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July 10, 2024

How employers can navigate GLP-1 access and costs

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How employers can navigate GLP-1 access and costs

In a remarkably short span, public awareness of glucagon-like peptide-1 (GLP-1) drugs has surged dramatically. According to a recent report, one in three American adults reports hearing “a lot” about these drugs (source).

At Garner, we recently analyzed our dataset encompassing over 320 million patient records to offer critical insights for employers navigating this challenging landscape.

Our analysis uncovered a surprising trend: "wasteful" prescriptions from a small cohort of doctors are disproportionately inflating employer costs. To provide access to these potentially transformative drugs while managing costs, it is essential employers understand how each individual physician prescribes them and guide patients to those who use these medications most effectively.

Access and Cost Implications For Employers

Beyond making headlines, the rise in actual GLP-1 usage is noteworthy. Our data reveals that nearly 2 percent of the U.S. population has utilized a GLP-1 drug. Projections from J.P. Morgan indicate that by 2030, this figure could swell to 10 percent, reflecting the ever-growing popularity of these treatments (source).

Figure 1: GLP-1 usage growth, 2018-2024, measured using Garner’s claims data of over 320 million patients corrected for claims lag.

For employers, the financial burden of GLP-1 drugs presents a formidable challenge, with most of these medications exceeding $10,000 per person annually. For example, one year's supply of Wegovy is priced at a staggering $16,188.24 (source).

Sign up for the webcast: "Navigating the GLP-1 Surge: Data-Driven Strategies for Employee Health and Cost Management"

Our findings reveal that GLP-1 drugs are already exerting a substantial impact on employer medical expenses, with costs rising exponentially in recent years.

Figure 2: GLP-1 medical spend as a percentage of overall employer medical spend.

Evaluating the Efficacy of GLP-1s

Given their considerable costs, one might ask: Are GLP-1 drugs worth the investment? For certain patients, the answer is yes. Research underscores that GLP-1 drugs yield significant benefits for a range of conditions. Specifically, GLP-1s demonstrate remarkable efficacy in managing diabetes (source) and enhancing cardiovascular health (source).

However, the answer changes when considering patients using GLP-1s solely for weight loss. Although these drugs facilitate weight reduction—Wegovy, for example, reduces body weight by 15 percent over 68 weeks for individuals with a BMI of 27 or higher (source)—there is scant evidence linking GLP-1-induced weight loss to improved health outcomes in patients without chronic diseases.

Minimal Impact, High Net Cost for Low-Risk Patients

To gain a clearer picture of GLP-1 cost benefits, we analyzed two patient segments: high-risk patients (e.g., those with diabetes, heart disease, morbid obesity) and low-risk patients (i.e., those with low to moderate obesity but no other chronic diseases).

For high-risk patients, GLP-1s notably enhance health outcomes, reducing incidents of heart attacks, hospitalizations, and emergency room visits. These improvements translate into lower overall healthcare costs by mitigating future medical expenses. Conversely, for low-risk patients, the benefits are minimal, with negligible differences in health outcomes and subsequent savings.

Figure 3: The 5-year net cost of a GLP-1 prescription for a single high-risk versus low-risk patient.

Poor Adherence Issues Lead to Significant Waste

A December 2023 study by JAMA (source) highlighted a critical issue: discontinuing GLP-1s prematurely results in losing nearly all benefits. Our further analysis revealed a concerning trend—65 percent of patients who initiated GLP-1 therapy have since ceased usage.

Figure 4: Percentage of the U.S. population currently on a GLP-1 medication versus all of those who have ever used a GLP-1 medication, measured using Garner’s claims data, corrected for claims lag.

Examining the cost and health implications of this trend, we focused on "low-value" prescriptions—those issued to patients diagnosed as obese solely to qualify for GLP-1s or who discontinued treatment within six months, deriving little lasting benefit. Alarmingly, the number of these prescriptions has more than doubled over the past four years, nearing half of all GLP-1 prescriptions.

*Low-value is defined as a prescription where the patient is diagnosed as obese by their doctors in order to qualify for the medication or stopped treatment within 6 months.

Figure 5: Percentage of GLP-1 prescriptions considered low-value over the past 5 years according to Garner’s claims data.

GLP-1 Management Strategies for Employers

Employers frequently inquire about how to incorporate GLP-1s into their health plans while restricting their use to high-impact cases. Our analysis underscores the pivotal role of physicians in optimizing GLP-1 efficacy. By assessing the "waste rate" of GLP-1 prescriptions for each doctor—defined as the percentage of prescriptions given to patients without prior disease history or discontinued within six months—we identified a stark disparity. The bottom quartile of doctors exhibited a waste rate six times higher than the top quartile. The profound implication is that if top providers managed all patients, GLP-1 costs could be slashed by 79 percent.

*Waste rate is defined as a prescription where the patient stops using the medication within the first 6 months or the prescription was for a patient that did not have a previous diagnosis of CAD, diabetes, or obesity.

Figure 6: The distribution of individual providers and their prescription waste rates.

A Call to Action for Employers

To maintain competitiveness and effectively support their workforce, employers offering GLP-1 drugs must consider pairing these offerings with programs directing members to high-performing providers. At Garner, we have incorporated new metrics on GLP-1 usage into our catalog of over 500 clinical metrics. By steering members toward Garner Top Providers, employers can ensure access to GLP-1s while curbing the costs associated with unnecessary waste. This strategy represents a mutually beneficial solution for both employers and employees.

For more, join our webcast "Navigating the GLP-1 Surge: Data-Driven Strategies for Employee Health and Cost Management."

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