According to Ward et al. (2019), 71% of adults in the U.S. are overweight and 40% of adults are obese. With the recent FDA approval of new weight loss medications Wegovy and Saxenda, the demand for Glucagon-Like-Peptide-1 (GLP-1) medications for weight loss has skyrocketed. Other medications in this class include Mounjaro, Ozempic, Trulicity, and Victoza. The other medications are used primarily for diabetes but possess the same ability to reduce weight.
To address the increasing burden that obesity has on healthcare costs, we’ve developed the Healthy Weight Program. This program provides controlled access to weight loss medications and monitors their success and participants’ adherence to the treatment plans suggested by their physicians.
Higher Pharmacy Costs for Obese Plan Members
Obesity is a growing problem worldwide, with an estimated 650 million adults classified as obese. In the United States alone, obesity affects over 40% of the population, leading to a higher risk of chronic diseases such as diabetes, hypertension, and cardiovascular disease. According to the 2019 study by Ward et al., this figure is expected to rise to over 50%, with over a quarter of patients exhibiting the characteristics of severe obesity.
Various studies (Gazmararian et al. 2015, Cawley et al. 2021, and Thompson et al. 2019) estimate that pharmacy costs for obese plan members are 87%-186% higher than pharmacy costs for non-obese members. Moriarty et al. 2012 compared the annual costs of obesity to smoking and found that, of the two, obesity results in significantly higher healthcare costs.
Both payers and their members benefit when maintaining a healthy weight using sustainable weight loss methods are encouraged.
Weight Loss Medications: Balancing Costs vs. Access
A study by Watkins, et. al. (2022) found that patients using GLP-1s are twice as likely to be classified in a lower obesity class than those not using anti-obesity medications. After an initial rise in pharmacy costs during the first year of use, pharmacy costs for those on GLP-1s and other anti-obesity medications decreased while costs for non-anti-obesity medication users continued to climb.
The effectiveness of these medications makes GLP-1s a popular choice for individuals struggling with maintaining a healthy weight. However, these medications also tend to be high-cost, sometimes costing as much as $1,200 per month. Many plan sponsors are concerned about the impact of increased use of these medications on already strained pharmacy budgets. The combination of the effectiveness of GLP-1s and the publicity these medications have received makes these medications a popular choice among prescribers and patients. In an effort to balance patient health and strained pharmacy budgets, sponsors are looking for ways to offer these medications while mitigating waste.
Introducing Araya’s Healthy Weight Program
Upon seeing both the increasing rates of obesity and the rising cost burden of obesity-related illnesses, Araya has created a program that helps address both problems. Our Healthy Weight Program gives patients access to the effective weight loss medications they need for better health while eliminating the use of these medications for cosmetic purposes alone.
With the Healthy Weight Program, utilization of products is limited to patients meeting recognized standard criteria for initiation of therapy. It further monitors patients’ progress toward goals to continue therapy. The program helps meet patient and prescriber demand while ensuring patients actively participate in their prescribed therapies. We strongly believe that adherence to the program will not only help reduce patients’ weight but will also reduce overall costs to payers through a reduced medical and pharmacy spend.
The Healthy Weight Program allows plan sponsors to know they are helping members improve their health while keeping pharmacy costs from running unchecked. The end goal is to help members achieve a sustainable healthy weight without the need for chronic use of these medications.
Healthy Weight Programs for PBMs Are a Necessity
The rising costs associated with the impact of obesity on overall health and the increasing cost of weight loss medications pose a significant challenge to plan sponsors and payers. Araya’s Healthy Weight Program provides a solution that gives members access to the necessary medications and the support and motivation necessary to meet weight loss goals.
By emphasizing the combination of physician-recommended diet and exercise programs alongside these medications and requiring regular check-ins and goals that are met, we can help ensure members adopt the healthy habits that benefit them in the long term and reduce medical costs.
Contact Araya today to learn more about how the Healthy Weight Program can help you manage the rising cost of weight loss medications.
