More than half of patients taking popular weight-loss drugs don’t adhere to therapy

A recent Blue Health Intelligence^® study completed by the Blue Cross and Blue Shield Association showed 58% of people taking a glucagon-like peptide-1, or GLP-1, agonist for weight loss stopped using the medication before reaching a clinically meaningful health benefit. More than 30% of patients discontinued the drug after the first month, before reaching their target dose.

GLP-1 therapy can help patients achieve clinically meaningful weight loss if they remain on the treatment for at least 12 continuous weeks. Only 42% of users stayed on the medication that long.

The BHI study is based on data from nearly 170,000 commercial health plan members over the past 10 years.

As demand for GLP-1 agonists has exploded among patients trying to lose weight, their high cost has forced health insurers to take a hard look at cost vs. benefit.

Wegovy^® costs more than $1,000 per month, and similar GLP-1 drugs range from $900 to $1,100 each month, according to the BHI study. The $62 million in GLP-1 weight loss spending for 2023 accounted for more than 5% of total customer pharmacy costs for Blue Cross Blue Shield of Michigan and Blue Care Network large group fully insured members.

With these challenges in mind, we’ve made the difficult decision to change prior authorization criteria for GLP-1s used for weight-loss, like Wegovy, Zepbound^® and Saxenda^®, for large group fully insured commercial insurance plans, effective Aug. 1, and to eliminate coverage effective Jan. 1, 2025. We’ll continue covering GLP-1s prescribed to treat Type 2 diabetes, including Ozempic^®, Rybelsus^®, Victoza^® and Mounjaro^®. (See the July Record article for details. See also our recent blog post, “Why we are changing coverage for GLP-1 drugs for weight loss.”)

This decision to remove coverage for our fully insured groups brings Blue Cross in line with other insurers in Michigan and across the country.

“Blue Cross has a responsibility to ensure the drugs we pay for benefit members without adding excessive costs that impact all members’ and customer groups’ health care costs through increased premiums,” said Atheer Kaddis, vice president and Chief Pharmacy Officer.

We carefully reviewed the safety and effectiveness of these drugs and considered the findings of the BHI study that showed lack of medication adherence affects the success rate for these weight loss drugs.

Therapy adherence may be related to the medications’ side effects, which include nausea, vomiting and other gastrointestinal issues. Some side effects may be serious enough to cause harm in some patients.

Other BHI study findings included the following:

• Patients who were prescribed GLP-1s by health care providers with expertise in weight management and obesity — such as endocrinologists and obesity specialists — were more likely to complete at least 12 weeks of treatment. However, fewer than 10% of all prescriptions for GLP-1s are issued by these specialists. Most of these prescriptions are written by primary care providers.
• Those who visited their physicians more often during the first 12 weeks of treatment were more likely to be persistent.
• Young patients aged 18 to 34 were more likely to drop off treatment sooner than any other age group.
• Individuals with coexisting health conditions — such as diabetes and liver disease — were more likely to continue treatment.

“This study underscores how much more we have to learn about these medications,” said Kim Keck, president and CEO of the Blue Cross and Blue Shield Association. “The science behind these drugs is moving faster than our ability to truly understand which patients will benefit, how to sustain their success and how to pay for them. If we don’t get it right, we will drive up costs for everyone with little to show for it.” 

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.