Is there anything that GLP-1 can’t do? Diabetes and obesity are increasingly looking like the tip of the semaglutide iceberg. The Food and Drug Administration (FDA) has approved Wegovy for cardiovascular disease, and researchers are currently testing GLP for many conditions including asthma, arthritis, psoriasis, certain liver diseases, depression, eye disease, and Alzheimer’s disease. We are researching the possibility of -1. and substance use disorders. A recent study even found that GLP-1 may reduce the risk of 10 different cancers.
A growing list of potential indications for GLP-1 suggests the drug may target the root cause (likely inflammation) of the most prevalent and costly condition in the United States If even some of the ongoing trials are successful, GLP-1 has the potential to reshape medicine as we know it.
But it can’t solve everything. In fact, the GLP-1 phenomenon further reveals the fragmentation and dysfunction of the healthcare system. Just as GLP-1 may help discover commonalities between seemingly disparate diseases, it is also shedding a bright light on the root causes of illness in health systems.
medicine is too expensive
GLP-1 costs up to $15,000 a year in the United States, much higher than in other wealthy countries, making it one of the biggest drivers of rising health care costs. Private employers, already facing unsustainable cost trends and feeling pressure from employees to cover drug costs, may literally not be able to afford it. Without cost controls, some studies suggest that widespread adoption of GLP-1 could bankrupt Medicare and the entire health care system.
GLP-1 also shines a harsh light on inefficiencies and inequities in healthcare. Those who can afford to pay out of pocket are gobbling up supplies of GLP-1 (sometimes for vanity purposes), but access remains limited for those on Medicare or Medicaid, who are disproportionately burdened by obesity and diabetes. Limited. For example, Eli Lilly’s recent move to reduce the price of Zepbound only applies to patients who pay out of pocket. And at a few hundred dollars a month, even discounted prices are out of reach for many.
GLP-1 shows how quickly medicine can turn into a gold rush
Pharmaceutical companies, telemedicine providers, and even supplement sellers are selling GLP-1 directly to consumers to meet runaway demand. Some health care providers are taking advantage of the GLP-1 deficiency loophole to prescribe generic versions of drugs that the FDA has warned may be unsafe.
This is a prime example of the limitations of the transactional Telehealth 1.0 model and the dangers of runaway consumerism. Patients can easily take formulated GLP-1 even when lifestyle changes or other approaches are clinically more appropriate. But who will look after their health after the deal is done? Who is helping them manage their side effects and overall physical and mental health?
If a patient becomes ill from a compounded GLP-1, the patient may end up in the ER, and the cost will be covered by the employer and insurance company. No one wins in this scenario.
Providing segmented care
The types of clinicians prescribing GLP-1 are rapidly expanding. The initial prescription of GLP-1 as a diabetes treatment was almost exclusively by endocrinologists. Currently, cardiologists, orthopedic surgeons, internists, and even psychiatrists are probably prescribing them with a different perspective than endocrinologists, and sometimes without a complete understanding of the patient’s overall health. . Various specialties have begun to establish their own clinical guidelines regarding GLP-1.
Given how siled specialty care is, it is increasingly likely that primary care physicians (PCPs) will prescribe GLP-1 for weight management without the knowledge of the patient’s cardiologist; The reverse is also true. Who is thinking about the whole person? Who is looking at the overall clinical outcomes and costs for the patient and the system as a whole?
Prescriptions you really need
I am rooting for GLP-1 to become a miracle drug. However, the jury is still out, and in the meantime, the GLP-1 frenzy is exposing healthcare stakeholders across the system (patients, employers, insurers, and providers) to unsustainable clinical and financial risks. are.
On the plus side, these increased risks and unprecedented attention from both consumers and industry may ultimately be what is needed to fix a broken healthcare model. And the solution to the problems surrounding GLP-1 is exactly what we’ve needed all along.
Prevention. The United States invests far less in preventive and primary care than other wealthy countries. Increasing access to primary care and mental health services, including virtual care, is essential to sustainably address the upstream causes of the conditions we currently treat with GLP-1. integrated care. This includes long-term care coordination between PCPs and specialists, navigators and patient advocates. The comprehensive financial and administrative support provided by these care team members is especially important given the high cost of medications and the challenges of managing chronic diseases such as diabetes. Performance-based payments. Recent moves to include GLP-1 in Medicare negotiations are a good start, but they are not a silver bullet for health care cost trends. Despite consumer demand for GLP-1, studies show that two-thirds of patients do not continue using the drug long enough to achieve or maintain clinical benefit. This means high initial costs with little return for patients. and health care purchasers. Business and payment models tied to important clinical and financial outcomes encourage the smart prescribing and integrated care needed to increase adherence and long-term outcomes, minimizing waste and ensuring GLP This is an important step in realizing the full value of -1.
GLP-1 has the potential to transform healthcare. But their potential will be stunted if we continue to force them into siled and fragmented health systems. This is another sign that we need to fundamentally rethink our healthcare system.
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