Weight loss medication trends: A Q&A with Nathan Cassin

Weight loss drugs have gained recent popularity, despite being around for awhile. This popularity brings up an important questions: Why are they becoming popular right now? Should employers cover the costs of these drugs? Who would be allowed to be prescribed weight loss drugs?

Nathan Cassin, the pharmacy director for Holmes Murphy discusses answers to these questions and other lingering thoughts.

When did weight loss medications originally come out?

A class of medications, called glucagon-like peptide 1 (GLP-1) receptor agonists, hit the market in 2005 for treatment of type 2 diabetes. These drugs mimic the action of a hormone called GLP-1, which reduce appetite and feelings of hunger, slow the release of food from the stomach, and increase feelings of fullness after eating. Popular brand name Ozempic (semaglutide) hit the marketplace in 2017 for treatment of T2 diabetes, while Wegovy (semaglutide) received approval in 2021 for chronic weight management. In November 2023, Zepbound (terzepitide) was approved as an anti-obesity medication (AOM).

Do these medications work and what are the side effects?

Studies found people using semaglutide and making lifestyle changes lost about 33.7 pounds compared to 5.7 pounds in those who didn’t use the drug. Intended to be used alongside diet management and exercise, most weight loss drugs are for adults with body mass indexes (BMIs) greater than 30, which is the CDC’s obesity standard, or for adults with a 27 or greater BMI and one or more obesity-related comorbidities. Without behavior modification, people who take these medications will be on them for the long haul because stopping will make appetite return. One year after stoppage of once weekly weight management medication (semaglutide 2.4 mg), patients regained over 60% of prior weight loss.

Regarding any side effects, the majority of people can tolerate GLP-1s well. The most common side effects (nausea, vomiting, and diarrhea) are usually mild and occur in the first few weeks of treatment, reducing over time. Some severe reactions, like gut paralysis, have been noted along with correlation investigations in the EU for upticks in suicidal thoughts.

What weight loss drug trends should employers expect to see in the near future? 

Once market competition increases and adherence challenges are addressed, coverage of weight loss medications is likely to expand. It’s anticipated that oral treatments and lower out-of-pocket costs should increase adherence. If plan sponsors cover AOMs, they must be aware of success bias. Patients may lower their BMIs through use of AOMs, of which prior authorization criteria is not weight-based for continuing treatment.

The current list price of Wegovy is about 20% lower than the list price for Zepbound, with the latter costing around $1,059.87. Uninsured patients also may be able to obtain a 50% discount off list price. By 2025, industry analysts expect competition in this class to significantly reduce monthly drug costs from $1,300 per month to $450 by 2025 and $350 by 2026.

Related: New weight-loss drug from Amgen shows promise

Heading into 2024, what considerations should employers make regarding employee health plans and weight loss medications? 

Some considerations for plan sponsors include:

• Moving from a traditional pharmacy benefit manager (PBM) to an acquisition cost-plus PBM
• Potential for a carve-out solution to your PBM’s standard offering
• Considering prior-authorization and utilization management criteria that serves your needs
• Considering coverage as an employee retention and talent attraction tool

Most importantly, this type of pharmaceutical support should be offered in combination with lifestyle and behavior support, as the medication alone will not be the long-term cure. Types of behavior support to consider include a proven weight-management vendor, connection with a registered dietitian, or following the research.