What do glucagon-like peptide 1 agonist (GLP-1s) have to do with health equity? Quite a lot, it turns out.

GLP-1s, as they’re commonly known, are an entire class of drugs that includes Novo Nordisk’s Ozempic and Wegovy, and Eli Lilly’s Mounjaro and Zepbound, among others. Originally developed to treat diabetes, these drugs show tremendous clinical potential for reducing the comorbidities of obesity and improving health outcomes for a large percentage of Americans.

Unfortunately, these treatments so far carry steep prices, and as a result, the individuals who might benefit most from their use may have the hardest time accessing them. Since most Americans receive their health insurance coverage from their employers, what do business leaders need to know about GLP-1s right now?

HBHI invited a panel of three guests to discuss this issue: Katey Bey, Global Head, Total Rewards, Sedgwick; Gregory Daniel, PhD, MPH, Vice President & Head of Global Public Policy, Eli Lilly and Company; and Shantanu Nundy, MD, EVP Care Delivery and Chief Health Officer, Accolade.

Together with HBHI's own Joseph Levy, PhD, the panelists shared their reflections and predictions for the future of GLP-1 antagonists and its coverage by employers.

  1. People of color in the U.S. are disproportionately impacted by obesity-related conditions. As an example, there are tremendous disparities in the rates of Type 2 diabetes. “African Americans, compared to whites, have a 30% higher risk of developing obesity,” said Daniel. “Hispanics have a 20% higher risk of developing obesity, and four out of five Hispanics and African Americans have overweight or obesity.”
  2. Obesity is overlooked as a chronic condition worth treating. “Individuals with overweight or obesity have 12 times the increased risk of developing four or more chronic conditions and our healthcare system covers those, but we don't really think about obesity itself as a medical condition that also needs coverage,” said Nundy.
  3. The comorbidities of obesity are major drivers of cost. “Average healthcare spending for members of large employer groups is about 2.7 times higher for people with obesity compared to employees and their families who don't have obesity,” said Daniel. People with obesity are also shown to be absent from work about three or more days per year due to injury or illness related to their obesity compared to healthy weight counterparts.
  4. The current prices of GLP-1 drugs, which would alleviate these conditions, is inhibiting access. Health systems and big employers (like the state of North Carolina) are in the uncomfortable position of trying to defend their decision not to cover GLP-1 drugs despite the clear benefits. “We want to ensure high quality of life for our participants, that’s our number one goal, but then we also have the fiscal responsibility of controlling costs," said Bey.
  5. The media coverage of celebrities using GLP-1s has complicated the picture. The challenge is to make sure the right patients–those who are most need–are getting access. “There’s been a disservice to real people who have obesity that now may not have easy access because of the associated knee jerk reactions of overemphasizing restriction," said Daniel.
  6. At present, shortages are widespread. As consumer awareness grows, demand is skyrocketing. “There’s only two medications patients ever walk in and ask me for. It’s antibiotics, and GLP-1,” said Nundy. “But some of my colleagues have said they don't even bother prescribing GLP-1 because it's been so difficult for patients to get it.”
  7. Production is ramping up to meet the need. “That is a serious concern that we're looking at and I know Eli Lily, as well as Novo Nordisk, have made recent announcements in significant investments in manufacturing capacity in order to increase production and supply,” said Daniel.
  8. Employers’ perspectives on GLP-1 coverage are (necessarily) evolving. “I don’t think there’s one right answer, but there’s a lot of different voices at the table. For instance, we can see claim trends, and use that data to inform our decisions about what is right for our population,” said Bey. “From an employer's perspective, staying current on what's going on in the marketplace, making informed decisions, and getting a pulse on what other employers are doing will help them keep pace with the changes.”

 

Shantanu Nundy is a physician, entrepreneur, and technologist who is passionate about reinventing healthcare for all. He currently serves as EVP of Care Delivery and Chief Health Officer of Accolade, overseeing the company’s clinical strategy and physician-led advocacy services for millions of members and their families. Shantanu is also the author of the book “Care After Covid: What the Pandemic Revealed is Broken in Healthcare and How to Reinvent It.” He continues to practice primary care at Neighborhood Health, a federally qualified health center in greater Washington, DC, and he serves as a lecturer in health policy at the George Washington Milken Institute for Public Health and as an advisor to the World Bank Group on digital health and innovation.

Gregory Daniel, PhD, MPH is Vice President & Head of Global Public Policy at Eli Lilly and Company. Greg has led the Global Public Policy group, which is responsible for proactively identifying, assessing, and developing public policies in areas such as prescription drug access, affordability and innovation, global value-based healthcare, health equity, and other high priority policy areas. Greg also leads external policy engagement, policy research prioritization, and develops partnerships with academic groups, think-tanks, and other policy research organizations. He is also currently the Editor-in-Chief of Therapeutic Innovation and Regulatory Science (TIRS), the scientific journal of DIA. Greg also serves on the Board of Directors and is Past President for the Innovation in Value Initiative (IVI) Foundation.

Katey Bey is the Global Head of Total Rewards at Sedgwick where she focuses on the strategic leadership of their total rewards offering and colleague experience. Katey has spent the bulk of her career in the global Total Reward space specializing in designing, implementing, and managing benefits, compensation, and rewards programs.

 

Watch the full conversation here.

 

 

This conversation is part of the Hopkins Business of Health Initiative’s Conversations on the Business of Health, a series of one-hour webinars that engage leaders in business and academia to explore questions such as:

 

  • Should companies invest in their employees’ health?
  • Are companies responsible for the health consequences of their products?
  • Will artificial intelligence actually advance health?
  • How can business offer healthcare in novel settings?

 

Moderated by faculty members and jointly hosted by the Bloomberg School of Public Health, the Carey Business School, the School of Nursing, and the School of Medicine, these events are open to all. Learn more here.