Are people really discontinuing GLP-1s before they lose weight?
May 31, 2024
Blue Health Intelligence reported last week that most of those (58%) given an initial prescription for GLP-1 drugs for obesity from 2014-2023 stopped the drugs in the first twelve weeks, and 80% were not continuing to receive coverage for these drugs 12 months after the initial prescription. The study included Saxenda (liraglutide) and Wegovy (semaglutide); Zepbound (tirzepitide) was not available during the study period. The study is large (169,250 members prescribed GLP-1s for weight loss), and the researchers only included members with continuous health insurance coverage.
The researchers stated that those who did not get GLP-1 obesity drug coverage from their health plans after the initial prescription had discontinued the drugs. However, members may have discontinued these drugs involuntarily due to insurance denials or obtained them through an alternative funding or procurement method.
This study’s findings are consistent with results reported last summer by Prime Therapeutics, which stated that 68% of those prescribed GLP-1 medications for obesity were “no longer taking the drug after one year.” Clinical research studies have shown much less frequent discontinuation of these drugs, ranging from 2% to 14%.
Here are some of the reasons other than intolerance or ineffectiveness that might have led to discontinuation in the Blue Health Intelligence study. Members could have obtained GLP-1s by way of:
A drug coupon with lower costs than their plan’s out of pocket costs.
Compounding pharmacies allowed to sell GLP-1s since there is currently a shortage.
Importation from Canada, Mexico, or another country.
Switchingto a GLP-1 labeled for diabetes if they were eligible.
It’s also possible that members discontinued these medications because their coverage was discontinued or they were unable to obtain the medication due to shortages. My discussions with prescribers suggest that most people who continue these medications past the initial weeks are eager to continue these medications, and highly unlikely to stop them.
If 80% of people who started these drugs were off them in 12 months, we would not be nearly as worried about the aggregate cost of these medications!
The Blue Health Intelligence report notes higher persistence rates for people treated by endocrinologists or weight specialists, people with lower out of pocket costs, and people who had complications of metabolic disease.
Some other interesting findings in the Blue Health Intelligence report:
These drugs exacerbate health equity problems. The quartile with the lowest social vulnerability index had almost three times the use of these drugs, even though those who are poorer are more likely to be obese. This is consistent with reports that high wealth neighborhoods have higher use of these medications than disadvantaged neighborhoods which have higher prevalence of diabetes and obesity. Here’s a report on this from Stat earlier this week.
Ten percent of those prescribed anti-obesity GLP-1 medications had diabetes and would have benefited from prescription of the drugs labeled for diabetes, which have substantially lower prices.
Ten percent of those prescribed anti-obesity GLP-1 medications had Metabolic Associated Steatohepatitis (MASH, previously called nonalcoholic fatty liver disease). The GLP-1 drugs cost considerably less than Rezdiffra (resmetirom), a recently approved medication to treat MASH.
Most anti-obesity GLP-1s are prescribed by PCPs. There simply aren’t enough endocrinologists or obesity specialists to care for people with obesity.
Implications for employers:
- Employers should not count on high rates of voluntary discontinuation of these medications to constrain the impact of GLP-1s on pharmacy total spending.
- Employers should look at the health equity impact of these medications. If employers cover GLP-1 medications for obesity, they can evaluate whether disadvantaged employees are less likely to be prescribed these medications.
- Employers should be cautious about proposals to restrict GLP-1 prescribing to endocrinologists or weight loss specialists, as there are not enough of these specialized clinicians to meet population needs.
- Employers can ask vendors for data on their impact on GLP-1 persistence and adherence.
Monday: Ozempic associated with lower death rates in diabetics with kidney disease