Unlocking the Potential of GLP-1 Agonists

In the last 5 years, robust clinical evidence has documented the effectiveness of glucagon-like peptide 1 (GLP-1) receptor agonists in numerous highly prevalent conditions, including obesity, type 2 diabetes, and more recently, kidney disease, dementia, and addiction. Though we are only beginning to comprehend the transformative nature of this medication class for health outcomes, already 1 in 8 US adults have reported taking a GLP-1 receptor agonist. Despite the clear clinical potential and rapid uptake, increasing real-world experience with GLP-1 receptor agonists has illuminated major challenges for the healthcare ecosystem. Verily is building evidence-based care solutions to address these challenges and maximize the potential for GLP-1 agonists to deliver clinically meaningful outcomes.

First, determining the right parameters around access to these medications has been complicated. For most health insurers, the high cost of GLP-1 receptor agonists (averaging between $900-1,100 per patient per month) paired with high utilization means providing long-term coverage for plan enrollees is financially unsustainable. In response to the rapid high volume uptake, many insurers have been forced to limit access by dropping coverage of GLP-1 receptor agonists for weight loss or increasing prior authorization requirements: a process that controls spending and limits unnecessary treatment but creates additional work for both the insurer and the prescribing clinician and can delay medically necessary patient care.¹

When patients do obtain coverage, filling a GLP-1 receptor agonist prescription at the pharmacy has occasionally been challenging as the sudden high demand for these products initially outpaced the manufacturers’ ability to supply them and created temporary shortages. And, for patients without commercial insurance, who are often those that could benefit most from health improvements associated with weight loss, access is nearly impossible. Only a handful of state Medicaid programs and only 1% of ACA Marketplace plans cover the use of GLP-1 receptor agonists for weight loss. Without insurance, out-of-pocket costs are approximately $1000-1400 per month (list price) depending on the specific medication.

Difficulty in access has led to widespread GLP-1 receptor agonist compounding: a process where pharmacies or physician offices assemble the active ingredients of drugs that are in short supply in order to produce a pharmaceutical product for local distribution. While useful for periods of time in emergent situations, GLP-1 compounding is not a long term solution to current access challenges. Though compounded medications can be cheaper than FDA-approved products, concerns with contamination and inaccurate concentration or potency are significant.² As the FDA-recognized shortages end, other solutions will be needed to address the widespread access problems.

Second, utilization patterns have demonstrated that accessing a prescription for a GLP-1 is not enough to guarantee clinical benefit. The side effects associated with starting GLP-1 receptor agonists, such as nausea, vomiting, and diarrhea, cause high rates of discontinuation.³ A recent BCBS analysis suggested that up to 30% of patients who start on GLP-1 receptor agonists discontinue use before the period where meaningful weight loss can be achieved and when medication dosing becomes stable around 12 weeks. For patients that do remain on therapy long enough to lose weight, regaining weight after discontinuation is very common and potentially attributable to several underlying clinical factors.⁴

More so than many other medications, research suggests that when taking GLP-1 receptor agonists, patients should make simultaneous changes to their diet and exercise routine to maximize and maintain the clinical benefits.⁵ However, there are several well documented barriers to these types of lifestyle changes, many of which can be nearly impossible to overcome without personalized support.⁶ In fact, because lifestyle changes are so critical to the success of GLP-1 medication in helping patients maintain clinically meaningful weight loss and other long term health benefits, some health insurers are requiring patients to enroll in clinical support programs as a condition of coverage for the medication. Though the need for support is clear,⁷ there is very limited evidence available to help determine what is the right level and type of support an individual needs to achieve long term clinical success.

At Verily, we have carefully considered the clinical implications of these two challenges in the design of our personalized, AI-powered chronic care solution, Lightpath. Lightpath offers a care pathway for people with diabetes or hypertension that is backed by deep clinical expertise and includes anti-obesity medication support for eligible participants.* In Lightpath, participants can interact with board-certified endocrinologists, registered dietitians, pharmacists, and coaches who work together to assess clinical need for GLP-1 medication or other weight loss treatments, proactively manage medications, and provide personalized, ongoing support to drive adherence and sustained behavior change.

To help navigate challenges related to accessing GLP-1 receptor agonists, Verily Lightpath will deploy a novel type of reinforcement learning methodology that considers participants’ expected clinical efficacy and predicted engagement to propose an optimal allocation of scarce resources like high demand medications.⁸ This approach helps the care team figure out which patients are most likely to benefit from a GLP-1 prescription while balancing the desire to provide equitable access. Once a medication need has been identified, the Lightpath care team helps participants promptly get access to high quality, FDA-approved drugs.

After starting a new medication, participants on a weight loss journey receive comprehensive support to maximize their ability to achieve clinically meaningful change. Coaches and registered dietitians use validated behavioral therapy to drive adherence and prompt sustained lifestyle change in areas such as nutrition, movement, and mental health, all of which are necessary to enable lasting improvement and limit the likelihood of weight regain after GLP-1 discontinuation. Clinicians and pharmacists monitor participants’ physiological measures because sudden weight loss often requires changes to other medications, such as those for blood pressure and diabetes medications.⁹ Finally, AI-enabled agents that are trained on clinically validated evidence will be available to answer common questions when participants might be experiencing medication side effects or struggling with a nutrition choice.

Because our understanding of how to best use GLP-1 receptor agonists for large segments of the population is still nascent, the generation of real-world data will be important in navigating the current and future challenges. Our technology solutions, like Lightpath, are designed according to the learning health system model, where internal data and clinical experiences are combined with external research and used to continuously improve quality and patient safety. We chose to build our care solutions on an evidence-based, learning platform to help answer questions such as “which specific barriers limit patient access to GLP-1 medications?", “what level and type of clinical and behavioral support does an individual patient need to avoid early discontinuation?", “if weight loss is achieved, when should a particular patient discontinue GLP-1 use and what level of support is needed to limit weight regain?”. The power of these insights can bring clarity to an emerging space where the importance of getting it right — from an economic, clinical, equity and access perspective — is absolutely critical.

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8. Killian JA, Jain M, Jia Y, Amar J, Huang E, Tambe M. New Approach to Equitable Intervention Planning to Improve Engagement and Outcomes in a Digital Health Program: Simulation Study. JMIR Diabetes. 2024 Mar 15;9:e52688. doi: 10.2196/52688.
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* Disclaimer: Verily Life Sciences LLC (“Verily”) offers virtual care management programs for eligible individuals, as further described at verily.com. Verily collaborates with Onduo Management Services LLC (“OMS”), Onduo LLC, and a network of affiliated Professional Entities to offer the services. These services are meant to be used in conjunction with regular in-person clinical services and not intended to replace routine primary care.