Struggling insurers aim to decrease GLP-1 drug usage among patients by various means

In the realm of weight management, a new approach is gaining traction: the deliberate 'deprescription' of GLP-1 medications. This strategy, which involves transitioning patients from these drugs to cheaper alternatives such as affordable medications or behavioural health programs, is being considered as a potential cost-saving measure.

One company at the forefront of this movement is Virta Health. Their nutrition-focused weight management program has been advertised as a proven approach for deprescribing GLP-1s when clinically appropriate. A Virta-funded study assessing 154 individuals with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta's program found that their weight did not significantly increase after a year.

However, maintaining weight loss without a GLP-1 remains a challenge for some people, even with other options available. The high cost of these medications is a significant factor. For instance, the injectable weight loss medication Zepbound carries a list price of roughly $1,000 a month.

This high cost, coupled with side effects, insurance issues, and other factors, leads many GLP-1 users to discontinue their use within a year. This trend has prompted concerns about the sustainability of the current approach to weight management, particularly among payers.

Some payers are indeed eliminating or restricting coverage for GLP-1 weight loss drugs. For example, North Carolina Medicaid plans to end GLP-1 coverage for weight loss on Oct 1, 20XX. Pennsylvania, which projects it will spend $1.3 billion on GLP-1 drugs this year, is planning to limit Medicaid coverage to beneficiaries at the highest risk of complications from obesity.

The University of Michigan's prescription drug plan caps coverage of GLP-1 drugs at two years if they're used solely for weight loss, mirroring the U.K.'s National Institute for Health and Care Excellence's recommendation for two-year limits on the use of some weight loss medications, such as Wegovy.

The growing interest in deprescribing GLP-1 medications is not limited to payers. Actor A. Mark Fendrick has argued that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them. Michelle Gourdine, chief medical officer for CVS Caremark, mentioned that time-limited coverage is appealing to payers struggling to pay for beneficiaries' GLP-1 prescriptions.

Despite the potential cost savings, there are concerns about the effectiveness of this approach. Allison Adams, an obesity and internal medicine doctor, stated that there's no standard of care or gold standard on how to wean off GLP-1 medications. Studies have shown that people typically regain a substantial amount of weight within a year of stopping GLP-1 medications.

Lily, a patient who regained 20 pounds since going off Wegovy at the beginning of the year, stated that nothing works as well for her as the GLP-1 medication. This underscores the need for careful consideration and individualised approaches when it comes to deprescribing GLP-1 medications.

Steep spending cuts in the budget reconciliation package recently signed into law by President Donald Trump will put pressure on all state Medicaid programs, further fuelling the debate about the cost-effectiveness of GLP-1 medications for weight loss. As the conversation continues, it's clear that the deprescribing of GLP-1 medications for weight loss is a complex issue with significant implications for both patients and payers.