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Omada Health’s Guide to GLP-1s

Q1 -Q2 2024

Weight Loss Quantity vs. Quality

As the GLP-1 conversation continues to evolve, Omada Health is updating its industry FAQs to deliver timely data and insights for employers, health plans and benefit consultants. This quarter, we’re focusing on weight loss quantity vs. quality, and how that theme permeates management strategies.

Q: What is Omada’s stance on GLP-1s?

Differentiating Weight Loss Quantity vs. Quality

GLP-1s are in high demand due to the number of pounds a patient can lose in a relatively short period of time. Studies show that weight loss drugs can help people with obesity lose as much as 20.9% of their body weight; however, with such rapid weight loss comes muscle deterioration and metabolic slowdown, along with a host of other challenges.

The patient journey on this medication is difficult.

The patient journey on this medication is typically difficult.  Before the prescription, they will need to learn about and comply with coverage requirements or pay out of pocket. During use, they’ll manage side effects, meet the conditions for prescription coverage renewal, and become accustomed to a changing physiology. Once they stop, they may struggle to adjust, and experience weight regain.  In fact, in one study, people who’ve come off the drugs, regained an average of two-thirds of their weight loss within one year.

While the FDA indicates GLP-1s should be taken along with diet and exercise modifications, there are no specific recommendations beyond that, leaving patients unguided on the behavior changes needed to navigate the side effects, maintain muscle mass, incorporate a nutritious diet, and sustain results. 

Quality weight loss means sustained weight health through supported nutrition and exercise.

As such, we believe benefit designs should couple GLP-1 therapies with an evidence-based behavior change program like Omada. Since we launched our diabetes management program in 2019, Omada has supported its members who are taking GLP-1s as an important component of their diabetes medication regimen. When it comes to GLP-1s used for weight loss, we will continue to offer support in a way that our members and the healthcare industry can sustain and is backed by clinical research.

Q: How can organizations better manage usage and costs of GLP-1s?

Long-term value means limiting weight regain

 The GLP-1 market is predicted to increase to $16.8B by 2028, pushing organizations to adapt and grow along with it. Knowing how to optimize the drug’s outcomes before, during and after is key to managing usage and costs. For Omada that means:

Streamlining the User Experience

Flexible member outreach and legally-permitted member data reporting supports benefit design and utilization management.

Bolstering Weight Loss

Holistic lifestyle support complements primary care with a dedicated care team and personalized care plans. The member experience is embedded within all cardiometabolic programs.

Limiting Weight Regain

Holistic lifestyle support complements primary care with a dedicated care team and personalized care plans. The member experience is embedded within all cardiometabolic programs.

Q: What are Omada’s off-ramp protocols for members taking GLP-1s?

The goal is to help members achieve weight health

GLP-1s have lasting physiological effects on the body, which needs to be taken into account when patients choose to stop taking these drugs. 

While taking the prescription, hunger decreases, which causes the individual to eat less, and lose weight. However, there are reductions in fat and muscle mass, which slows the metabolism.

 When an individual stops taking the GLP-1, their normal appetite returns, but their metabolic rate remains low. As a result, the individual will gain weight if they return to their regular eating habits. Only by maintaining a caloric deficit via food or maintaining a higher level of physical activity will the individual be able to maintain the weight they lost on GLP-1s. 

That’s why Omada helps members do the hard work of maintaining weight health by starting the necessary behavior change while the member is taking the drug, as opposed to after. The goal is for members to develop healthy lifestyle changes while they are seeing quick results, then help turn those changes into habits.

Success Factors to Optimize GLP-1 Use and Reach Weight Health

Omada’s GLP-1 Care Track accounts for the drug’s physiological impact by focusing on five areas to help members maintain as much weight loss as possible.

Medication Assist
  • Onboarding and optimization  
  • Effective use of medication
  • Education to manage side effects
  • Preparation for discontinuation

  • Balanced exercise plan
  • Build lean body mass

  • Caloric guidance
  • Focus on nutrient density
  • Individualized eating habits

Coaching and Community
  • Personalized care
  • Tailored learning curriculum
  • Motivation discovery & goal setting

  • Weight, blood pressure, A1c
  • Activity and food tracking

Q: What does the future look like for GLP-1s?

Investing in populations who need GLP-1s, versus just those who can access them

As the industry develops strategies for managing coverage and costs for their populations, the accessibility gap continues to widen. The Kaiser Family Foundation estimates that GLP-1 coverage for the Medicare population alone could cost up to $26.8 billion annually. A study on GLP-1 access for patients with type 2 diabetes determined that Black, Hispanic, and low-income populations are less likely to have used the medication. Even when coverage exists, as it does for type 2 diabetes, GLP-1s are relatively inaccessible for the populations that need them most.

These cost barriers do more than limit access to GLP-1s, they also limit our understanding of the drug and possibly their effectiveness."

- Sojung Yi, MD

The future of GLP-1s lies in addressing these disparities, not only in access, but in how we approach obesity care in general. To create a more equitable landscape, the industry must turn its focus from the number of prescriptions filled, to the quality of the patient experience. To achieve this, GLP-1s, along with the entire breadth of obesity treatments, must be prescribed with clinically rigorous behavior change programs, to give everyone a fair chance at sustained weight health.