The Rising Use of GLP-1 Drugs and How it Impacts Pharmacy Spend
PharmPix Corp
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By: Dr. Eric Frontera , PharmD
The rising use of novel obesity and diabetes management drugs, particularly GLP-1 agonists, continues to impact drug spend and patient health. Glucagon-like peptide-1 (GLP-1) agonists are a class of medications used to treat Type 2 diabetes and obesity. You may recognize some of the brand names: Wegovy (semaglutide) and Zepbound (tirzepatide) are approved by the Food and Drug Administration (FDA) for weight loss, and Mounjaro (tirzepatide) and Ozempic (semaglutide) are approved for helping with Type 2 diabetes. This new class of drug spend is growing fast; IQVIA reported utilization of nearly 700,000 GLP-1 agonist new prescriptions across diabetes and obesity in February 2024, up 181% compared to two years prior.
Clearly, these drugs have changed the landscape for the treatment of obesity and diabetes, and additional testing shows the benefits don’t stop there. According to a recent study published in the New England Journal of Medicine, tirzepatide was shown to reduce the risk of obstructive sleep apnea, and other studies have shown a reduced risk of major cardiovascular events. While tirzepatide is not currently approved for the treatment of obstructive sleep apnea among obese patients, the findings from these trials may be used to seek approval for this indication from the FDA in the future. Given the high-cost medications such as tirzepatide and other GLP-1 agonists, there is significant concern regarding affordability.
PharmPix’s utilization data for GLP-1 drugs shows a 97% increase in plan cost for H1 2024 compared to H1 2023. As a major driver for increased drug spend, PharmPix has implemented robust utilization management strategies to ensure these drugs are being used appropriately and to ensure access to GLP-1s to those members with clinical necessity. Additionally, we’ve implemented point of sale alerts and edits to block inappropriate drug combinations with GLP-1s. Our clinical team is alerted to the rejection and then evaluates the potential side effects of the drug treatments together and determines if the combination will lead to better outcomes.
An example of this strategy that proved successful was when a 52-year-old patient was prescribed two diabetes medications, Trulicity and Januvia, which caused PharmPix’s HyperCare POS alert ?program to detect a potential duplicate therapy when the pharmacy processed the claims. Before the drugs were dispensed, PharmPix’s clinical team was alerted to the issue. After reviewing the clinical guidelines for diabetes management, they found the use of a dipeptidyl peptidase-4 (DPP-4) inhibitor (Januvia) and a glucagon-like peptide-1 (GLP-1) receptor agonist (Trulicity) have not shown better clinical outcomes and are not recommended. Therefore, the request was denied. The ability to detect and evaluate duplicate therapy before a prescription is filled helped the patient to avoid potential side effects such as pancreatitis and renal failure. It also helped reduce costs to both the patient and the payer, estimating approximately $150,000 in annualized savings.
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A combination of utilization management, clinical programs, and technology is needed to provide better access to GLP-1s for those members who need it most and to help lower plan costs. However, the efforts shouldn’t stop there. Member education on the appropriate use of these drugs is important and necessary. PPx offers? cost savings opportunities? through our Dynamic Clinical? Management Programs and will work with clients to implement point of sale alerts to monitor appropriate use.
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