GLP-1减肥药物的支付策略

MILLIMANWHITE PAPER PayerstrategiesforGLP-1medications forweightloss Helpingpayersunderstand thelandscape,develop acoverage strategy, andminimizewaste AJ Ally,RPh, MBADeana Bell,FSA,MAAAMelody Craff, PhD,MBA,MD,MS,MA,FAHMJeffrey Garbe,RPhMark Gruenhaupt,RPhPeter Heinen, FSA, MAAAEllynM.Russo, MS Approximately 42% of the U.S.population hasobesity1and,with morethan 200 diseases associated withthis condition,the demand for weightloss solutions has never been higher. The glucagon-like peptide-1 (GLP-1)receptor agonist drug class, which has been clinically proven toeffectivelymanagetype2diabetes,2is also proving to be highly effective for thetreatmentof obesity.3Many believeithas the potential to meet thisgrowing need. While GLP-1 medications are costly,they have the potential to decrease medical cost if treated patients achievesustained weight control4in combination with diet andexercise.Furthermore,these medicationshavenow beenshown to reduce the risk of majoradversecardiovascular events.5They also have potential gastrointestinal (GI) sideeffects,which may contribute to low medication adherence and early discontinuation of therapy.In a recent study,more than68% of patientsdid notmaintainGLP-1therapy for12 months.6Based on thesepublished results,Milliman estimates that a payer with similar discontinuation rates may experience 26% waste in drug spend. To properly manage theseopportunities andchallenges, there are key actions payers should take related tocoverage of GLP-1s for weight loss, including: evaluating coverage of obesity medications, ensuring appropriateutilization to addressadherence and persistency issues, developing a patient engagement strategy to ensure optimalvalue, and evaluating pharmacy supply chain contracts to ensure optimal pricing. Ultimately, a comprehensive weightloss and therapy management approach is neededto increase treatment successandimprove patient wellness. Over the past year, there has been a dramatic increase in utilization of the GLP-1 receptor agonist drug class. Thisclass of drugs includes recently approved injectables that have demonstrated a much greater efficacy in weightloss, with a fast onset, and low incidence of serious side effects (requiring warnings and precautions in labeling).Figure 1 summarizes the select GLP-1 receptor agonist medications with weight loss indication and their reportedeffect on body weight. Current medications The estimated average annualwholesale acquisitioncost(WAC)for GLP-1 drug class productsthat areutilized forweight loss ranges from $12,200 to $17,600.12Three other medications(Qsymia, Contrave, and Xenical)arecurrently approved for chronic weight management,withtheWACranging from$2,300to $9,200annually. Clinical distinction GLP-1 drugs mimic the action ofnaturally occurringGLP-1 hormonein the intestinal tract. One of GLP-1’s mechanismsof action is increasing the sense of satiety, the feeling of beingsated orfull, by slowing down the rate at which foodleaves the stomach. GLP-1s also impact the brain’s perception of fullness, leading people to reduce food intake.13 The firstGLP-1 drugs were originally studied and approved to treat type 2 diabetes, showing effectiveness atlowering blood sugar levelsand A1C(a blood testshowing average blood sugar over the priortwo to threemonths).It became evident duringdrug trials that some of the GLP-1 drugs were alsocausing significant weight loss ina largeportion of thestudypopulation, which led to specific drug trials forthat indication.GLP-1 drugs approved for weightloss are all injectable products, dosed either daily or weekly.Once daily Rybelsus (semaglutide) is thesoleoral GLP-1 product currently on the market. It is onlyindicated for the treatment of type 2 diabetes,butit is being studiedfor weight loss at significantly higher doses than those indicated for treatment of diabetes.Initial results were recentlyreleased and show weight loss comparable to the injectable versions of the drug.14 The most commonside effects of thisdrugclassinvolvethe digestive system. Incidenceratesaredependent on themedication and dose, but the most frequent adverse reactions are nausea (31%-44%), diarrhea (21%-32%), vomiting(12%-25%), and constipation(12%-23%).15,16,17,18To minimize the initial side effectsofthese products, theyrequirean initial dose escalation period(stepwise escalation in dosage to achieve therapeutic levels). For example,to reachthe full maintenance dose,Saxenda and Victoza have the shortestdose escalation period (fourescalations over28days),whileOzempicandWegovyhavefour escalations over a 16-week period, and Mounjarohasfive escalationsover a 20-week period.Some potentiallyserious but much rarerside effects includeacutepancreatitis, thyroidtumors,acute kidney injury,heart rate increases,andacute gallbladder disease.15,16,17,18 Noticeable weight loss can often be seen in afewweeks after starting the drugs, with peak weight loss typically seenafter approximately 12 to 18 months on therapy. W