The clinical footprint of GLP-1 drugs has expanded dramatically. Individuals are no longer using these drugs just for obesity care. Many are now taking GLP-1s for cardiovascular conditions, chronic kidney disease and sleep apnea.
In a featured session at Becker’s 4th Annual Spring Payer Issues Roundtable, titled “From Cost Containment to Care Strategy: Reframing GLP-1s for ROI,” sponsored by Noom Health, Jennifer Jones, director, clinical solutions at Noom Health, discussed challenges facing payers and employers as they strive to create sustainable GLP-1 programs. She shared strategies that generate better member outcomes and a positive ROI.
Here are three key takeaways from the session:
1. Acute cost-containment measures aren’t appropriate for GLP-1s
In 2022, GLP-1s represented 6.9% of total pharmacy claims. That jumped to 10.5% in two years and for 27% of the largest employers, grew to over 15%. When drug costs increase dramatically, health plans and employers often turn to cost-containment measures like prior authorization, step therapy, formulary exclusions and limiting the amount of medication permitted.
Ms. Jones explained that these strategies work well for acute or episodic medications and conditions. However, people are using GLP-1s to treat chronic conditions. Viewing GLP-1 usage through a total cost of care lens can be more helpful.
“In 2024, overall healthcare spending reached around $5 trillion,” she said. “The majority was reactive care. Treating chronic diseases proactively can bend the total healthcare cost curve and GLP-1s can be part of the proactive care conversation.”
2. Structured GLP-1 program design generates the best outcomes and highest ROI
The biggest risk for health plans and employers arises when people stop using GLP-1s.
“Without a structured program, only 32% of people are still taking GLP-1 drugs 12 months later,” Ms. Jones said. “The other 68% have paid anywhere from $1,000 to $1,200 a month for the medication, but haven’t derived any downstream benefits. It’s like a rental.”
The greatest savings occur when people learn lifestyle and behavior changes in parallel with taking GLP-1s. Every dollar invested in structured weight management programs generates a return of 4.2x.
3. It’s time to manage GLP-1 outcomes, not just costs
Noom Med with SmartRX is a carve-out solution that delivers positive results for members, employers and health plans. Noom’s multi-disciplinary team handles prescribing GLP-1s and supports participants with behavior change. Rather than sending GLP-1 prescriptions to a formulary or pharmacy PBM, Noom works with partners that have direct contracting rates with drug manufacturers. Employers pay a substantially lower copay and split the cost with members.
One group that’s been using Noom Med with SmartRX for three months has seen an 80% reduction in annualized GLP-1 spending. “Last year, this group spent $6.2 million on weight loss GLP-1s,” Ms. Jones said. “We are now projecting those costs to be around $1.3 million annually. Step therapy has also reduced the overall volume of prescribed GLP-1s.”
Perhaps most exciting is the member engagement. Program participants interact with the Noom app 15 times a week, on average, to log meals, monitor their weight and watch physical activity videos. Higher levels of engagement translate to better member outcomes.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.