these expectations.

Dr. Shealynn Buck advises that employers not currently covering GLP-1 medications beyond diabetes treatment should prepare for broader coverage responsibly. To ensure cost-effectiveness and appropriate use, employers should consider the following:

- Implement Integrated Management Programs: Ensure proper medication use and sustained weight loss by combining utilization management with lifestyle intervention programs.

- Engage Pharmacy Benefit Managers: Learn about medically managing these medications and monitor the percentage of patients still using them after a year to determine if a coverage adjustment is needed.

- Evaluate Vendor Claims Carefully: Be cautious of vendors promoting de-prescribing tactics, as ongoing medication use is essential for maintaining weight loss benefits. There are no long-term studies supporting de-prescribing as a broad approach to weight management.

- Consider Expanding Indications: As these medications gain additional FDA-approved uses, they may no longer be seen solely for weight loss and could merit broader coverage.

Many health clubs are exploring ways to integrate GLP-1 medications into their programs. They are developing plans to help clients manage known side effects like muscle loss through targeted exercise regimens and nutritional support. This holistic approach aims to ensure clients achieve and maintain healthy weight loss while minimizing potential negative effects.

Healthy weight loss is a journey, not a destination. Combining medication with lifestyle interventions is critical to successful adherence. Without this balanced approach, the likelihood of discontinuation and lost investment for employers increases.

By planning ahead and adopting comprehensive strategies, employers and health clubs can support their populations more effectively, ensuring sustained health benefits and cost-effective care.

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