Insights from the inaugural BMO Obesity Summit with David Lassen

Last month, I had the honor of speaking at the inaugural BMO Obesity Summit on the future of weight-management care, in a payors panel entitled, “Key Considerations for Coverage and Access.”  

In a discussion with Evan Seigerman, managing director and senior research analyst at BMO Capital Markets, I shared the passion we have at Prime Therapeutics/Magellan Rx (Prime/MRx) to help people get the medicine they need to live well and to optimize therapy in a way that will produce better outcomes, specifically as it relates to glucagon-like peptide 1 (GLP-1) receptor agonists.  

As we know, this booming class of drugs has been approved to treat type 2 diabetes, for chronic weight management and, most recently, to help prevent adverse cardiovascular events. Prime/MRx continues to be an industry leader when it comes to GLP-1 insights. Last June, we uniquely automated our prior authorization for GLP-1s at the point of sale in pharmacies, making it easier for patients who meet the necessary medical criteria to obtain the drugs they need to live happier, healthier lives. This has had a significant impact for individuals as the industry average time it takes for patients to receive their GLP-1 prescription is 72 hours; we take pride in offering an average turnaround time of 48 hours.  

Our innovative approach for handling GLP-1s — which we outline in our GLP-1 Strategy page — is to separate our strategies based on indication. This ensures the drug’s classification doesn’t affect its impact for treating certain conditions. We also work to ensure patients get the medicine they need and provide access to the most effective therapies using evidence-based guidelines.  

In fact, it’s our commitment to data that led us, in July 2023, to evaluate real-world adherence to GLP-1s for weight-loss usage. We found that 68% of individuals who started taking GLP-1s for weight loss were no longer taking the drug after one year. We’ll soon have GLP-1 year-two real-world persistency and adherence numbers.  

While we’ve been a leader on this topic for some time, in many respects this is just the beginning. As I mentioned in the panel, we will soon have additional research regarding the new indication for GLP-1s to prevent adverse cardiovascular events, evaluating real-world data of more than 16 million individuals. We’ve found that about 1 in 100 patients or members potentially meet the criteria for Wegovy, and about 1 in 43 of those members has been on a GLP-1 drug. This means that many of our members have all the risk factors and should be on these therapies who have not yet received the drug.  

One thing I also discussed — which also serves as a key focus for our April Fraud Focus content series — is the risk of health care fraud for GLP-1s. This is especially true among telehealth providers, from which we have received some prior authorization requests with invalid information. In some cases, doctors have claimed their patients have type 2 diabetes when they don’t. Up to 30% of requests for GLP-1s are falsified. We take this kind of fraud seriously, as it impacts health care costs for everyone. This is magnified further when you consider the costs these drugs carry.  

We remain committed to our evidence-based approach to this class of drugs, working with partners to develop strategies that promote appropriate use and consider total cost of care, long-term value and member health outcomes.