Mar 01, 2024
A drug class known as glucagon-like peptide 1 (GLP-1) has soared in popularity due to social media and celebrity endorsements. As use of brand name drugs like Ozempic, Wegovy, and Mounjaro increases, your clients are likely inquiring about how GLP-1 drugs work and how these drugs are covered.
How they work:
Originally developed for management of Type 2 diabetes, the GLP-1 class of drugs emulate the actions of hormones in the body, increase insulin levels, curb hunger, and slow movement of food through the GI tract, resulting in weight loss.
Prioritizing lifestyle modifications:
These drugs are not designed for rapid weight loss and are not a stand-alone solution for losing weight. GLP-1 drugs should be regarded as supplementary to lifestyle modifications like diet and regular exercise.
Coverage and prior authorization:
- The FDA has approved different GLP-1 drugs for specific uses.
- Drugs like Wegovy and Zepbound are specifically approved for use in chronic weight management only.
- Drugs like Ozempic and Mounjaro are only approved for use in treatment of Type 2 diabetes.
- GLP1s that are FDA approved for treatment of obesity require prior authorization. Members must meet specific lifestyle modification requirements, BMI thresholds and/or have certain co-morbid conditions may qualify for GLP-1s.
- The most up to date formulary information can be found Blue Shield's Drug Formularies page.
Key considerations:
- As with any medication, GLP-1 drugs have potential side effects and safety concerns. Nausea, vomiting, diarrhea, and headaches are common side effects.
- Long-term effects of these drugs are still being examined. Members should be aware of the potentially life-long use of GLP-1 drugs in order to maintain weight loss. One study showed that, after one year, patients who stopped their GLP-1 drugs and lifestyle changes regained two-thirds of weight lost.
- An informed evaluation of the risks and benefits associated with GLP-1 drugs is essential, especially when alternative options are available.
Individualized approach and Blue Shield services:
- Weight loss is a multi-faceted journey that demands an approach tailored to each person's unique needs, preferences, and medical history.
- Blue Shield of California supports establishing and maintaining a healthy weight and has consistently promoted weight loss programs through their award-winning Wellvolution platform.
Blue Shield's pharmacy team is closely monitoring the development and evolution of GLP-1 drugs to assess their policies for coverage.
