The world of GLP-1s is quickly evolving with new clinical research, insurance coverage decisions, and emerging products on the market.
To dive into these issues, Becker's sat down with Christine Ren Fielding, MD, professor of surgery at NYU School of Medicine, director of the NYU Langone Weight Management Program and chief of the system's division of bariatric surgery.
Question: The GLP-1 market is facing low supply and competition right now, alongside high consumer demand and pricing — what are you seeing and hearing among your patients?
Dr. Christine Ren Fielding: The challenges are very real and very significant because of demand that has always been there. This tremendous demand is merely a reflection of the severity of our country's obesity problems. The supply issues are the same or worse because the demand is there and the indications have been broadened. For example, Mounjaro or Ozempic are really for diabetes but now we're seeing evidence that it'll help with sleep apnea or other comorbidities. You can make the argument that these medications are beneficial for fatty liver disease, hypertension, high cholesterol, infertility, or really any medical problem that is impacted by weight.
Q: In June, we saw the first generic GLP-1 announced. What kind of impact do you think that could have on the market?
CRF: I don't think there's going to be any major impact because it'll just address and help the people who have had no access. Paying $1,000 a month is quite prohibitive for most people. I don't know what the cost of the generic will be, but it will be more approachable. But it's still going to be out of pocket and I'm sure it's not going to be $5.
Still, it will allow a gigantic population of individuals to have some hope in weight control. Not everyone is a responder to GLP-1s, so if you can purchase something that's cheaper, you can at least try it. If it doesn't work, that box is ticked off and you can try something else. So the generic will help more people that didn't have access in the first place, but I don't think it will replace or decrease the current demand.
Q: Research recently published by BCBS found nearly 60% of patients taking GLP-1s don't reach a meaningful health benefit — what do findings like that suggest to you?
CRF: This is very important because it brings up to two issues. Number one, it's true that there is a threshold of how much weight people will lose. And number two, if they stop using these medications, then their weight will most certainly recur, along with all their health problems. Sustaining people on these medications can oftentimes be difficult because they can't get a certain dosage, which slows down the appropriate treatment. You need access to consistency and the right utilization of these medications in order to gain a benefit. Sometimes there's a better option and medications. If you're a responder to appetite control caused by a GLP-1, then there's another treatment option that will do exactly the same thing: bariatric surgery. That includes Lap-Band, sleeve gastrectomy, and gastric bypass.
Insurance companies are seeing that they're getting more reliable outcomes and savings in the long run if they pay for someone to have bariatric surgery. Insurers are even putting up barriers for people who want to be covered for GLP-1s and taking down barriers for people who want to have surgery.
Q: We've seen insurers and employers drop coverage of these medications recently. What would your message be to organizations weighing this decision?
CRF: They have put the brakes on very quickly because they've seen the tremendous expense. And if you do the population health math, these medications will bankrupt the healthcare system. The generics are a good thing because it'll help spread out the cost across the system and weed out the people who are not responders.
Still, insurers don't seem to balk at covering diabetes medications such as Metformin. If you can control weight, then you can control a lot of other medical problems that often require many other medications anyway. Paying for one medication to help a patient lose weight often means they're saving money in other ways.