Improve GLP-1 effectiveness for weight loss with condition management

The weight loss drug market is exploding, with some estimates predicting that the market could be worth $30 billion by 2030.¹This is due to the widespread and growing prevalence of obesity (~40% of US adults²) and the approval of supplemental weight loss indications for drugs initially developed to treat diabetes. As payors consider implementing cost management strategies for GLP-1s, they should also consider how condition management programs can accelerate savings and promote better health outcomes for members.

This class of drugs is most effective when paired with proper dosing and lifestyle support; therefore, it’s imperative to offer appropriate care to members. Providing a condition management program not only will help to control costs, but also ensure that weight loss is sustainable. In addition, these techniques may help to prevent members from developing costly comorbid conditions.

More than medication

Most clinical trials that investigated GLP-1s for weight loss combined drug therapy with changes in diet and physical activity. One 2022 trial involved participants taking semaglutide, available under the brand name Wegovy, once a week for 68 weeks. When participants quit taking the drug and stopped receiving diet and exercise counseling, they regained two-thirds of their weight loss.³This particular study, and others like it, show that these types of weight loss medications are most effective when implemented with lifestyle interventions.

Because obesity is so closely linked to other conditions, it can be advantageous for payors to add weight loss medications to their formularies when combined with a care management component. Obesity greatly increases risk of chronic disease morbidity—namely disability, depression, cardiovascular disease, certain cancers—and mortality.⁴The link between obesity and type 2 diabetes is also well-documented and can be costly to members and payors alike. Losing weight for some might prevent them from developing diabetes, reducing future spend on anti-diabetic medication. Proactively treating obesity can result in substantial medical cost avoidance in addition to pharmacy spend offsets for health plans and employers.

For members who would benefit from losing weight, and are ready to do so, having a weight management solution in place can offer options, which for some might include diet and exercise only; and for others might include the use of weight loss medications.

High-touch support, meeting members where they are

Following clinical and drug manufacturer guidelines, we developed a weight management program that integrates high-touch, coordinated care and lifestyle interventions that may include the use of GLP-1s for weight loss. It has been carefully designed for clinical integrity and to meet the needs of payors and members alike and aligns with the drugs’ FDA-approved prescriber labels.

Our approach is to support members motivated to lose weight through a high-touch, customized program that is flexible to best meet member needs:

• Proactive member outreach and high-touch oversight to help ensure appropriate use and maximize clinical efficacy of drug therapy
• Nutrition and lifestyle coaching from an obesity-certified registered dietitian to position members for success
• Live clinician visits in a virtual setting that are frequent and convenient
• Dosing adjustments, when appropriate, managed by a provider, which in some instances may be an endocrinologist
• Diet-agnostic nutrition plan tailored to fit individual needs, including social determinants of health, culturally relevant diets, dietary restrictions, and food preferences
• Food journaling made as easy as snapping a photo

Members who prefer not to take these medications, or who have had adverse side effects from them, receive a similar level of support from registered dietitians, through a lower-touch, app-based model.

Payors can integrate this condition management program with such cost management strategies as utilization management to maximize savings. Flexible options enable payors to choose the level of control that best meets their needs:

• Required: Members are required to complete the weight management component of the program prior to medication approval.
• Incentivized: Participation in the program is encouraged through cost share differential.
• Voluntary: Members can join the program on their own.

The program’s flexibility allows us to create a customized solution to meet clients’ plan design goals. Combining prevention and therapy support, the program is integrated with foundational cost management strategies to help ensure appropriate medication use and maximize therapy effectiveness.

A comprehensive, coordinated care model

Dedicated care team

Many members who have been prescribed weight loss drugs are not getting the right level of support or care. Implementing a care management solution provides a higher level of coordinated care, which can drive better outcomes and lower costs. Our coordinated care team offers a comprehensive approach to maximize the clinical efficacy of GLP-1s for weight loss:

Digital app

• Track lab orders and view results
• Chat with a registered dietitian
• Browse meal recommendations
• Track biometrics (A1C, weight and more)

Improved outcomes, lower costs

The CVS Caremark Weight Management Solution delivers a 2:1 ROI on care management program fees.* Additional cost savings can be found from benefit integration, and a custom Opportunity Analysis can best show a payors’ actual numbers.