News & Insights
Check out EpiphanyRx’s latest Fast Five Series post!
Got 5 minutes (or less)?
We’re sharing 5 quick industry insights about pharmacy benefits.
Read Time: < 5 minutes
Navigating the current complex landscape of weight management programs and tools can be overwhelming. GLP-1 prescriptions for weight loss are rising, along with higher costs and concerns about their side effects.
Many employers are realizing the need for healthier weight solutions that manage plan costs while empowering members to take control of their health and prioritize wellness. In this Fast Five, we’ll address five common questions regarding GLP-1 medications and alternative healthy weight solutions such as Noom and Virta.
1. What are GLP-1 medications, and why are they popular for weight loss?
GLP-1 (glucagon-like peptide-1) agonist medications have recently surged in popularity for their effectiveness in promoting weight loss and managing type 2 diabetes. They work by enhancing insulin secretion, suppressing appetite, and slowing gastric emptying.
However, as costs for these medications rise and concerns about long-term reliance grow, many individuals and health plans are seeking alternative solutions that focus on sustainable lifestyle changes rather than prescriptions.
2. What are the potential risks and side effects of using GLP-1 medications?
While GLP-1s can offer benefits for managing conditions like type 2 diabetes and obesity, they are not without side effects. Common side effects may include nausea and digestive issues, which may or may not improve over time as the patient adjusts to the medication. In some rare cases, more serious risks such as pancreatitis, kidney problems, or thyroid tumors have been reported. GLP-1s require ongoing monitoring and focus on diet. Nutritionists recommend patients adhere to high protein, high fiber diets with nutrient supplementation to stay healthy and reduce side effects. Additionally, patients with a personal or family history of certain health conditions, such as thyroid cancer or pancreatitis, may need to avoid GLP-1s entirely.
Beyond health risks, the high cost of GLP-1 medications can financially impact both patients and pharmacy benefit plans. These medications are often priced at a premium, leading to high out-of-pocket expenses for members, especially if their insurance coverage is limited. For pharmacy benefit managers (PBMs) and health plans, costs are also substantial, as the increasing use of GLP-1s contributes to higher overall drug spend.
3. How can a pharmacy benefit manager help implement healthy weight solutions?
A true PBM partner understands that members’ health extends beyond the pharmacy counter. Therefore, a PBM should be committed to providing a holistic suite of healthy weight solutions tailored to clients’ needs. Examples may include:
- Providing Coverage Options: PBMs may give clients the option to cover weight loss medications or not; for example, EpiphanyRx specifically offers a standard formulary with a number of opt-in lists for drug categories such as weight loss.
- Innovative Prior Authorization Processes: The PBM can facilitate streamlined approvals for GLP-1 medications while providing comprehensive analyses and pharmacy audits to ensure appropriate use. PBMs may offer the option of standard or stricter PA criteria including BMI standards or comorbid condition diagnoses and advise whether one approach risks a financial impact to overall costs of these medications.
- Integration of Comprehensive Healthy Weight Programs: Resources such as nutrition education, fitness programs, personalized wellness coaching, and programs like Noom and Virta support members in creating sustainable lifestyle changes that enhance their overall wellness. By incorporating these programs, PBMs can help clients provide effective, behavior-focused solutions that empower members on their weight management journeys.
A combination of the above strategies ensures medication is only used when appropriate and members also receive behavior modification strategies.
Everyone’s weight journey is different, just like every client’s clinical needs and requirements are different based on their employees. We recommend working with a PBM partner like EpiphanyRx and Navitus that helps clients reduce health care costs and enhance member wellness through customized solutions, unique to their needs.
4. What are the advantages of implementing weight-loss and diabetes reversal programs such as Noom and Virta over just covering or managing GLP-1 medications?
While GLP-1 medications focus primarily on pharmacological interventions, Noom and Virta provide holistic, behavior-focused strategies that prioritize lasting lifestyle changes.
- Noom’s focus on sustainable habits aligns well with long-term health goals. Noom uses a digital platform that combines behavioral science with personalized support from registered dietitians and trained health coaches. It emphasizes education and accountability to help individuals develop healthier habits for long-term weight management.
- Noom participants frequently report improved health metrics, including successful weight management and better nutritional choices, leading to enhanced overall well-being.
- Virta offers a high-touch approach with individualized coaching and a “food-as-medicine” philosophy. It aims to reverse diabetes and obesity through behavioral changes, remote monitoring, and collaboration with existing healthcare providers. Virta encourages deprescribing medications where appropriate, focusing on sustainable health improvements with less reliance on GLP-1s.
- Virta users achieve an average weight loss of 12% after one year and a 60% reduction in prescription utilization.
- 97% of prediabetic participants did not progress to type 2 diabetes over two years.
- Virta presented research at the 2023 American Diabetes Association Conference which demonstrated that at one year, Virta delivered clinically significant reductions in A1C and body weight for members, regardless of their socioeconomic background.
Both programs are custom tailored to each user’s unique health needs and goals. Noom and Virta’s remote care teams provide support when and where users need it via a smartphone app.
5. What are the benefits of utilizing healthy weight programs like Noom and/or Virta?
Noom and Virta each provide a proactive approach to member health, helping members at risk for obesity or type 2 diabetes prevent or delay disease onset. By helping members lower their blood sugar, they can also reduce the risk for medical complications like kidney disease, eye problems, heart attacks, and strokes which are costly for both the member and plan.
Both Noom and Virta have demonstrated significant clinical outcomes highlighting their effectiveness, along with substantial cost savings for plans due to lower drug spend.
Noom has shown success in fostering weight management and behavior change by focusing on personalized support and educational resources. Participants often report improved health outcomes and greater awareness of their lifestyle choices.
- 40% of engaged users lost more than 5% of their body weight.
- 42% of users maintained that weight loss for 2 years.
Virta boasts impressive results from clinical trials, including significant weight loss and reduction in diabetes medication usage. The program’s emphasis on reversing chronic conditions has led to positive health changes for many participants.
- 94% of type 2 diabetes patients reduce or eliminate insulin after one year.
- $551 PMPM type 2 diabetes plan cost savings (a 2:1 return on investment) over 2 years.
These outcomes indicate that investing in lifestyle-based solutions can lead to meaningful health improvements for members without needing to intensify drug regimens and reduced plan healthcare costs over time.
To encourage holistic health benefits for members, consider implementing healthy weight solutions through the pharmacy benefit. At EpiphanyRx, we’ve expanded our existing healthy weight solutions to include partnerships with Noom and Virta. These behavioral modification programs have the potential to significantly enhance members’ health, with or without additional drug coverage.
Noom and Virta are available to all EpiphanyRx clients, regardless of client size, at special discounted pricing, with simple contracting and implementation.
To learn more about all of EpiphanyRx’s innovative healthy weight solutions and how their impact results in savings for your members and plan, reach out to us at sales@epiphanyrx.com.