From our Partners at Innovative Rx Strategies

February 8, 2024

Glucagon-like peptide-1 (GLP-1) receptor agonists, or GLP-1s, have emerged as game-changers in weight management. And they are not slowing down. GLP-1 market size is projected to grow to $72 billion in the next 10 years. There is a lot of buzz on these drugs, but as we look to the future, questions remain for use in the weight management space. Can GLP-1s deliver long-term results? Can access and affordability issues be resolved? Let’s look at four trends impacting the future of GLP-1s.

1. Long-term efficacy

While GLP-1s have shown impressive short-term results, the long-term picture remains blurry. Limited data exists about the impact beyond weight loss when use in patients without a diagnosis of diabetes. Extended clinical trials and real-world data are crucial to understand their lasting impact on weight, metabolic health, and potential side effects.

Additionally, studies have shown that patients who utilize GLP-1s for weight loss regain a significant portion of lost weight after stopping medication. Discontinuation rates have been found to be high in this space leading to questions about wasteful spending when weight does rebound. Those responsible for pharmacy benefits need to know — is the cost of covering these medications justified by long-term health outcomes? The jury is still out for now.

2. Access and Affordability

Despite the remarkable progress, the high cost of GLP-1 drugs remains a significant hurdle for many patients. Here are a few solutions in the pipeline which have potential to improve affordability and accessibility, such as:

Increased competition:

There are many new GLP-1s and GLP-1s in combination with drugs with other mechanisms that may enhance weight loss in the pharmaceutical pipeline. While this increased competition in the marketplace has the potential to drive down prices, as we saw with the pricing of Zepbound when approved, but this is not always the case.

Loss of exclusivity

The first GLP-1 for diabetes is anticipated to experience a loss of exclusivity in 2024. While the first GLP-1 for weight loss has the potential to experience a loss of exclusivity in 2027, it may be a few more years until we see the impact on cost for GLP-1 in the weight management space.  More affordable versions of existing GLP-1 drugs could increase patient access and reduce the overall financial burden on healthcare systems.

Alternative delivery methods

Currently there is only one oral GLP-1 approved for diabetes management, Rybelsus. This oral GLP-1 has been studied in weight loss and did find significant weight loss impact. The manufacture is expected to seek additional approval for weight loss outside of a diabetes diagnosis in 2024. This removes the need for an injection which may be seen as a barrier for some patients. However, it is important to note that currently, the oral GLP-1 option does not provide significant cost savings when compared to injectables.

Even with these potential changes in future years, the cost of these therapies will remain high and potential a barrier for years to come. Based on the starting pricing today, competition and potential loss of exclusivity is not going to decrease these prices to a point where other cardiovascular impacting medications such as statins currently are today.

3. Beyond Diabetes and Obesity

Researchers are currently studying additional indications that would extend GLP-1s’ focus beyond diabetes and obesity. Emerging opinions suggests these drugs have potential for treating a variety of conditions, including:

  • Non-alcoholic fatty liver disease (NAFLD): GLP-1s’ ability to reduce fat accumulation and improve insulin sensitivity makes it a promising candidate for managing NAFLD
  • Polycystic ovary syndrome (PCOS): GLP-1’s impact on insulin regulation and metabolism could offer relief to women with PCOS, who often experience insulin resistance and weight management challenges
  • Neurodegenerative diseases: Studies hint at GLP-1’s potential to protect brain cells and slow the progression of diabetes-related Alzheimer’s disease and Parkinson’s disease

4. Cultural and Legal Events

As with any major class of medication, it is vital to monitor current events as well as the legal landscape. As an example, the majority of court cases have not recognized obesity as a disability under the Americans with Disabilities Act (ADA). For now, no immediate revisions to policies and practices are required.

Legal developments aside, leaders must consider the cultural relevance of obesity and GLP-1s. As the demand for these medications continue to increase, pharmacy benefit plans will be pressured to answer questions like:

  • Can my budget handle covering these drugs?
  • Should we cover these drugs to impact member health?
  • Who should receive GLP-1s?

The answers are often complex. It essential to work with a pharmacy benefits consultant that has their finger on the pulse of the future of GLP-1s as well as the latest developments in diabetes and weight loss drugs. This will ensure that those responsible for pharmacy benefits are not caught off guard by legal changes or the tidal wave of cultural opinions on GLP-1 innovation.

Outlook Summary

These four trends are just one drop in the bucket of pharmaceutical innovation. GLP-1s may have the corner on media and cultural significance, but there are countless other therapies and orphan drugs that could affect both pharmacy benefit and patient outcomes in the future.

If you are responsible for pharmacy benefits, seek out a consultant who can help them manage the ever-changing future of GLP-1s and ensure your plan remains viable without disrupting member care.

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About Innovative Rx Strategies

In addition to their valued partnership with Apex Benefits, the pharmacist-led team at Innovative Rx Strategies serves organizations across the United States who are serious about reducing their pharmacy benefits costs. No other independent pharmacy benefits consulting firm offers the same level of proficiency across the pharmacy, PBM and health care industries. They do all the heavy lifting and hold PBMs accountable to make sure clients receive the greatest value possible from their pharmacy benefits plans.

Learn more about the Innovative Rx Strategies Team
The Future of GLP-1s

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