The GLP-1 Scramble

Feature
Article
MHE PublicationMHE June 2024
Volume 34
Issue 6

Telehealth companies, Costco, other companies — they are all looking to take advantage of the soaring demand for the weight loss drugs.

The demand for weight loss drugs has telehealth providers flocking to provide weight loss services. While some experts welcome the additional capacity to handle the demand, others are concerned about the quality of some companies or the ethics of certain arrangements.

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Catherine Varney, D.O.

“Any time we can increase access to obesity treatments, [it] is a good thing,” said Catherine Varney, D.O., an assistant professor at the University of Virginia School of Medicine and the director of obesity medicine at UVA Health. Varney is one of only about 9,000 physicians certified by the American Board of Obesity Medicine. “My concern is whether the patient receives high-quality treatment,” she added. That means focusing on diet, exercise, sleep and stress management as well as medications.

Everyone from the Mayo Clinic to WeightWatchers to the telemedicine site Ro is offering telehealth services for weight loss medications. Even weight loss drugmaker Eli Lilly and Company has joined the fray with its LillyDirect website.

Demand for the glucagon-like peptide 1 (GLP-1) drugs has soared. Originally approved as treatments for people with type 2 diabetes, drugs in the class have also been greenlighted for weight loss. The FDA now has approved Wegovy (semaglutide) and Zepbound (tirzepatide) for weight loss in people who are obese or who are overweight and have a health condition that relates to being overweight, such as cardiovascular disease or obstructive sleep apnea. But there has also been a great deal of off-label prescribing.

Insurance coverage for the GLP-1s for weight loss varies. Without coverage, the drugs are expensive, with a wholesale acquisition cost — the list price — of more than $1,000 per month. A recent survey of large employers by Mercer, a consulting firm, found that almost all insurers cover GLP-1s to treat type 2 diabetes while less than 45% covered them to treat obesity.

According to the Centers for Disease Control and Prevention, more than 40% of the U.S. population was considered obese between 2017 and 2020. And the prevalence of severe obesity nearly doubled during that time, from 4.7% to 9.2%.

J.P. Morgan Research predicts that by 2030, the market for GLP-1s will top $100 billion, fueled by demand for the medication for both diabetes and obesity treatment. Total users could top 30 million, or about 9% of the population, by that time.

Weight loss wave

Sesame is one business that is trying to ride the weight loss wave. Last year the telehealth company announced it was teaming up with Costco to provide lower-cost medical care for the warehouse club’s members, including $29 virtual primary care visits. The company, which also offers telehealth services for anxiety, erectile dysfunction and urinary tract infections, is now offering a weight loss program, which includes potential access to weight loss drugs, with a slight discount for Costco members.

Michael Bottta, Ph.D.

Michael Bottta, Ph.D.

Michael Botta, Ph.D., Sesame president and co-founder, says the day the partnership with Costco was announced in early April 2024, visits to its website for weight loss soared by 2,000%. “It was a much bigger response than we expected.”

Sesame considers itself a healthcare “marketplace,” where several thousand independent doctors from around the country compete for patients based on their availability and price.

For $179, Costco members receive three months of consultation with a clinician, including an initial live video consultation, the ability to message with their clinician outside of appointment times, nutritional recommendations and a “clinically appropriate” treatment program; not everyone may be recommended to receive weight loss medications. The monthly price does not cover medications.

Sesame does not take insurance, Botta said, but patients can use health insurance to cover medication costs or take advantage of any discounts from the manufacturers.

For prescription discount cards, patients are “really at the mercy of the individual manufacturer,” Botta said. Even with a discount card from Eli Lilly, patients may pay $500 a month out of pocket for Zepbound. Those with insurance may pay just $25 or $50, he said.

Patients who meet with clinicians now may not be able to access the medications until summer or later, when the drugs become more widely available, Botta said. “There’s no magic supply of medications.”

WeightWatchers is also hopping on the GLP-1 bandwagon, offering consultations with board-certified clinicians trained in obesity medicine through the telehealth platform Sequence, which it bought last year.

Eli Lilly, maker of Zepbound, has teamed up with the telehealth provider Form Health, giving patients access to its medication through the website LillyDirect, the first such site connected to a pharmaceutical company. Providers can prescribe any weight loss drug approved by the FDA, not just Zepbound. But those who are prescribed Zepbound will be eligible for Lilly’s prescription-delivery service. The telehealth company Ro also is offering weight loss medications. Along with Zepbound and Wegovy, which it labels as in a “supply shortage,” it also offers compounded semaglutide, which is the same active ingredient as in Wegovy.

Wary of compounded versions

Some of these efforts are raising concerns. “All are responding to the ability to make a lot of money and their enormous demand,” says Arthur Caplan, Ph.D., a professor of bioethics at NYU Langone Health in New York. Caplan said he considers Eli Lilly offering its medications through LillyDirect “a huge conflict of interest,” and he has concerns that the providers on the site won’t discuss other alternatives to Zepbound.

“I’m not against the drugs,” Caplan said. “[But] I’m not sure we can afford to put everybody on drugs. Payers are obviously balking at the cost.”

Caplan also has concerns about overdependence on telehealth and is wary of potential issues if a patient doesn’t “have an ongoing relationship with a provider you’re involved with,” compared with someone having a telehealth appointment with their regular provider.

But Anthony Pick, M.D., an endocrinologist at Northwestern Medicine Lake Forest Hospital and a clinical assistant professor at Northwestern Medicine, says he sees “no reason not to do [weight loss treatment] remotely.” But he added several caveats. Pick cautions that telehealth must include appropriate monitoring because those taking the GLP-1s can lose lean muscle mass, not just fat tissue. Depression can be a side effect. Plus, patients should be prepared for a range of responses: Some people lose a great deal of weight while others lose none, Pick says. Heis concerned about telehealth providers, clinics and spas that offer compounded weight loss drugs that might not come from an accredited compounding pharmacy. “It’s kind of the Wild West,” Pick said. Varney at UVA also is concerned about compounded medications: “They have not gone through the rigorous FDA research process and approval.”

She said Eli Lilly and Novo Nordisk, which manufactures Wegovy, had compounded weight loss medications tested by a third party and found that up to 30% had impurities and some did not contain the medication they were purported to contain. Such pharmacies “prey on people desperate for treatment,” Varney said, and take advantage of an FDA loophole that allows them to make medications if there is a shortage.

In a letter on its website, Eli Lilly, which manufactures Zepbound for weight loss and Mounjaro for diabetes, said it “stands against the use of its medicines for cosmetic weight loss.” Along with the medications, patients should follow a reduced-calorie diet and increase their physical activity, Eli Lilly says. The company also warns about safety risks from using compounded or counterfeit tirzepatide, the active ingredient in its medications. “Neither the FDA nor any global regulatory agency has reviewed these products for safety, quality or efficacy, and unsafe products should not be on the market,” the company wrote.

With more people seeking weight loss medications, it “exacerbates the extreme shortages that we’re seeing with the medications,” Varney said, and that makes it harder for patients to remain on the drugs.

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