Rethinking Medication Management—and Patient Engagement—Around GLP-1s

One of the more complex policy/care management tangles in healthcare right now revolves around GLP-1 medication therapies. Glucagon-like peptide-1 receptor agonists, or GLP-1 therapies, are offering new hope for patients struggling with diabetes, heart disease, obesity, and sleep apnea. At the same time, the high costs of the GLP-1s are posing problems for payers, providers, and patients alike.

Recently, the Evernorth Health Services consulting firm published a report on the issues, via its Evernorth Research Institute. The introduction to the report states that,” To help our partners better understand how to navigate these challenges, The 2025 Pharmacy in Focus report tackles these issues and explores solutions. ‘From understanding how these therapies work to exploring their financial implications, this report aims to spark thoughtful conversation and drive meaningful action,’ said Urvashi Patel, Ph.D., vice president of the Evernorth Research Institute, which produced the report. ‘Together, we can foster partnerships, streamline solutions, and deliver care that is accessible, sustainable, and effective.’”

The introduction to the report went on to state that “The report is based on a comprehensive nationwide survey of consumers with employer-sponsored health benefits, employers, providers, pharmacists, and health plan leaders, along with an extensive analysis of claims data from 28 million commercially insured individuals and an evaluation of industry and scientific literature.”

What did the Evernorth Research Institute find? There were several key findings in the report:

Ø  GLP-1s drive a historic shift in traditional drug spending increases, outpacing specialty drug trends for the first time. Drugs targeting weight management accounted for about half of the total increase in drug spend in 2024. GLP-1s for weight loss were the predominant driver, equating to 6.7% of total drug costs. GLP-1 therapies are poised for continued growth, with 24% of consumers currently considering GLP-1s and 65% of providers willing to prescribe them. This will likely fuel the upward trend, with a projected 73.1% increase in utilization for GLP-1 weight loss in 2025.

Ø  While GLP-1 weight loss therapies are driving significant growth in drug trend, their increasing use in diabetes management further solidifies their prominence in the health care landscape. We saw a notable decline in the use of traditional, lower-cost diabetes therapies such as metformin and insulin and a significant rise in the adoption of newer, high-cost therapies such as GLP-1s.

Ø  As GLP-1 demand and utilization expand, providing comprehensive clinical support and cost-management strategies are crucial for keeping pharmaceutical innovation accessible to patients while safeguarding health care budgets. Key strategies include implementing lifestyle interventions, optimizing formularies, and choosing capable, clinically focused partners to ensure sustainable and patient-centered outcomes.

Ø  GLP-1s face dual challenges of rapid uptake and high discontinuation rates, raising questions about long-term value  Establishing clear eligibility guidelines and specific requirements when prescribing GLP-1s for weight loss are important to ensure long-term value. Discontinuing GLP-1 therapy – even for the short term – has a significant influence on clinical outcomes and drug trends. Our research shows that more than 50% of patients using GLP-1s for weight loss stopped their treatment within 12 months. Concerns about side effects and medication safety were the main reason for discontinuation, cited by almost half of the patients who stopped utilizing GLP-1s. Another 4 out of 10 patients said they no longer needed the medication, while less than a third cited financial and insurance barriers.

Ø  Surging GLP-1 use among youths amplifies sustainability and supply concerns. GLP-1 prescriptions for weight loss are growing fastest in younger generations, with the highest percent of increase from 2023 to 2024 among members of Gen Alpha (children 14 and younger), who had an 84.6% jump in utilization, and Gen Z (15 to 28), whose utilization increased by 67.8%. The FDA’s first approval of a GLP-1 for weight loss in adolescents came in December 2022.

Looking at the patient engagement angle

One healthcare leader who has been pondering these issues is Colin Banas, M.D. Dr. Banas worked in clinical informatics at VCU Health in Richmond, Virginia, from 2002, 2019, and served as CMIO at the health system from 2009-2019. After that, he joined the Rockville, Md.-based DrFirst as CMIO. DrFirst focuses on optimizing prescribing workflows for physicians. Banas spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland. Below are excerpts from their conversation.

Let’s start at 40,000 feet up. What should our audience understand about the survey’s findings?

