New Treatments for Diabetes
November 11, 2022
Benefits of new treatments for diabetes: Focus on Glucagon-like peptide 1 (GLP-1) agonists
and Sodium-glucose co-transporter 2 (SGLT2) inhibitors
What is Diabetes?
Diabetes mellitus (DM) is a chronic health condition that affects how your body turns food into energy. Most of the food we eat is broken down into sugar, which causes our organ called the “pancreas” to release insulin. Insulin is a substance produced naturally and is needed to help move sugar from the blood into other parts of the body, like your legs to help you walk. Insulin is the key to letting sugar into your body.
If you have diabetes, your body either doesn’t make enough insulin or can’t use insulin. When there isn’t enough insulin or cells stop responding to insulin, too much sugar stays in your blood which causes damage to your body. Over time, that can cause serious health problems, such as vision loss, heart disease, and kidney disease. Initially, none of these health problems may have symptoms.
Common complications in diabetic patients
- Cardiovascular complications in diabetes: People with diabetes are at increased risk of cardiovascular disease (CVD), which can lead to problems like heart attack, stroke, or even death.
- Kidney complications in diabetes: Diabetes can alter the normal function of the kidneys. Kidney problems related to diabetes are referred to as "diabetic kidney disease" or by the older term, "diabetic nephropathy." Over time, this can lead to chronic kidney disease and even kidney failure.
- Weight complications in diabetes: People who take insulin often gain weight. Insulin is a hormone that regulates how the body absorbs sugar, also known as glucose. The weight gain can be frustrating because keeping a healthy weight is important to manage your diabetes.
Benefits of SGLT2 Inhibitors and GLP-1 Agonists:
- SGLT2 Inhibitors like Empagliflozin, Canagliflozin, and Dapagliflozin have demonstrated benefit in lowering heart failure (HF) hospitalization, risk of kidney disease progression, and mortality. Current guidelines for diabetes place SGLT2 Inhibitors as possible first-line treatments, especially in patients that have high risk of suffering from heart failure in the future, currently have heart failure, or currently have chronic kidney disease (CKD).
- GLP-1 Agonists like Semaglutide, Dulaglutide, and Liraglutide have also demonstrated benefits in reducing the risk of cardiovascular events. Semaglutide and Dulaglutide are also approved for weight management. These agents have reported significant results in helping patients reduce up to 15% of their Body mass index (BMI). Unfortunately, the weight loss benefit of GLP-1 receptor agonists does go away when you stop the medication. Patients can regain some or all of the weight they lost.
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Mental health parity and medication adherence
Understanding GLP-1 Medications The landscape of obesity management is evolving, with GLP-1 receptor agonist (RA) medications emerging as a significant player. These FDA-approved drugs have proven effective in helping individuals lose weight, prompting a shift in how they are viewed and covered by health plans. However, the cost implications and strategic decisions surrounding these medications require careful consideration by employer groups and their members. The Case for GLP-1 Medications GLP-1 RAs, originally developed for diabetes management, have shown remarkable efficacy in weight loss. With the growing prevalence of obesity and its associated healthcare costs, there's increasing pressure on health plans to cover these medications. Despite their high cost—annual retail pharmacy expenses can exceed $10,000 per patient—GLP-1 RAs offer potential downstream savings by reducing obesity-related comorbidities such as diabetes, hypertension, and cardiovascular disease. Balancing Coverage and Cost Historically, weight loss medications were deemed "lifestyle" drugs and excluded from coverage. However, the rising popularity of GLP-1 RAs and their demonstrated benefits are challenging this perspective. For plan sponsors, the decision to cover these medications involves balancing the high upfront costs with the potential for long-term savings on medical expenses related to obesity. Cost-Containment Strategies For payers choosing to cover GLP-1 medications, several cost-containment strategies can be employed: Formulary Management : Deciding on the placement of these medications within the formulary is crucial. Options range from not covering the drugs to placing them on a high-cost tier with patient cost-sharing. Prior Authorization and Step Therapy : Implementing these measures ensures that only patients with a proper diagnosis (e.g., ICD-10 code for obesity) access these medications, preventing misuse and overutilization. Prerequisite Programs : Requiring participation in wellness or nutrition programs before approving weight loss medications can encourage lifestyle modifications that complement pharmacological treatment. Specialist Restrictions : Limiting prescriptions to weight loss specialists, such as bariatric doctors or endocrinologists, ensures appropriate therapy and monitoring. Duration Limits : Establishing treatment guidelines, such as discontinuing medications if a target weight loss is not achieved within six months, helps manage long-term costs. The Role of Brokers and Employer Groups Brokers play a pivotal role in guiding employer groups through the complexities of covering GLP-1 medications. Understanding the cost-benefit dynamics and available cost-containment strategies enables brokers to provide informed recommendations that align with their clients' financial and health objectives. Employer groups, in turn, must weigh the potential benefits of covering these medications against their budgetary constraints and the overall well-being of their workforce. Member Education and Engagement Effective communication with members is essential to ensure they understand the coverage options and adhere to prescribed treatments. Educational initiatives can include: Patient Communication Programs : Providing information on medication adherence, compliance, and lifestyle modifications. Continuing Education : Ongoing programs to keep members informed about the benefits and proper use of weight loss medications. Monitoring and Support : Utilizing pharmacy and medical data to track outcomes and adjust strategies as needed. Balance the Scale with Expert Guidance from MC-Rx The adoption of GLP-1 medications for weight loss represents a significant advancement in obesity management. However, the high costs associated with these drugs necessitate careful planning and strategic implementation by brokers, employer groups, and members. By employing robust cost-containment strategies and prioritizing member education, health plans can navigate the financial challenges while delivering meaningful health benefits to their populations. MC-Rx, as a full-service pharmacy benefits manager, offers the expertise and tools to help clients optimize their coverage decisions and manage the complexities of incorporating GLP-1 medications into their health plans. Here are just a few of the GLP-1 strategies we use to shield our clients from excessive costs: Implementation of Drug Management Tools, which is critical to ensure proper utilization for GLP-1s. Strategic Benefit Design, which also protects clients from improper GLP-1 utilization. Clear Member Communication, which is crucial for proper adherence and compliance. When implemented with an existing client, the above-listed strategies helped them achieve $382,000 in cost avoidance for GLP-1s. With the right approach, the benefits of these medications can be realized, contributing to better health outcomes and potentially lowering overall healthcare costs in the long run. For more information on managing GLP-1 medications and other pharmacy benefits, reach out to an MC-Rx expert today .
Mental Health Parity and Medication Adherence
MC-Rx, powered by ProCare Rx, has been notified by the Academy of Managed Care Pharmacy (AMCP) of the acceptance of their abstract, “Improving Adherence to HIV PREP via a PBM-Driven Educational Intervention” , for presentation at AMCP 2024 Conference in April.
Exploring the rising costs and demands of weight-loss medication and how to combat those costs, significantly lowering drug costs for payors and increasing access for patients who need them.
A message from Marileny Lugo, President, MC-Rx
A message from Marileny Lugo, President, MC-Rx
To decrease the burden on healthcare costs, at MC-Rx we strive to create awareness by educating our community regarding the importance of prevention.
Increased medication adherence has been linked to better clinical and financial outcomes.
