With consumer and prescriber interest in GLP-1 receptor agonist drugs “triggered,” health plan administrators have a new source of financial stress and clinical questions on their to-do list.
A team of Virta Health leaders held a webinar on July 13, 2023 to explain the results of a study the company just completed to assess the current views of health plan executives on Ozempic and other GLP-1 drugs. with a look at both the clinical outcomes and cost implications for this growing category of drugs that treat diabetes and obesity.
In fact, diabetes and obesity are the top health concerns among the 80 health plan executives Virta Health surveyed by phone in March and April 2023. You can see other top concerns displayed in the word cloud diagram here, included in the study report.
Why diabetes and obesity? Due to increased costs and subsequent conditions, health impacts, Virta noted in the report.
All of the health plan leaders interviewed were concerned about the growth of GLP-1 drugs for both clinical indications, and the increase in acceptance “overwhelmed” the ability of health plans to manage costs, the study noted.
The hockey stick growth in adoption and media coverage of these new drugs has become entrenched in popular culture: Dr. Paul Frank was quoted as saying that,
“Apart from Viagra and Botox, I have not seen other drugs become so quickly part of the social vernacular of modern culture.” That quote is shown here with two magazine covers that emphasize the point that Dr. Frank is making.
(An interesting sidebar FYI: Dr. Frank, a dermatologist, coined the phrase “Ozempic face” as a side effect he observed in some of his patients experiencing a form of sagging or aging skin as a result of using the drug).
With the motivation of “Eat, Inject and Repeat” that The Economist Described in its March 2, 2023 cover story, the story talks about the rapid growth of the GLP-1 market as shown in the line chart here, with the predicted market for these drugs reaching $150 billion by 2031, on the current market for cancer therapies
“Some think they could become as common as beta blockers or statins,” The Economist Tell us.
With that bullish prognosis comes the sobering health economics of the scenario. “The price rivals a mortgage payment,” Dr. Adam Wolfberg, Virta’s chief medical officer, emphasized in the webcast.
Per Dr. Wolfberg’s point, Virta calculated that for payers, the costs of GLP-1 could be “enormous,” to the tune of an additional $60 per member/per month based on assumptions in analyst forecasts.
In total, based on 100,000 lives covered in a plan, that would calculate an additional cost of $72 million to the payer.
So how might health plan leaders deal with what Virta calls the GLP-1 cost tsunami?
The bar chart identifies the most common strategies that health plans are implementing to contain the costs of GLP-1 drugs.
Start with provider education, when health plans focus their efforts on updating prescribers’ knowledge of alternatives to GLP-1 drugs, such as lifestyle programs. Provider education is used by 3 out of 5 plans today.
Second, more than half of health plans focus on member communications, informing health plan members about alternative options to expensive drugs.
Third, half of health plans prescribe food as medicine, which more and more consumers are also willing to use for a variety of conditions, including heart disease, intestinal problems, and general energy and wellness.
Health Populi Hot Spots: The combined public health crisis of diabetes and obesity is associated with three converging driving forces:
- An epidemic of diabesity, the actual convergence of the two conditions expected to affect nearly half of the US adult population by 2030
- Health equity challenges, where diabetes and obesity disproportionately affect Black and Latino people living in the US, caused largely by risks from social determinants of health, from food security and the availability of healthy food to safe neighborhoods to play and be active outdoors along with access to primary care, as well as other factors.
- A growing prescription drug cost crisis, where in the case of GLP-1s they involve an average of $12,000 to $15,000 per patient per year.
And this current generation of GLP-1 drugs is required to be taken for life… year after year for life… compounding the cost to hundreds of thousands of patients over dozens of years.
Ken Mishler, former Chief Pharmacist for Blue Cross and Blue Shield of Kansas, is quoted in the Virta report as stating that,
“This is a long game. Without lifestyle intervention, none of these drugs … will work to help you improve overall cost and quality.”
Here, “you” are both the health plan and the patient, each facing their respective untenable scenario for managing diabetes and obesity in an era where people are looking for an easy fix, the miracle in a pill bottle, or hypodermic stroke. .
For both patients and health plans, drugs alone are an untenable model in terms of financial toxicity, whether we’re talking about a patient’s wallet paying more than $12K a year, or the bottom line end of the health plan and per member. /per month trend medical expenses.
This “long game” means lifestyle education and continuous reinforcement of behavior change, which is very difficult, but doable, if we employ smart, savvy and insightful design teams who deeply understand what lies beneath life and patients’ daily choices. The rule of that long game is all about loving and knowing the design, empathy for patients and their families, and a commitment to doing the right thing this year, even if a plan member might move on to a new job and plan of care. health or being a Difficult Customer with a history of non-compliance. Meet people where they are…with empathy and understanding and incredibly smart tools, delicious meal kits and amazing wearable technologies that make people want to own their health.