GLP- 1 discontinuation affirms need for holistic weight-loss plan
GLP-1 drugs like Wegovy, Saxenda and Zepbound have been game changers in healthcare. The amount of weight loss is clinically significant for patients taking GLP-1 drugs. This, in turn, has positively affected other comorbid conditions like high blood pressure and diabetes.
Yet, many patients find it difficult to continue the therapy. Understanding the issues that are leading to discontinuation can help improve outcomes and enhance value – a significant concern for employers given that GLP-1 medications are now a leading driver of their non-specialty drug costs.
Studies show high discontinue rates
Most patients should complete at least 12 weeks of continuous treatment to achieve meaningful weight reduction. However, a recent analysis by Blue Health Intelligence found that 30% of patients utilizing GLP-1 medications discontinue treatment during the first month. Other studies looked at drop-off rates over longer time periods. In a study published in JAMA, 26.2% of patients had discontinued GLP-1 therapy at 3 months, and 30.8% and 36.5 % had discontinued it at 6 and 12 months. A Prime Therapeutics study also found that adherence to these drugs was poor, with 71% of individuals taking GLP-1 drugs discontinuing use after one year and 85% after two years. Put another way, only 1 in 7 patients in the study remained on therapy at the end of two years.
A number of factors are blamed for discontinuation:
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Side effectsAlmost all new utilizers experience side effects like stomach pain nausea, vomiting and diarrhea.
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Ineffective prescribingProviders may not be specialized in obesity management. According to a Blue Health Intelligence study, those who receive prescriptions from an endocrinologist or obesity specialist were more likely to continue and complete 12 weeks of treatment.
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Dosing frequencyAdherence to once a week treatment.
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CostsMany GLP-1s cost over $1,000 a month. Based on plan design and availability of copay cards, some patients may not be able to afford to long term.
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Drug shortagesSignificant increase in demand. Manufacturers are expected to increase production to meet demand. Some pharmacy benefit managers no longer offer GLP-1s via home delivery and are limiting day supplies (30 days) even if plan design allows for 90 days.
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AgeYounger patients may be less likely to be adherent or continue therapy.
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Changes in plan coverage/plan designPatients may experience a change in cost share, stricter prior authorization requirements or even lose coverage.
