Earlier this year, Corporate Insight attended the 2024 Moonshots for Health: Sparking a Revolution in Metabolic Health, a conference sponsored by Virta Health. Over three days, industry leaders, including representatives from major health insurers, gathered virtually to discuss the ongoing craze of GLP-1 drugs and their future in healthcare. With ever-increasing avenues for patients to access these medications—one panelist noted that the ease of access to a GLP-1 prescription is “unprecedented”—and with new GLP-1 drugs on the horizon, concerns about the drugs’ manufacturing, cost and regulation are more important than ever to address. Speakers took several approaches to discussing the topic. Here, we’ll explore some prominent themes including patient education and digital engagement.

Consider all options before turning to a GLP-1

The high cost of GLP-1 drugs forces insurers to consider the extent to which they cover these medications for specific patient populations. Panelists at the 2024 Moonshots for Health Conference expressed concern about the cosmetic use of GLP-1s. In response to such concerns, insurers are attempting to focus efforts on creating a determination process that would certify a patient as a qualified GLP-1 candidate who would truly benefit from the drugs’ intended purpose. Since the drugs are so expensive, insurers seem hesitant to propose GLP-1s before exhausting other approaches to weight loss.

Representatives of two large health insurers, BCBS of Massachusetts and Blue Shield of California, discussed their similar runway approaches in which patients must complete a six-month weight management program before trying a GLP-1 drug. Such a runway might ensure that those who receive coverage for a GLP-1 have tried other lifestyle-focused options before resorting to an expensive injectable. A runway also proves to the insurer that the patient is “in it for the long haul,” as Angie Kalousek, Senior Director of Lifestyle Medicine at Blue Shield of California, put it. Effective lifestyle modification seems to be insurers’ favored preliminary method for funneling down the number of patients seeking GLP-1 coverage.

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Optimizing GLP Usage in the Digital Age

It is assumed that patients will begin exploring the risks and rewards of GLP-1 use from a computer screen, whether that’s reading about the drug in an article or conducting a search via a health insurer’s site. Insurers and health systems are thus tasked with creating appropriate resources that aptly capture their drawbacks and benefits of these medications. Representative Sukanya Soderland from BCBS of Massachusetts recommended implementing personalized navigation to help patients understand the relative tradeoffs “in terms of costs, side effects, time commitment, etc.,” when taking GLPs. However, given these drugs come at such a significant cost and require long-term usage, insurers must also consider implementing personalized navigation guiding users toward alternative options before they commit to GLPs. Digital engagement is a key area of development for GLP-1 programs as well as an opportunity for user-centric design to positively impact the weight loss medication journey.

Personalized navigation guides users toward resources tailored to their unique needs, streamlining their search process and eliminating the need to sift through irrelevant sources. Ideally, this navigational feature promotes user participation in health programs by fostering meaningful user engagement. Seth Friedman of Gallagher Insurance echoed this sentiment, stating that individuals must engage with their coverage to productively utilize holistic weight loss solutions rather than defaulting to high-cost weight loss drugs as a primary option.

CI’s Wellness Rewards Program report (subscription required)—a comparative analysis conducted on 12 major insurers last September—shows that approximately half of firms offer customizable experiences, providing members with recommended activities based on their health assessment results and topics of interests. Enrollees of these firms have a greater incentive to initiate and complete activities related to health, nutrition and fitness as the activities themselves are connected to the enrollees’ personal preferences. For instance, Anthem BCBS members can find personalized content and programs by indicating what areas of change they would like to focus on, such as weight loss, eating healthy, and getting active

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Anthem BCBS My Health Dashboard Ready to Make a Change Section

Patient education is a key to long-term success

Speakers at Moonshots for Health 2024 agreed that patients need to understand not only what happens upon stopping a GLP-1 drug but also the side effect and efficacy profiles of the drug. Panelists emphasized pre-treatment education as a solution to currently high discontinuation rates for these drugs. Educating patients on the known side effects and financial requirements of GLPs could help alleviate the issue of nonadherence, as both factors are major contributors to discontinuation as seen in the graph below.

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The popular narrative of these drugs as a quick-and-dry weight loss solution is not what the scientific data supports. When a patient ceases GLP-1 treatment, they risk regaining weight that was shed during treatment. One idea proposed at the conference was providing GLP-1 adherents with a specialized healthcare team to help them adjust their lifestyle before stopping the drug. The recovery journey of gastric bypass patients is a good reference to illustrate a potential solution for transitioning off GLPs, suggesting it may take different types of healthcare providers—i.e., nutritionists and primary care providers both—to provide patients with the support and expertise they need. Further, this specialized care team presents an opportunity for patients to have an extensive personalized education center, allowing them to develop a relationship with vital weight loss resources both during and after treatment. Organizations with the predictive capabilities to produce digitized post-GLP resources will gain the most from covering these medications, as enrollees will be less likely to backslide into unhealthy habits with access to external support.

The Future of GLP-1s

Despite the constant debate surrounding management and financing of GLP-1s, the drugs’ future remains uncertain. Soderland of BCBS of Massachusetts estimates that GLP-1s will be responsible for 10% of the firm’s spending by 2025—up from a mere 2% in 2022—while national projections predict that current GLP spending will double by 2035. As the healthcare field prepares to face this surge in spending, payers and providers must keep in mind how to deliver quality care that is both affordable and accessible. New advancements in manufacturing may also play a role: Ellen Kelsey from Business Group Health shed light on the impending production of alternative versions of GLP-1s in the form of pills and tablets rather than injections. Such innovations will likely impact the cost of production—the direction of which is yet to be determined—affecting accessibility and potentially spurring increased usage.

The healthcare field expects the voice of large group employers to be the most influential in creating tangible action regarding GLP-1 coverage expansion. Soderland of BCBS of Massachusetts highlighted the role of large group employers, as what these firms advocate for often flows downstream into small group coverage and establishes norms across the payer landscape. Eberle of Navitus proposed another theory, suggesting that public pressure will play a pivotal role:

“History teaches us that public pressure is able to sway coverage,” Eberle stated. “I’d be shocked if there wasn’t expanded coverage from CMS, which will put huge pressure on public plans to afford these products.”

As the popularity of GLP-1s grows, stakeholders are faced with critical questions regarding manufacturing, cost, regulation and equitable care. The emergence of alternative formulations, evolving insurance coverage models and increased educational resources highlight shifting dynamics surrounding the medication. However, what is clear is the need for ongoing dialogue and strategic planning. The future of GLP-1s offers opportunities for innovation and collaboration among providers and payers as they create improved metabolic health outcomes for patients on a broader scale.

For more insights into digital innovation in the healthcare space, check out our research services in four areas: Health Plan, Medicare, Health System and Pharmacy. For deep dives into specific topics, check out our Healthcare Briefings. Don’t forget to visit our Insights section for more industry trends and best practices across the healthcare industry.

Christal Oji

Christal Oji is an analyst on CI's healthcare research team.

Jackson Farmar

Jackson Farmar is an analyst on CI's healthcare research team.