When I’ve talked about this survey in the past, it was around the 50-percent abandonment rate after 12 months—for a lot of patients, these are life-altering interventions that transform their lives for diabetes, weight loss, even dementia—even kidney health. And one-third of patients will cite cost. Depending on where you’re getting them, it could be $400-500 per month if it’s not covered. So I’m not surprised that that’s cited as a rationale for cessation. And where DrFirst comes in—our mantra is to help patients get onto and stay on appropriate medication therapy. We have a transparency solution: the DrFirst tool will tell me what’s covered for the patient, what the copay is; whereas in the past, without access to transparency tools, it’s “fire and forget it.” And then the patient comes to see me six months later and I find out they never filled the prescription because of cost.

We also have a patient engagement solution. At the point of me writing the prescription, the patient gets a message. We don’t make you go to the app store; it looks and behaves like an app. It tells you where the prescription went, what your out-of-pocket is; and if we can line you up with a coupon card or a pharma copay assistance program, we’ll serve that up in the experience. So now it’s a two-fer, because you’ve educated them and reminded them and given them their best experience. And from the transparency experience, there are tools that can help.

Are there any instances in which attrition makes sense?

Yes, there are. One of the main ones is side effects; not everyone can tolerate the medications. What’s more, the medications don’t work for everybody. So there’s a certain amount of attrition that is appropriate; I wouldn’t call that attrition abandonment, per se. And research has been done around the long-term impact in terms of quality-adjusted life years, just as is done around cancer drugs.

Where are we in terms of transparency for physicians and patients?

E-prescribing is 20 years old; it really got its legs in 2011 with meaningful use. But this is essentially 20-year-old technology. And a lot of the problems with these other tools is that often, they’re bolt-ons that are layered on.

And here’s a key reality: if you force a doctor to click and to go somewhere to use it, they won’t do it. So the tools are there, but they’re not quite optimized. There’s also heavy fragmentation in the payer world. It’s very hard to address the fact that you might have Humana, but someone else has UnitedHealthcare or Blue Cross, so you’re only seeing a part of the pie. And if I’m not getting the right answer all the time, how can I be sure? Or I wrote for doxycycline and it said it was a two-dollar copay, but the patient finds out it’s $25. It’s only to some extent that doctors will have patience with all of that. And you actually have better visibility into your Domino’s pizza order than I do into the lifesaving technology that helps us with eprescribing.

There’s some thinking that this should be rethought as the complex process it is. So it’s an antibiotic and it’s 5 PM and you as the patient can figure out where you want the script sent. I had a situation years ago in which a patient needed Prednisone for a bee sting and I sent it to his normal CVS; well, he found out that CVS was closed; so I had to get onto my mobile and look up a new pharmacy. That’s a lot of work for both of us. That doesn’t happen with Amazon or with American Airlines.

So yes, the technology’s there, the adoption isn’t always, and ubiquity isn’t always. But I think we’re at an important inflection point. So if 2010 was the EHR adoption moment; and then 2013 or so was optimization; now, with the emergence of agentic AI that can offload some of the cognitive burden, the issues needed to be resolved, are on the doorstep. Agentic AI is moving forward insanely fast. And I think this technology makes it solvable much more quickly. That coupled with the rise of consumerism. That prednisone thing: we don’t tolerate that anywhere else.  And the non-traditional folks are looking at healthcare and saying, there’s a real opportunity here.

Would physicians embrace the technology if it could be made more user-friendly?

A thousand percent, they would. Because there’s an opportunity time cost that I’m avoiding. So if I’m getting a better experience for the patient and a better experience for me, and I’m getting the patient onto medication therapy and averting an abandonment—yes. If you offer doctors a better experience without friction. And patients might vote with their feet: holy cow, the Banas experience was so great. This has legs. Consumerism is real.

What should CIOs and CMIOs be doing right now about all of this?

This is tricky, because I’ve lived on both sides of the aisle. Going back to the meaningful use era and since then, there is a tendency to try to rely on your EHR vendor to accomplish it all. We already have the agreements in place, theoretically, you wouldn’t have to use integration engines, etc. But you still need to be open to third parties who are experts in these areas, particularly when it comes to prescribing and prescribing networks. Look at the Change Healthcare debacle: we were so heavily dependent on one vendor for claims adjudication and even script-writing. That was devastating. So, health system HIT leaders need to be open to these opportunities. Chances are there’s a company that will be more adept in this particular field than your EHR vendor ever will be or ever will want to be.