Data Brief: GLP-1 Prescriptions for Weight Loss over Time, 2018-2023

Introduction#

GLP-1 (Glucagon-like peptide-1) drugs have been around for many years but have recently grown in popularity among diabetes and obesity patients. GLP-1s are injectable medications that work by increasing insulin production and delaying digestion to control hunger. For diabetic patients this therapeutic class helps control blood glucose levels and can be used in combination with other common diabetic drugs such as insulin and metformin. For obesity and weight loss patients, the delayed digestion and feeling of fullness promotes weight loss.¹

GLP-1s have been part of diabetic treatment plans since 2005. In 2014, the FDA approved the first GLP-1 for weight loss. While GLP-1 use has been shown to lead to meaningful weight loss and to greatly reduce the likelihood of conditions and complications associated with obesity, such as cardiovascular disease, the costs of these drugs are prohibitive. Reducing the costs of GLP-1s for weight loss is essential for maintaining equitable access for all Californians^{4, 5}.

In this data brief, HCAI will examine the usage of GLP-1 for weight loss, over time comparing Medi-Cal and commercial total costs and mapping total cost per member by county. The NDCs for the GLP-1s were limited to weekly inject pens and patients with diabetes were removed from the analysis.

The analyses for this report were conducted using data from California’s Healthcare Payments Data (HPD) Program. HPD is California’s All Payer Claims Database or APCD; it is a research database comprised of healthcare administrative data: claims and encounters generated by transactions among payers and providers on behalf of insured individuals. For additional information about the HPD Program, including details on data sources, populations included, and data elements available, see HPD Public Reporting FAQ, HPD Resources and Technical Notes.

The following visualizations present data from retail pharmaceutical claims paid by Medi-Cal or commercial plans. The analyses of total costs and out-of-pocket costs do not include rebates, coupons, or other discounts (see the Notes and Glossary sections for definitions and more details).

This analysis increased the homogeneity of the GLP-1 drugs by removing any NDC which is a weekly injection pen. In addition, prescriptions that were prescribed to an individual with diabetes were removed, which increased the likelihood that the prescription was for weight loss.

Notes: These visualizations display fee-for-service (FFS) retail pharmaceutical costs (billed on a pharmacy claim) paid by an insurance plan only; medical pharmaceutical costs (billed on a medical/institutional claim), non-FFS (e.g., capitated) pharmaceutical costs, and non-covered drug products are not included in these numbers.

The cost data does not reflect rebates, coupons, or other discounts, as these are not reported to HCAI.

Funding sources are based on the companies, programs, and organizations that oversee insurance plans and reimburse healthcare providers. Medi-Cal is a public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed by state and federal funds. California’s version of Medicaid. Includes FFS Medi-Cal and managed care Medi-Cal. Commercial are Insurance products for which the coverage premium is paid by a private party, such as an employer, individual, or other entity.