Managing the Spend Gain of OZEMPIC

Spending on GLP-1 drugs, specifically OZEMPIC? and its higher-dose version WEGOVY?, has surged due to their off-label use for weight loss rather than treating Type 2 diabetes. OZEMPIC? prescriptions have increased significantly, surpassing other specialty medications. This unexpected spike in spending caught employers off-guard as most plans are not designed to handle such fluctuations. Employers can implement strategies like timely data analytics, preventive measures against off-label utilization, and combining medication coverage with care programs to manage costs while meeting employees' needs.

The Rising Expenses of GLP-1 Drugs

Spending on GLP-1 drugs which treat Type 2 diabetes and obesity has surged. Weekly prescriptions for OZEMPIC? soared 111% between Feb 2022 to Feb 2023, making it the costliest drug for many employers, surpassing common specialty medications in total annual spending. The popularity is primarily due to off-label use of OZEMPIC? for weight-loss rather than Type 2 diabetes.?

WEGOVY? is a higher-dose version of OZEMPIC? that has been approved by the FDA for chronic weight management with criteria in place to ensure appropriate access.?

OZEMPIC? and WEGOVY? typically cost $10.8K and $15.6K per patient annually. While immediate weight-loss can come quickly for patients, obesity is a chronic condition and medications for weight-management are meant for long-term use, not a 3–4-month stint. A recent study supported this and concluded that “One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.

Because of the chronicity of obesity, employers should anticipate that costs associated with off-label utilization of OZEMPIC? and WEGOVY? prescriptions will increase in perpetuity with new patients.

The Off-Label OZEMPIC? Challenge for Pharmacy Plans

Most pharmacy plans are not set up to protect against unexpected spikes in spending due to off-label OZEMPIC? utilization.

Weight-loss medications are often excluded from plans, but plan language typically does not require a diabetes diagnosis to obtain GLP-1 drugs like OZEMPIC?. This allowed off-label usage of OZEMPIC? to suddenly spike, catching plans and budgets off-guard. Because employers usually do not have timely access to data, many did not realize this was the driver until budgets had already been breached.??

Excluding weight-loss medications entirely could harm employee retention as demand and availability increase.?

According to a recent survey, 44% of people with obesity would change jobs to gain coverage for treatment. Addressing needs by providing access to appropriate weight-loss medications combined with care programs to help patients achieve and maintain goals will become increasingly important.?

Strategies for Managing Weight-Loss Medications in Benefit Plans

Managing the plan requires oversight and enforcement of plan rules while ensuring patients get the care they need. With the rise of expensive, but effective, weight-loss drugs, employers need to be prepared to contain costs while meeting the needs of their employees. Top strategies to consider for a cost-efficient and effective weight-management strategy include:?

1. Deploy timely data analytics to track utilization and cost for these medications on demand?
2. Prevent off-label OZEMPIC? utilization – proactively discuss and implement measures such as requiring a diabetes diagnosis to obtain OZEMPIC? to ensure appropriate usage of the drug?
3. Combine coverage of weight-loss medications with programs that promote diet and exercise changes – ensures members have access to these medications while giving them a support system to help them maintain goals for the long-term?

How You Can Address Off-Label OZEMPIC? Utilization

For one client, we noticed significant utilization of OZEMPIC? driving an unexpected upward trend as soon as we were engaged in late 2022. The client needed to quantify drivers of trend in 2022, plan for 2023 budget, and explore ways to address these issues (OZEMPIC? utilization being a primary one) in 2023.?

As soon as we received the data, we identified that the OZEMPIC? trend was likely due to off-label utilization – as more than half of their OZEMPIC? utilizers had no history of other diabetes medications. After working with Finance to quantify impact on 2022 budgeting and plan for 2023, we proactively worked with the PBM to understand what options existed in the current plan design to address this. Through this questioning, we identified that there were hardly any controls in place to prevent off-label utilization.

As a result, the client pushed the PBM to implement their new strategy to prevent this off-label utilization of OZEMPIC? starting in the summer of 2023 and we are well-positioned to immediately track the value this is providing. Through on demand analytics and access to data, the client is confident in their ability to voice concerns about the strategy and back it up with numbers if it does not perform as expected.?

We are seeing similar (albeit less dramatic) trends across most of our other clients.

What impact could this trend have on your organization? Wellnecity can help track down the necessary data to do a full analysis and create strategies to incur savings. Contact me today at [email protected] for more information.

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