Ripple effects

• Supply chain issues will lessen as more treatment options increase supply
• Steeper rebates for health plans as pharmacy benefit managers gain the upper hand in negotiations with manufacturers
• Net costs likely to decrease, but patients may face cost sharing barriers from persistently high list prices

Novo Nordisk’s SELECT trial for semaglutide seeks to demonstrate the drug’s efficacy in reducing major cardiovascular events for individuals with established cardiovascular disease. Researchers and clinicians seem confident that results will be positive, making it likely that the FDA will update the drug’s indicated use to include cardiovascular risk reduction in addition to chronic weight management for those above a designated BMI threshold.

Ripple effects

• Increased pressure on commercial health plans and employers to cover semaglutide (and future competitors) given demonstrated relation to cardiovascular health
• A new mechanism for Medicare to provide coverage for semaglutide for patients with established cardiovascular disease
• Force competitors with drugs in the pipeline to expand their trials to also focus on cardiovascular disease and/or other related health outcomes

Today, we have little real-world data on how GLP-1s are prescribed and used, limiting the ability of decision makers to form long term strategies. In the coming years as more data becomes available, payers and providers will be able to make more informed moves, influencing how these drugs are prescribed, managed, and reimbursed.

Ripple effects

• Providers will have a better sense of the overall patient population and more insight into how to manage follow-up care to improve outcomes
• Payers will develop more informed coverage policies to limit low-value use of the drugs
• Patient medication use and adherence patterns will reveal the scale and clinical impact of drug-related weight cycling (patients take the medication, lose weight, go off the treatment and regain weight, and then get on the medication again)  

Some payers are responding to the demand for GLP-1s and weight loss services by directing members to obesity centers of excellence to ensure the right patients are receiving weight management medications as part of holistic obesity care. At the same time, wellness companies like WeightWatchers and Noom are expanding into prescribing with new telehealth offerings that increase subscriber access to GLP-1s in combination with behavioral interventions. The success (or failure) of these wrap-around service models will likely shape how patients access these drugs and obesity management services in the future.

Ripple effects

• If wrap-around service models improve patient outcomes and experience long-term, more payers and wellness companies are likely to employ these models, solidifying this as a new model for obesity care that will come with its own risks and rewards
• If these early wrap-around models aren’t successful, healthcare leaders will likely experiment with different ways to facilitate use of weight management medications as part of holistic obesity care in order to improve long-term outcomes. Whether via wrap-around services or some alternative model, weight management drugs are unlikely to have a positive impact unless healthcare leaders find a way to integrate them into holistic obesity care  

Right now, Medicare cannot legally cover weight-management medications. Advocates have been lobbying to reverse this restriction for years and lawmakers are likely to reintroduce a bill that would do so later this year. The bill had bipartisan support in the past; however, its passage is uncertain given Medicare cost implications. If lobbyists are successful, the change will increase access to these medications—not to mention costs to Medicare and patients, increasing fears about the financial impact of GLP-1s.  

Ripple effects

• Large group of patients would gain access to medications covered by their Medicare Part D plans, reducing access disparities
• Increase in Medicare Part D plan premiums to accommodate for high cost and projected high utilization of weight management drugs
• 11 years after FDA approves each weight-management drug, Medicare could negotiate its price as long as generics are not developed

Providers, especially those unused to providing obesity care, can brush up on clinical guidelines and ensure that patients seeking out weight management drugs receive holistic care. Purchasers can start collecting claims data on prescribing and utilization practices, and surveying members and employees about how likely they are to seek access to these medications.