{"id":3677,"date":"2024-07-12T13:58:22","date_gmt":"2024-07-12T18:58:22","guid":{"rendered":"https:\/\/www.bluekc.com\/blueprint\/?p=3677"},"modified":"2024-07-24T11:53:30","modified_gmt":"2024-07-24T16:53:30","slug":"putting-glp-1s-in-the-hands-of-those-who-need-them-most","status":"publish","type":"post","link":"https:\/\/www.bluekc.com\/blueprint\/gated-agent\/putting-glp-1s-in-the-hands-of-those-who-need-them-most\/","title":{"rendered":"Putting GLP-1s in the hands of those who need them most"},"content":{"rendered":"\n

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<\/sup>. 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.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

Prescriptions of the drugs in the U.S. soared 300% between 2018 and 20232<\/sup>.<\/p>\n\n\n\n

However, the prescription windfall isn\u2019t due to a sudden increase in diabetes. Rather, obesity has made GLP-1s a household name.<\/p>\n\n\n\n

The rise of GLP-1s mirrors the rise of obesity<\/strong><\/h2>\n\n\n\n
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Since 1980, the prevalence of obesity in the U.S. has risen steadily from 15% to 42% in 20202<\/sup>. 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.<\/p>\n\n\n\n

It wasn\u2019t until 2014 that GLP-1s entered the weight-loss landscape when Saxenda received FDA approval for weight loss.<\/p>\n<\/div>\n<\/div>\n\n\n\n

Turns out, GLP-1s don\u2019t 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.<\/p>\n\n\n\n

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 \u2013 list price can be over $1,000 per month1<\/sup>.<\/p>\n\n\n\n

Blue KC\u2019s GLP-1 strateg<\/strong>y<\/h2>\n\n\n\n

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\u2019s due, in part, to off-label use as a weight loss aid for those without<\/em> obesity.<\/p>\n\n\n\n

Blue KC\u2019s 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<\/sup>.<\/p>\n\n\n\n

Blue KC GLP-1 Requests<\/strong> and Approvals<\/strong><\/p>\n\n\n\n

 <\/td>2021<\/strong><\/td>2023<\/strong><\/td><\/tr>
GLP-1 Requests by Blue KC Members<\/strong><\/td>2,054<\/td>11,214<\/td><\/tr>
GLP-1 Approvals by Blue KC<\/strong><\/td>68%<\/td>34%<\/td><\/tr>
Industry Benchmark for Approved Requests<\/strong><\/td>~80%<\/td>~50%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

“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.”<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

More Blue KC weight loss resources<\/strong><\/h2>\n\n\n\n

GLP-1s are just part of the weight loss conversation at Blue KC. With obesity-related complications \u2013 such as heart disease, hypertension, joint pain, and certain cancers \u2013 tallying $173 billion annually in the U.S., we take great care to provide members multiple pathways to manage weight4<\/sup>.<\/p>\n\n\n\n