Semaglutide associated with large weight loss in the “real world”

June 22, 2023

The question I continue to be asked most often by reporters is “what will employers do about GLP-1 agonists,” the drugs like Wegovy, Ozempic and Mounjaro. This category of drugs has been used for treatment of diabetes for 18 years; two are already approved for treatment of obesity (Saxenda and Wegovy), and a third (Mounjaro, tirzepatide) is expected to be approved soon. The cost implications of these drugs are huge, since as many as a third of members of employer-sponsored health plans are likely eligible. Here’s a link to a great article on this published a few weeks ago by my WTW colleagues Siupo Becker, MD and Cody Midlam, PharmD (and others).

Epic, the giant medical record company, published ‘real world’ data about the effectiveness of semaglutide (Ozempic and Wegovy) in diabetic and non-diabetic patients cared for by providers who use this medical record.  At the recommended dose, median weight loss was 8.2% of body weight in diabetics and 11.1% in nondiabetics. This is lower than average weight loss from bariatric bypass surgery (over 20%), but much higher than weight loss from dietary interventions with exercise. The researchers note that about a quarter of those on the lowest dose of these medications gained weight.

Source: Little, et al Epic Research Network April 26, 2023 LINK

Implications for employers:

-       This class of drugs is effective when used in real clinical practice, although weight loss is lower than in published clinical trials.

-       Most people will gain benefit from the recommended dose, and many will not gain benefit from the lowest dose.

-       We should be jubilant about a safe, effective class of drugs to address obesity.  Unfortunately, at current prices employer sponsored health plans will have difficulty providing these drugs to all those who could benefit.

-       Employers can expect continued physician and patient demand for these medications, and many telemedicine vendors are now prescribing GLP1 drugs.

-       Employers and should push their pharmacy benefit managers for lower acquisition costs.

-       The FDA warns against using compounded formulations of GLP1 medications, which sometimes use forms of drug that have not been properly tested for safety or effectiveness.