One of the issues around GLP-1 drugs is that the demand is outstripping the supply, leading to shortages that are very problematic for patients who have more of a need for the drugs' medical benefits, as opposed to patients who are relatively healthy but see the drugs as a weight-management option. Issues created by the supply-and-demand problem include unauthorized treatments and medical side effects that can happen when patients are not careful about finding the most appropriate drug for them. Anegawa noted that current supplies of the drugs don't really scratch the surface of probable demand, citing d data showing that of the 126 million obese U.S. adults, only 4% are currently being treated. "The shortages are continuing to accelerate the rise of …  unauthorized medications, often being prescribed in settings without expert physician-led obesity care," Anegawa said. "There have been loopholes created for compounding pharmacies to try to step in and fill this gap, but not all of these follow standardized protocols, which unfortunately could potentially lead to serious side effects for patients. And these side effects are often quite costly for employers and payors."

Galante noted that the shortages may be an opportunity for companies and providers to encourage patients to try more traditional therapies for weight-management. "Members who seek out specialty obesity care, which can include medications plus behavioral change programs, can be just as successful," as the new drugs, she said. 

Several issues play into ongoing health disparities

Another prediction was that the GLP-1 shortages will further exacerbate health care disparities. 

"We know that obesity has disproportionately impacted people of color long before there were even GLP-1 medications, but the disparity has only been exacerbated by the cost of GLP-1s," Anegawa said. "Wealthier upper middle-class individuals may be willing and able to pay thousands of dollars if their GLP-1 drug isn't covered. But this simply isn't an option for members of marginalized communities."

The speakers noted that many marginalized communities lack access to information that helps with making informed decisions. Galante stressed the importance of having good benefits communication and addressing diversity, equity, and inclusion (DEI) issues as part of an overall benefits program. The top three suggestions were: (1) educate clients (plan sponsors) about health inequities relating to accessibility and affordability for marginalized communities in regard to these drugs; (2) consider GLP-1 coverage that enables easy access for all employees, regardless of income levels, and (3) advance employee health literacy by partnering with insurers or PBMs to share information on GLP-1s. Galante added it will help for employers to work on promoting DEI strategies that are visible and accessible to employees. 

Future developments in the weight management/obesity treatment area

The speakers also made several predictions about developments on the horizon in this area. For one, the change in attitudes toward obesity treatment is promising, since there is much less stigma than in past years. "Before the GLP-1 therapy and before modern obesity medicine, we really believed obesity was simply caused by a lack of willpower. The more modern take is that obesity is in fact a medical disease. It's fueled by biology, not lack of willpower," Anegawa said. This attitude change is likely to lead to the growth of medical treatment resources, such as centers for excellence for obesity medicine. At the same time, development of GLP-1 medications will continue. This is likely to result in lower-cost GLP-1 drugs. However, the current population trends suggest there will be more people with obesity requiring these drugs, Anegawa said, so it's likely the overall employer spend will continue to rise. It will be an ongoing challenge for employers looking to balance coverage and affordability when it comes to these treatments. 

"We do see that employers' attitudes toward GLP-1s continue to shift, she said. "And 99% of companies who already cover the drugs intend to continue to cover them. GLP-1 coverage is seen as an attractive and desired benefit." The data in the presentation also showed that GLP-1 coverage in employer plans has nearly doubled from 2023, when 25% of those surveyed said they intended to cover GLP-1 drugs, to 43% in 2024. 

Galante noted that employers feel more pressure to provide in-demand drugs and treatments, especially at a time where there is so much emphasis on recruitment and retention of employees. At the same time, she said employers should pursue a broad-based, clinically supported approach. "GLP-1s are not necessarily the only pathways to success; we know there are other anti-obesity medications out there, and it really depends on the individual and making sure we're taking a full look at that individual's health history and health makeup."