80% of Health Plan Leaders Express Significant Concern About GLP-1 Cost Crisis in Recent Survey

Published on 
January 25, 2024
August 1, 2023
Virta Health
Virta Health
Virta Health

Amid GLP-1 coverage considerations, health plan execs advocate for sustainable lifestyle interventions

Demand for glucagon-like peptide 1 (GLP-1) drugs—used to treat type 2 diabetes and increasingly, obesity—is surging. While proving effective for weight loss, GLP-1s are very expensive (up to $16k per person per year), with low adherence rates and a demonstrated rebound effect, where the majority who stop taking a GLP-1 see significant weight regain. 

That said, nearly one-third of U.S. adults are eager to try a GLP-1, and many providers are willing to prescribe them—even off-label. Now payers must address this onslaught of demand by determining what drugs to cover, for what conditions, and for how long, and where lifestyle approaches fit in.

To understand how health plans are thinking about GLP-1s, we worked with Beresford Research to survey 80 executives from major national and regional insurers covering 150M+ Americans. 

This issue is top of mind for health plan leaders—80% of those surveyed are significantly concerned about rising utilization and cost of GLP-1s for both obesity and diabetes given the increase in consumer demand, on and off-label prescribing, and pharmaceutical marketing. 

Unsurprisingly, cost was the biggest concern reported around GLP-1s. Analysts predict GLP-1 Mounjaro could be the first $100B drug. One recent real-world study showed that use of GLP-1s for obesity in a commercially insured population nearly doubled the total cost of care for members using these drugs. As approval expands, payers will need to deploy strategies to manage the costs. 

Additional key survey findings include: 

  • Diabetes and obesity are the top two concerns of health plan leaders. Due to rising prevalence, skyrocketing pharmacy and emergency department costs, and downstream health impact, respondents ranked diabetes and obesity above even cancer, cardiovascular disease, musculoskeletal conditions, and mental health. 
  • Majority expect rapid GLP-1 growth to continue. 72% of health plan leaders predict GLP-1s will grow by 25% or more in 2023. Over a third anticipate 50%+ growth. 
  • To minimize GLP-1 costs, insurers are experimenting with various utilization management strategies. The most popular approaches include provider education on alternative approaches, member communications, and food as medicine programs. Nearly half are also looking at combination and step therapy options. 
  • 85% of health plan leaders have policies to restrict off-label utilization, but report that these aren’t doing enough to curb prescribing practices. 

Health plan leaders are also eager to find lifestyle-based options that provide an alternative to these drugs or a successful off-ramp for sustainable weight loss. Over one-third of those surveyed are already investing in lifestyle solutions to improve clinical and financial outcomes and satisfy member choice, and now look to these to mitigate GLP-1 costs. 

Virta's clinically-proven, cost-effective solution delivers significant, comparable results to GLP-1s. Through virtual, provider-led support and personalized nutrition, Virta helps members lose weight safely and keep it off without expensive medications. Currently, Virta works with over 70 health plans and employers such as U-Haul and Quartz that offer Virta’s provider-led weight loss solution in addition to diabetes reversal.

In the company’s clinical trial, completing patients with obesity and prediabetes saw on average 13% weight loss at one-year alongside lower blood sugar and improved cardiovascular markers. Commercial members are seeing similar results. 

Says one Virta member: “I was on Ozempic, but I never noticed any weight loss from it. I’ve lost over 30 pounds on Virta. My knees hurt less and I have so much more energy. But the psychological effects of no longer having to stick myself? That alone made Virta worth it.”

The blinded survey was conducted by Beresford Research of 80 health plan executives. View the complete survey findings report here.

Are you living with type 2 diabetes, prediabetes, or unwanted weight?

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