Health plan brokers are well aware that GLP-1 receptor agonists, such as Ozempic, Trulicity, Tirzepatide (Mounjaro and Zepbound), and Wegovy, offer significant benefits for managing type 2 diabetes and obesity. GLP-1 medications help control blood sugar, promote weight loss, and improve cardiovascular health. But, they also come with high costs for health plans and employers. Mismanagement and improper use—such as people using GLP-1s for minor weight loss—are significant drivers of these expenses. Implementing a GLP-1 management solution can ensure that the appropriate members receive these medications, use them correctly, and achieve optimal outcomes.
GLP-1 therapies are among the most expensive treatments available, with annual costs exceeding $10,000 per member. While some GLP-1 medications are primarily approved for managing type 2 diabetes, the FDA has approved some for the treatment of obesity.
GLP-1 medications—particularly by individuals who seek to lose just a few pounds rather than manage obesity—will significantly drive up costs. While semaglutide and high-dose liraglutide are FDA-approved for weight loss, the demand for these drugs among individuals who do not meet clinical criteria for obesity leads to higher spending for health plans and employers.
To control costs while maximizing health outcomes, it's essential to implement a comprehensive GLP-1 management solution. This approach ensures the right members receive the right treatments at the right times, reducing misuse and improving effectiveness.
Here are the key elements of an effective GLP-1 management solution:
Eligibility Screening: The solution should include screening processes such as blood panel tests and a physician interview to assess a member's health status and confirm whether GLP-1 therapy is appropriate. This helps ensure that treatments are medically necessary and align with the health plan’s summary plan description.
Alignment with FDA Guidelines: The solution must adhere to FDA guidelines on proper use of GLP-1 medications.
Ongoing Monitoring: A robust GLP-1 management solution should incorporate monitoring to track member progress, side effects, and treatment efficacy. Regular assessments help optimize therapy and allow for proper titration.
Assisted Lifestyle and Behavior Modification: The solution should include support for lifestyle and behavior changes, such as diet and exercise programs, to maximize the effectiveness of GLP-1 therapy.
Here’s a closer look at some of the key pieces.
Healthcare should never be one-size-fits-all. Every health journey should begin on the individual’s current path.
Considering the barriers and limitations they may be facing is part of a holistic approach to treatment. Tailored dosing, which may include adjusting doses to minimize side effects or altering co-medications like insulin or metformin, helps ensure the most efficient use of GLP-1 therapies, optimizing results and reducing costs..
Monitoring is key to determining whether members are responding effectively to GLP-1 therapy. A good GLP-1 management solution should incorporate medication adherence tools, like reminders or telehealth check-ins, to ensure members stay on track with their treatments.
Regular monitoring and follow-ups help providers catch issues early, optimize treatment outcomes, and reduce unnecessary spending.
While GLP-1 medications can be effective on their own, their success is greatly improved when paired with lifestyle changes. Members who don’t adopt healthier eating habits or exercise routines may not see the full benefits of the treatment, leading to extended or unnecessary costs.
Lifestyle counseling services that include dietitian support and exercise programs should be accessible and personalized.
Even after members achieve their health goals, there is always the risk of relapse if they discontinue medication or backslide into old lifestyle habits. By offering long-term support you can help members maintain healthy outcomes, even after discontinuing GLP-1 medications. Preventing relapses not only improves overall health outcomes but also helps control long-term spending.
Managing the high costs associated with GLP-1 therapies requires a structured, well-targeted approach. That’s why Diathrive Health has created a GLP-1 management solution that focuses on member assessments, education, monitoring, and lifestyle coaching to ensure that the right members are receiving GLP-1 therapies. Our solution maximizes benefits while controlling costs. If you are ready to implement a GLP-1 solution for your members, let’s talk!