Weight management GLP-1 deprescribing

Weight management medications in the GLP-1 and GIP/GLP-1 classes – commonly referred to collectively as GLP-1s – have helped many people lose significant weight. Unsurprisingly, demand for these drugs has soared. But what happens after people who use them reach their goal weight? Can they stop using the medication?

The prospect of discontinuing can be appealing to both payors and plan members for a variety of reasons, including the high cost of these drugs. 

Additionally, people who use weight management GLP-1s may experience needle fatigue, unpleasant side effects, or difficulty filling their prescriptions due to shortages. Some may not be seeing results or may have hit a plateau with their weight loss. Others may simply want to try maintaining their weight through lifestyle changes alone. Clinical data indicate that as many as half of all patients who use GLP-1s stop using them within a year.

Those who are interested in trying to discontinue their medication should consult with their prescribers. Together, they can discuss the benefits and drawbacks of stopping the medication on an individual basis, as well as the importance of committing to long-term lifestyle changes, such as diet and exercise, to manage weight.

What we know about GLP-1s and deprescribing

GLP-1s help control blood glucose, promote feelings of fullness, and suppress appetite. When paired with lifestyle changes, the drugs can contribute to substantial weight loss, which is why it is so important to provide wrap-around lifestyle and nutrition support for plan members who use these medications.

Payors hear a lot about “deprescribing” when they are evaluating weight management programs. Some vendors actively promote a time-limited or mandated deprescribing off-ramp as a key component of their program. This can be enticing to payors who are trying to control drug spend. Current medical literature, however, does not support it as a blanket approach.  

It’s important to remember that obesity is a chronic condition with numerous underlying causes – including socioeconomic, environmental, and genetic factors, as well as cultural influences⁸ – that are not fully resolved simply because a person reaches their goal weight.

The drawbacks of a one-size-fits-all approach

Programs that promote GLP-1 deprescribing often employ a one-size-fits-all strategy – including the diet used as a part of their program. A common assumption is that people can safely and effectively discontinue a weight management GLP-1 and maintain their weight loss if they adopt a ketogenic – or “keto” – diet.

While some people do have success losing weight on a ketogenic diet, this highly restrictive eating plan is not for everyone. It requires moderate protein and high daily fat intake, as well as very restrictive carbohydrate intake. Ketogenic diets may pose risks to people with certain health conditions. Adherence is an issue, as well, with many people finding the diet difficult and unrealistic to sustain over a long time.⁹

Deprescribing medications for other conditions

Weight loss achieved through the use of medications may make it possible to deprescribe – or adjust prescriptions for – other medications. Obesity is a risk factor for numerous health conditions, including diabetes, high blood pressure, high cholesterol, and sleep apnea. Achieving and maintaining a healthy weight may make it possible to discontinue medications used to treat many of these related conditions, which can affect overall drug spend.

This is why it’s so important to take a whole-person approach to weight management that looks beyond the numbers on the scale or the cost of a single medication. Patients can see changes in their blood glucose, cholesterol levels and blood pressure. These numbers together provide a more comprehensive indicator of a person’s overall health.

A personalized approach to therapy

There is a lot we’re still learning about how GLP-1s affect the body, which may help guide prescribing decisions for plan members who use them. While universal deprescribing is unlikely to drive optimal results, it may make sense on an individual basis to explore discontinuation, lowering the dose, or increasing time between doses, as patients enter a maintenance phase with their treatment. Alternately, some individuals may be able to successfully transition to an older generation medication.¹⁰

Whatever path a member and their prescriber may choose, it is important to continue the lifestyle changes these medications are intended to be an adjunct to. Lifestyle coaching and nutrition support, such as through the CVS Weight Management™ program, can help boost the efficacy of GLP-1s and may even help some people achieve their weight goals without medication.

The CVS Weight Management program provides one-on-one support from a dedicated registered dietitian, personalized nutrition planning, an engaging digital app, a connected scale and other devices as appropriate, and more. Members who struggled to lose weight on medication alone increased their weight loss by six times after enrolling. The program has also driven significant cost savings for clients.

Members enrolled in the program are monitored to identify opportunities to deprescribe medications for high blood pressure, high cholesterol, diabetes, and other conditions, in coordination with their primary care provider. If a member expresses interest in decreasing their GLP-1 dosage or discontinuing it altogether, their program care team will support them in doing so. Their dedicated registered dietician will continue to work with them on healthy eating, exercise, the importance of sleep, and other habits that can help them maintain their weight. 

As the clinical landscape for GLP-1s continues to evolve, we’re committed to supporting plan sponsors with evidence-based, clinically appropriate coverage, cost, and care solutions that can help control spend without compromising health outcomes.