Managing the Costs of GLP-1 Drugs: A Strategic Approach

June 2024
At Crystal Clear Rx (CCRx), we understand that the rising popularity and costs of GLP-1 drugs have raised many questions and concerns. We aim to provide clarity and guidance on managing these expenses effectively while ensuring patient care remains uncompromised.

Understanding GLP-1 Drugs
GLP-1 drugs are injectable medications prescribed for the treatment of diabetes and, increasingly, for weight loss. Their efficacy in promoting significant weight loss has made them popular among both patients and healthcare providers. However, this therapy comes with a substantial price tag—approximately $1,350 per month. Moreover, early studies suggest that discontinuation often leads to weight regain, indicating that these drugs may need to be taken indefinitely to maintain weight loss.

Side Effects and Patient Suitability
While effective, GLP-1 drugs are not without side effects. Common issues include gastrointestinal problems such as diarrhea, nausea, and abdominal pain. There are also potential serious side effects, and patients experiencing any adverse effects are strongly advised to consult their healthcare providers. Given these side effects, not all patients are suitable candidates for GLP-1 therapy. It is crucial for patients to have thorough discussions with their doctors to determine the best course of action.

CCRx’s Current Coverage Recommendations
Currently, CCRx advises our clients to cover GLP-1 drugs exclusively for diabetes treatment. Most Pharmacy Benefit Managers (PBMs) will require a diabetes diagnosis, and in some cases, additional documentation such as BMI data and other test results, before approving coverage.

Obesity and the Cost-Benefit Analysis
Obesity affects 60% of Americans and can lead to numerous severe and costly health issues. However, the high cost of GLP-1 therapy could potentially outweigh any savings derived from weight loss. Therefore, while we recognize the potential health benefits, the financial implications necessitate a cautious approach.

Looking Forward
CCRx is actively exploring solutions that could potentially alter the financial landscape of GLP-1 drugs. Until such solutions are viable, our stance remains to cover these medications solely for diabetes management. This strategy is expected to result in better patient health outcomes and reduced diabetes-related costs.

As GLP-1 drugs continue to gain popularity, CCRx anticipates that they will become the primary cost driver for many employer groups. We are committed to closely monitoring claims to ensure appropriate utilization and to support our clients in navigating these challenges.

We encourage you to reach out with any questions or concerns. Our team at Crystal Clear Rx is here to assist you in making informed decisions that balance cost management with patient care.