Omada Health’s Guide to GLP-1s | Q3 - Q4 2024
As the GLP-1 conversation continues to evolve, Omada Health is updating its industry FAQs to deliver timely data and insights for buyers. In the first half of the year, we focused on weight loss quality vs. quantity, addressing usage and costs, off-ramping protocols, and equity issues. This quarter, we’re drilling into emerging details of the GLP-1 experience, including compounded GLP-1s, how to manage the drug’s impact on body composition, and ways to assess the value of virtual companion programs.
While cost management remains a sticking point in the GLP-1 conversation, other, more nuanced concerns emerged during a recent Benefit Consultant Roundtable hosted by Omada President Wei-Li Shao. Here is what leaders are hearing across the industry:
1. The potential value of GLP-1s lies in how we view obesity
There’s now far more widespread recognition of obesity as both a chronic disease and a main driver of many other chronic diseases. For employers working with consultants, while the potential value of GLP-1s is apparent, the ROI still feels uncertain. Employers with evolving views on obesity are seeking clear guidance on managing their long-term investments in obesity and weight management treatments.
2. Effective GLP-1 use doesn’t stop at the prescription
Beyond weight loss outcomes, GLP-1 medications are unique for a variety of reasons. One key reason is that they impact a person’s physiology before, during and after use. For example, GLP-1 use has been linked to certain adverse side effects and lean muscle mass loss (more on that later). After discontinuing GLP-1s, users regain two-thirds of their prior weight loss within a year, on average.
Physicians, who in many cases are overburdened to begin with, may not have available resources to closely monitor a patient’s progress during all stages of GLP-1 care. This care gap is one that needs to be filled in order for employers to achieve ROI. A common area of interest appears to be a virtual companion program that supports members on their weight health journey in between doctor visits.
3. No single party within the healthcare ecosystem can solve cost
A solution to GLP-1 cost management and ROI requires strong collaboration between all parts of the healthcare ecosystem that impact patients. The matter doesn’t simply boil down to employers having a decision to make: reimburse vs. not. Nor does it exclusively fall on pharmacy benefit managers, or just on pharmaceutical companies to lower prices. All of these decisions are intertwined.
As GLP-1s continue to be a popular and dynamic topic, it’s helpful to remember that they represent an opportunity to change the trajectory of chronic disease in the U.S. It won’t be easy, but it’s certainly worthwhile."
- Wei-Li Shao, President, Omada Health
While compounded medications account for less than 3% of all U.S. prescriptions, the GLP-1 shortage is putting this healthcare rarity in the spotlight. In response, online pharmacies are jumping into action. As a virtual care provider that neither prescribes nor distributes medications, we can provide a more objective perspective on compounded anti-obesity medications.
Weighing the Benefits and Risks of GLP-1 Compounds
For patients and providers alike, the risk of using compounded medications should be weighed against the risk of stopping or switching the medication. The following are key considerations to inform that decision.
The Benefits
A benefit of using compounded GLP-1s is maintaining continuity of care during any supply shortages while a patient is taking the manufactured medication. This is especially true when we consider the titration schedule and side effects associated with starting GLP-1s, and the weight regain that can happen when the medications are stopped. Sudden loss in access to GLP-1s can significantly hinder a patient’s progress and health goals.
While compounded GLP-1s can help with continuity of care, they also allow more patients to start prescriptions. In fact, the makers of WegovyⓇ report that they have limited quantities of the lower dosages — typically prescribed when first starting the medication — as a way to control demand for the higher dosages.
The cash price for GLP-1s can be prohibitive for people who don’t have insurance coverage for them. Compounded GLP-1 prices (without insurance) vary depending on the pharmacy, but are typically sold at a significantly reduced price. Recently, Hims & Hers made headlines when they announced they were offering compounded semaglutide at an 85% discount off the list price of WegovyⓇ.
The Risks
Compounded drugs are intended to be chemical “copies” of available medications. However, they are not FDA-approved (learn about the law here), and their ingredient quality, manufacturing and distribution do not have the same safety and effectiveness assurances. Quality requirements for compounded drugs differ depending on the setting where compounding occurs.
