Weight-loss medications were very much in the news this year, and the pages and website of Managed Healthcare Executive were no exception. Articles on off-label use of the GLP-1s such as Ozempic (semaglutide) and the FDA approval of Zepbound (tirzepatide) garnered the most page views.
They are the trendy way to lose weight, and payers have been noticing an increase in GLP-1 claims. An analysis of the pharmacy and healthcare claims of a small commercial health plan in Texas documents the growth in the off-label usage of the GLP-1s, such as Ozempic, for weight loss.
Insurers are using prior authorization and other managed care strategies to control costs associated with the growing number of prescriptions, on- and off-label, for the weight-loss medications.
Patients with heart failure and obesity who were administered semaglutide experienced better results — they reported fewer symptoms, felt less physically limited, lost more weight, and could walk longer in a 6-minute test.
Tirzepatide, with the brand name Zepbound, is expected to be available by the end of the year in six doses at a list price of $1,059.87, which is about 20% lower than semaglutide.
The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.
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