GLP-1 drugs commonly used for weight loss management purposes can be a miracle solution for people who have struggled with their weight, but leaders at Solera Health say there are financial and health benefits to trying out other options first.
Step therapy can vary per patient. The approach tries to find a customized weight loss solution that is best suited for the person, instead of immediately jumping to GLP-1 drugs that can be a costly, long-term commitment since the weight can return if a person quits using the drug. Solera Health experts begin by guiding individualized care of lifestyle behavioral changes, then layering in mental health and other support systems. Before finally prescribing GLP-1 medications, they might start a patient off with Gen 1 drugs, a cheaper alternative to a drug like Wegovy.
“There's multiple components that you want to bring together in one place,” said Byron Crowe, M.D., chief medical officer at Solera Health, in a recent webinar. “You're trying to run a program that is identifying the right individuals for the right solution.”
Solera’s program partners with health plans and employers to give patients the ability to enter step therapy for six to 12 months. Patients can be supported as much as possible through a food as medicine approach and managing co-occurring cardio metabolic conditions like diabetes and hypertension.
Where a person begins on a step therapy journey can depend on BMI and other medical conditions. While there is a structure in place, and that foundation often begins with changes to lifestyle, step therapy aims to provide the best care possible for everyone. Because long-term effects of GLP-1s are still not known, it may be in a patient’s best interest to not jump headfirst into the drugs. A recent JAMA study found that GLP-1 drugs can lead to increased, but rare, risk of pancreatitis, gastroparesis and bowel obstruction.
“I've been in the field for obesity a long time where people are stigmatized,” said Gary Foster, Ph.D., chief scientific officer at Weight Watchers, during the webinar. “If these steps are construed or positioned as a place you have to prove yourself or a place you have to fail, it’s a waste of a clinician’s time and it's a waste of the patient's time. That kind of thinking is going to be not only stigmatizing, it's going to be quite costly because you're entering people into a pathway that they're not going to be engaged in because they know that their role is to fail, so they can ultimately get to GLP-1s.”
Weight Watchers first partnered with Solera Health in 2016, providing a diabetes prevention program to members as an Affordable Care Act-covered preventive benefit.
While step therapy has potential to save health payers and patients lots of money by not mass prescribing GLP-1 drugs, that doesn’t mean GLP-1 drugs are ignored in step therapy, as they are still the best option for some people.
Solera’s hope is that true step therapy, where patients are given real guidance on how to make progress, can be an alternative to long-term GLP-1 usage. They pointed to research showing that once people realized they could gain the weight back if they stop taking the drug, they were significantly less interested in GLP-1s.
The company believes it is well positioned to address weight management concerns compared to other practices, because traditional physicians have very little training in nutrition or other lifestyle interventions.
“It’s almost a guarantee that if you have an M.D. behind your name, it means you don’t know a whole lot about nutrition, so you tell your patients to lose weight … but you don’t equip your patients in terms of how to actually achieve that,” said Dexter Shurney, M.D., chief medical officer at Modify Health, a food as medicine at-home meals company that partners with providers, payers, employers and patients.
Many medical professionals are not trained to provide obesity care. In the U.S., less than 100 actively practicing doctors have completed a fellowship in obesity medicine, Stat reported.
A successful step therapy solution would be welcomed by payers and patients alike. Customers outlay up $1,349 for Wegovy in the U.S., the highest cost for the drug in the world.
“I think if step therapy works well then what will happen is that you'll reduce the overall cost associated with obesity,” said Foster. “I think the way to manage an ROI in this context is not to give everybody the most potent medication and the most expensive medication off the bat.”