When selecting a compounding pharmacy, patients and providers should confirm that the compounding pharmacy:
- Is accredited by a recognized body and licensed by (and in good standing with!) your state board of pharmacy;
- Requires a prescription for medication; and
- Has a licensed pharmacist on staff to answer questions.
While price breaks on GLP-1s may seem like a welcomed relief, prioritizing price as the main factor in using compounded formulations does not tell the whole story. Some compounded formulas may include unapproved add-ins or exclude key components to cut costs. These alternatives have not undergone the rigorous research required for FDA approval and may not be overseen in the same way the FDA oversees manufacturing and distribution of medication. This means they could present higher risks and potentially lead to serious adverse effects.
It’s also worth noting that compounded GLP-1s may not be a more affordable option for all patients, because not all insurance plans cover compounded medications and not all compounding pharmacies take insurance. So patients who have insurance coverage for GLP-1s may actually end up paying more for their medication if they obtain it through a compounding pharmacy.
Unlike WegovyⓇ, OzempicⓇ, and ZepboundⓇ, which come in easy-to-use pen injectors, compounded versions will not be in the same delivery tool as a manufactured version. Common tools, such as an injection pen, are typically patented by the manufacturer. There are also novel formulations only available from compounding pharmacies, such as sublingual semaglutide and tirzepatide tablets that may be placed under the tongue. Still, keep in mind that sublingual formulations have not been extensively studied nor approved by the FDA.
Two ways that body composition changes during GLP-1 use include:
-
Lean Muscle Loss - Research indicates lean body mass reduction of 39% of total weight lost. This leads to changes to metabolism, physical health and wellbeing. The muscle lost is not easily restored after discontinuing a GLP-1.
-
Weight Regain - While studies have demonstrated that GLP-1s can help people with obesity lose as much as 15-21% of their body weight, one study found that most people regained an average of 2⁄3 of the weight they lost within a year of stopping the medication and supporting lifestyle intervention.
Knowing that GLP-1-driven weight loss can significantly alter body composition (fat vs. muscle mass), re-introducing unhealthy habits after discontinuing the drug can lead to weight gain, a risk factor for cardiovascular disease.
The good news is, these issues can be countered through an increase in muscle mass via resistance training, which is known to reduce the risk of metabolic health conditions.
To regain muscle mass, individuals need to engage in specific forms of resistance exercise and consume an adequate diet. Omada’s highly trained care teams address lifestyle support, caloric intake guidance, physical activity, and weight monitoring to proactively personalize a member’s care plan.
Through consistent care team support, members can maintain lifestyle change improvements, increasing their chances of achieving a healthy body composition that is vital to long-term weight health once the drug is discontinued.
Omada partnered with a national PBM to conduct a retrospective analysis of the impact of engagement in the Omada program with GLP-1 use and weight loss.
-
The study found 82% of Omada members on a GLP-1 experienced amplified weight loss.
-
These members were meaningfully engaged with Omada and experienced 1.7x the weight loss compared to the 18% with limited engagement.
-
-
During its 12+ year history, Omada has delivered holistic wellbeing benefits and peer-reviewed outcomes for more than 1,900 diverse clients and 1M members, with an industry-leading NPS of 77.
-
Additionally, our prevention program results include:
-
-
-
Sustained weight loss at 12 months of 5.5%
-
58% of participants shifted to normal A1c by 12 months
-
One of the largest CDC fully recognized virtual DPP providers
-
-
-
-
-
The ANSWERS Initiative (ANalyzing Success of WEight medication with Real-world evidence and Stats) is an extension of the Omada Insights Lab that studies the impact of coupling behavior change with weight loss medications. It uses real-world data and insights to discover meaningful synergies between GLP-1 use and lifestyle companion programs. The research that is underway will focus on key metrics such as long-term weight maintenance, medication optimization, and overall health outcomes.
Omada will also explore the impact of our program on other chronic conditions such as hypertension and heart disease as new indications for GLP-1 drugs arise.