Introduction
Federal policymakers are evaluating a new class of drugs for managing and preventing type 2 diabetes symptoms. These medications, known as glucagon-like peptide-1 (GLP-1) receptor agonists, have shown unexpected success in weight loss, potentially reducing obesity rates, cardiovascular diseases, and metabolic disorders. This shift could significantly lower long-term healthcare costs and improve lives.
The Promise of GLP-1 Medications
GLP-1 receptor agonists are innovative drugs that offer substantial benefits. Nearly 42% of adults in the US are obese, costing the healthcare system $173 billion annually. Around 90-95% of the 38 million Americans with diabetes have type 2 diabetes with associated costs exceeding $413 billion annually. GLP-1s are not a magic solution but have shown remarkable success in treating these conditions.
Traditionally, obesity treatments aimed for a 5% weight loss to be effective, with a 10% loss improving cardiometabolic health. GLP-1s, however, consistently achieve 12-18% weight loss. When combined with lifestyle changes, these medications have led to even more significant weight loss. One study found that over 52% of participants lost 15% of their body weight, and 36% lost more than 50%.
Broader Benefits and Potential Uses
Beyond weight loss, GLP-1s offer other benefits that are still being explored. For example, studies have shown that GLP-1 treatment can reduce alcohol consumption in individuals with obesity. Novo Nordisk, the manufacturer of Ozempic and Wegovy, is planning further studies to explore this potential. GLP-1s have also been reported to reduce inflammation in organs, including the brain, suggesting potential uses in treating conditions like Alzheimer’s and Parkinson’s diseases. Some individuals have even reported unexpected fertility improvements, leading to the term “Ozempic Babies.”
A Milliman study commissioned by Novo Nordisk found that adding GLP-1 coverage to Medicare Part D could prevent $8 billion in medical costs over ten years. Another study estimated that Medicare coverage of GLP-1s could save the program $175-245 billion over a decade, with cumulative social benefits nearing $1 trillion.
GLP-1s as a Preventive Service
The US Preventive Services Task Force (USPSTF) is developing a research plan to consider grading anti-obesity medications (AOMs) as preventive medications. The Task Force has previously only reviewed behavioural interventions for obesity, providing them with a Grade B recommendation. The potential recommendation of GLP-1s as preventive medications signifies a shift in anti-obesity care standards.
Studies have shown that GLP-1s prevent many conditions in individuals with obesity and type 2 diabetes. The benefits of GLP-1s far outweigh any associated harms, making a timely recommendation essential for those at risk of complications. The Task Force should consider these benefits when making their recommendation.
Coverage and Access
Commercial insurers in the US are required by Section 2713 of the Public Health Service Act to cover preventive services with an A or B rating from the USPSTF without cost sharing. This requirement would ensure access to GLP-1s for millions of low-income Americans. States that have expanded Medicaid eligibility must also provide first-dollar coverage of all USPSTF-recommended preventive services with an A or B rating.
For Medicare beneficiaries, there is a statutory bar against covering drugs for “anorexia, weight loss, or weight gain.” However, Medicare Part D plans may cover GLP-1s approved for conditions like type 2 diabetes. A recommendation from the USPSTF with an A or B rating would provide the necessary predicate for GLP-1s to be added to Medicare coverage as preventive services.
Conclusion
The potential increase in quality of life globally for individuals taking GLP-1s is immeasurable. For the healthcare system, the savings from GLP-1s are significant and measurable despite the high price tag. Like other preventive interventions recommended by the USPSTF, GLP-1s should be made available to those who need them without cost sharing. Further research should be conducted in lower income countries to determine the impact of GLP-1s in other parts of the world.
