Approximately 42% of the U.S. population has obesity, and the demand for weight-loss solutions has never been higher. The glucagon-like peptide-1 (GLP-1) receptor agonist drug class, used to manage type 2 diabetes, is also proving to be highly effective for the treatment of obesity and has the potential to meet this growing need. Approved medications include Wegovy, which is a higher strength version of diabetes drug Ozempic. To properly manage opportunities and challenges surrounding these drugs, payers should take some key actions related to the coverage of GLP-1 prescriptions for weight loss. This paper provides a thoughtful care management framework with robust medication counseling and education, which are both considered essential for payers and relevant healthcare stakeholders if they choose to cover these medications.
Our discussion includes the following topics:
- Current medications available
- Clinical distinction
- Media attention and market demand
- Current coverage status by U.S. market segment
- Importance of medication adherence and persistency
- Potential for prescription benefit spend waste
- Utilization and care management impact
- Strategies for payers
Payer strategies for GLP-1 medications for weight loss
We examine various strategies related to GLP-1 medications such as Wegovy when used for weight loss to help payers understand the landscape, develop a coverage strategy, and minimize waste.