Putting GLP-1s in the hands of those who need them most
GLP-1s are having a moment. They could take the lead as the most-sold drug class in 2024, dethroning the anticancer PD-1 inhibitor class1. However, demand for use outside the FDA indication, cost, and product shortages have made it a challenge to ensure the drugs are available to those who need them most.
Originally approved to treat Type 2 diabetes, GLP-1s mimic the naturally occurring glucagon-like peptide 1 (GLP-1) and stimulate the pancreas to produce more insulin after meals.
Prescriptions of the drugs in the U.S. soared 300% between 2018 and 20232.
However, the prescription windfall isn’t due to a sudden increase in diabetes. Rather, obesity has made GLP-1s a household name.
The rise of GLP-1s mirrors the rise of obesity
Since 1980, the prevalence of obesity in the U.S. has risen steadily from 15% to 42% in 20202. Along with its growth came a flurry of 1990s-era weight loss medications quickly followed by reduced demand triggered by the cardiac side effects of Phen-fen.
It wasn’t until 2014 that GLP-1s entered the weight-loss landscape when Saxenda received FDA approval for weight loss.
Turns out, GLP-1s don’t just cause the pancreas to produce more insulin, they also suppress the appetite by slowing the movement of food from the stomach into the small intestine.
Now, 10 years after GLP-1 approval for weight loss, the drug class is expected to see nearly $50 billion in annual sales driven by increased use and a hefty price tag – list price can be over $1,000 per month1.
Blue KC’s GLP-1 strategy
The popularity of GLP-1s has caused nationwide demand and product shortages that make it a challenge to put the medications in the hands of those who need it most. That’s due, in part, to off-label use as a weight loss aid for those without obesity.
Blue KC’s coverage of GLP-1s relies squarely on our strategy to balance member need, product supply issues, and cost containment. For diabetes use, approval follows prior authorization and a rigorous review to ensure the member has a diabetes diagnosis and a clinical need for better glycemic control. For members covered by an employer group that has opted-in to cover weight loss, we require prior authorization and proof of lifestyle modifications3.
Blue KC GLP-1 Requests and Approvals
| 2021 | 2023 | |
| GLP-1 Requests by Blue KC Members | 2,054 | 11,214 |
| GLP-1 Approvals by Blue KC | 68% | 34% |
| Industry Benchmark for Approved Requests | ~80% | ~50% |
“The fact that Blue KC approves fewer GLP-1 requests than the industry benchmark is actually a good thing,” says Blue KC’s Chief Pharmacy Officer Danny Weiss. “It means we’re doing our due diligence, reviewing each request thoroughly, so that people who need the drugs most based on their conditions get them.”
It is this level of scrutiny that has made Blue KC a market leader in the oversight of weight loss drugs and has resulted in 2023 book of business cost savings of $35 million.
More Blue KC weight loss resources
GLP-1s are just part of the weight loss conversation at Blue KC. With obesity-related complications – such as heart disease, hypertension, joint pain, and certain cancers – tallying $173 billion annually in the U.S., we take great care to provide members multiple pathways to manage weight4.
- Blue KC Care Management app connects members to our Kansas City Care Team for help with weight loss and support for other conditions and health goals. Our toolkit makes it easy for employers to encourage employee use of the app.
- Nutritional counseling helps members choose a lifestyle change rather than turning to a pharmaceutical option.
- A Healthier You, available through the MyBlueKC.com member portal, has tools, resources, and incentives for weight loss and healthier living.
- Solera connects qualified members to lifestyle programs to help them eat better, move more, and reduce their risk of developing Type 2 diabetes.
Blue KC covers weight loss medications for large employer groups who choose to cover them3. These groups have the option to apply different cost sharing to weight loss medications versus their standard pharmacy benefit.
Your Blue KC representative would be happy to discuss our weight loss management options. Give yours a call today.
1Fierce Pharma, March 2024
2Innovativerxstrategies.com, Rx History: The rise of GLP-1s, January 2024
3Blue KC offers weight loss medication coverage to large groups. Small groups are not eligible to opt in for weight loss drug benefits.
4 Harvard.edu, Association of body mass index with health care expenditures in the U.S. by age and sex, October 2021
