GLPs: We're Into Them (With Caveats)

Many eyes are on “GLPs” right now - the newsmaking drug class of GLP1 receptor agonists that has moved from treating diabetes (example: Ozempic) to approval for weight loss (example: Wegovy).

Even prior to approval for weight loss, GLPs were being used off-label by celebrities, spurring both pop culture slang (Ozempic face) and red carpet coverage.

It is, I think we can safely say, the start of something exciting.

How does it work?

According to the FDA, “Wegovy works by mimicking a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake.” Its effectiveness in decreasing appetite while not diminishing pleasure is novel. For people struggling with obesity who have long been told weight loss is a matter of willpower, it is a game-changing demonstration that weight loss is, in many cases, actually a question of chemistry.

Looking ahead:

We’re excited to see the possibilities of GLPs achieving approval in other indications that are in the early stages of being explored, such as addiction. We are also excited for more GLPs that are currently approved for diabetes to achieve approval in weight loss. When it comes to pharmaceuticals, more options is always better for the patient and the payor.

What we want to hear more about:

We’d like to hear a lot more public discourse on GLPs’ potential to cause pregnancy complications, as it has done in animal trials. Current recommendations are to stop treatment two months prior to conceiving. But we think this message needs to be louder so it is unmissable.

We also want to better understand what lifestyle changes should accompany GLP use for weight loss. The current understanding is that when you stop the drug, the weight will come back. We need information on whether pairing diet and exercise regimes with GLP medication enables an eventual weaning from GLPs without a return of the weight.

Cost Implications:

Employers are just starting to make decisions about coverage. Currently, Wegovy costs over $1300 a month at major pharmacies using a GoodRx discount card.

Given how much more effective GLPS are for weight loss than previous options, we expect many people with BMI over 30 who weren’t previously on medication for weight loss to start medication. Short-term, this will increase plans’ pharmacy spend. In PSG’s 2023 Trends Drug in Benefit Design Report, one of the top reasons given by employers for excluding FDA-approved weight loss medications from coverage was “too expensive for all members for whom the medication would be prescribed.”

But obesity and the co-morbidities it engenders are expensive. Our hope is that, over time, better managing obesity will decrease total cost of care meaningfully.

Final word:

If our mother needed it, we’d put our mother on it. Given the side effect profile, which is not benign, we’d titrate on and keep a close eye on her.