A class of diabetes drugs known as GLP-1 agonists has recently taken the pharmaceutical and weight loss industries by storm. This is because GLP-1 agonists suppress appetite and slow gastric emptying, which makes you feel full faster and longer. 

While results can be significant, this off-label weight management method carries risks for both the member and the plan sponsor. 

The Risks

• Clinical Uncertainty

>> Currently, only two GLP-1 agonists have been FDA reviewed and approved for weight loss.

>> Without FDA review, there is no way to know if these drugs are safe and effective for their intended use. Unapproved drugs have resulted in patient harm.

• Cost Driver

>> Outside of specialty drugs, diabetic drugs are a leading cost-driver in prescription benefits plans.

>> The recent uptick in the use of GLP-1 agonists for weight loss can exponentially increase drug spend for the plan, especially if the plan does not knowingly cover weight loss drugs.

TrueScripts Protection

• Clinical Certainty

>> To ensure that GLP-1 agonists are being used for FDA-approved conditions and in accordance with plan coverage parameters, Prior Authorizations (PA) for these drugs have been put in place.

>> No pharmacy ownership and use of an independent PA provider ensures that each drug and patient receives an accurate, unbiased clinical review.

• Cost Containment

>> As part of our Brand Care Program, we work to qualify many GLP-1 agonists to be received at a discounted rate.

>> When applicable, our team will explore international sourcing options to obtain the best pricing for these drugs.

>> We understand that diabetic comorbidities can drive costs exponentially, so we will work with clients to develop a benefits plan design best suited for the needs of their unique population.

Drug List

GLP-1 agonists - work by triggering insulin release and blocking sugar production in the liver

   • Ozempic (semaglutide) – once weekly injection

>> Can help lower the risk of heart attack and stroke, plus potential kidney benefits

>> Not approved for weight loss

   • Rybelsus – oral semaglutide (Ozempic) taken daily

>> Not approved for heart-related benefits or weight loss

   • Trulicity (dulaglutide) – once weekly injection

>> Has heart and kidney benefits

>> Not approved for weight loss and less weight loss noted compared to semaglutide

   • Victoza (liraglutide) – once daily injection

>> Has heart benefits and potentially kidney benefits

>> Not approved for weight loss and less weight loss noted compared to semaglutide

   • Wegovy – higher dose semaglutide (Ozempic)

>> Approved for weight loss

   • Saxenda – higher dose liraglutide (Victoza) 

>> Approved for weight loss; studies showed greater weight loss with Wegovy

GLP-1/GIP agonists - newer class of medication that works by mimicking 2 gut hormones: GLP-1 and glucose-dependent insulinotropic polypeptide (GIP)

   • Mounjaro – approved to treat Type 2 diabetes and the FDA is fast-tracking it’s review for weight loss approval

>> Head-to-head with Ozempic showed better Hemoglobin A1C reduction and greater weight loss 

Zepbound (tirzepatide)– FDA approved for chronic weight management that activates both GIP and GLP-1 hormone receptors•   

Factors for Choosing Which GLP-1 Agonist Is Right for You:

   • Age – only some drugs are approved for children

   • Underlying Conditions – added heart and kidney protection in some drugs

   • Treatment Preference – oral vs. injection, daily vs. weekly

   • Treatment Goals

   • Body Mass Index (BMI)

   • Insurance Coverage

Please reach out to the TrueScripts team with any questions or concerns you may have. 

We are happy to provide you with answers and Amazing Care!