Only 1 in 4 US patients given Novo Nordisk’s Wegovy or Ozempic for weight loss were still taking the popular drugs two years later, according to an analysis of US pharmacy claims provided to Reuters that also showed a decline in continuous use over time.
The analysis does not include details of why patients quit smoking. But it provides a longer view of the real-world experiences of patients taking the medication than previous research that has studied use over a year or less.
Evidence that many people may stop using weight-loss therapies not long after starting is influencing a debate over their cost to patients, employers and government health plans.
Wegovy and similar drugs, which belong to a class of drugs known as GLP-1 receptor agonists, can cost more than $1,000 a month and may require prolonged use to provide meaningful benefits.
Their prices in the US have drawn fire recently from President Joe Biden and other public officials, who said such drugs could cost the country $411 billion a year if only half of obese adults use them. . That’s $5 billion more than Americans spent on all prescription drugs in 2022.
“GLP-1 for everyone is not cost-effective”, said Dr. Rekha Kumar, an obesity specialist at New York’s Presbyterian-Weill Cornell Medical Center and chief medical officer at Found, an online weight loss program. “People want to provide their employees with obesity care, but they want to do it in a way that doesn’t bankrupt them.”
More news on weight loss drugs
Prime Therapeutics and Magellan Rx Management, a pharmacy benefit manager, reviewed pharmacy and medical claims data for 3,364 people with commercial health plans that cover GLP-1 drugs. They all had received new prescriptions between January and December 2021 and had a diagnosis of obesity or a body mass index of 30 or higher.
The PBM excluded patients using the drugs for type 2 diabetes, for which these drugs were originally developed. The average age of the patients included in the analysis was 46.5 and 81% were female.
Last year, Prime published data that found 32% of patients were still taking a GLP-1 weight loss drug 12 months after their initial prescription. The new data shows that overall, for all the drugs included in the study, only about 15% were still on the medication after two years.
For Wegovy, 24.1% of patients continued therapy for two years without a gap of 60 days or more, out of 36% who had stayed on the drug for a full year. With Ozempic, which has the same active ingredient as Wegovy – semaglutide – 22.2% of patients continued to fill their prescriptions at two years, up from 47.1% who had used it for one year.
Older GLP-1 drugs fared worse. At two years, only 7.4% of patients were still taking Novo’s Saxenda, a less effective weight-loss drug that some health plans require patients to try before newer GLPs like Wegovy or Eli Lilly’s Zepbound.
In the analysis, 45% of patients were taking Ozempic or Wegovy. Others were taking Saxenda or Victoza, which are both liraglutide, Rybelsus, an oral version of semaglutide, or Lilly’s Trulicity (dulaglutide).
The analysis also found that 26% of patients switched GLP-1 drugs during therapy, possibly reflecting shortages or changes in insurance coverage, according to Dr. Patrick Gleason, assistant vice president for health outcomes at Prime/MRx and a co-author of the analysis.
Both Novo and Lilly have been unable to keep up with unprecedented demand for new drugs.
“No one really knows”
Novo Nordisk in a statement cited several limitations in the analysis. He noted that Wegovy did not launch until June 2021, in the middle of the study period, and was not immediately covered by insurance. And Ozempic is not approved for weight loss, which could affect coverage and patient adherence to the therapy, the Danish drugmaker said.
The company said it “does not believe these data are sufficient to draw conclusions about overall patient adherence and persistence to various GLP-1 medications, including our treatments.”
The newer GLP-1s in clinical trials helped people lose more than 15% of their body weight by suppressing appetite and promoting a feeling of satiety. They are being tested for a host of other health benefits that can improve insurance coverage.
Wegovy in March won US approval to reduce the risk of strokes and heart attacks in overweight and obese adults.
The analysis did not track long-term use of Lilly’s Mounjaro and Zepbound, which began after the study’s baseline. Eli Lilly declined to comment on the overall findings.
Prime/MRx did not ask patients why their prescriptions were stopped. Gleason said a mix of side effects such as nausea and vomiting, out-of-pocket costs not covered by insurance and supply shortages are likely.
Some patients may decide to stop the medication after successful weight loss, doctors said. Other studies have shown that most patients who stop their GLP-1 drugs usually regain most of their weight.
“No one really knows how long you should be taking these medications,” said Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.
Some clinics and telehealth services aren’t properly screening patients or providing adequate nutrition and exercise training along with the medicine, Kumar said, leading to poor results and patients dropping out.
Prime/MRx is owned by 19 US Blue Cross and Blue Shield health insurance plans and manages pharmacy benefits for approximately 38 million people.
Dr. David Lassen, PBM’s chief clinical officer, called the steady decline in persistence two years after therapy troubling.
“It’s not leveling off, but it’s getting a little bit worse,” he said. “It’s really about sustaining your weight loss to achieve long-term results.”