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June 25, 2024
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David Burda
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Economics Outcomes System Dynamics
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GLP-1 Drugs, Healthcare Trade Associations and the Healthcare Industrial Complex®

One of the most important gears in the machinery of the Healthcare Industrial Complex® is the healthcare trade association. Healthcare trade associations exist for one reason, and that’s to protect the economic interests of their members. That’s it. Everything else is window dressing, eye candy, tinsel, noise. Choose your euphemism.

A great example of this is playing out right now over GLP-1 drugs to treat diabetes and obesity. Patients want to take them. Doctors want to prescribe them. Drug companies want to sell them. Online consumer health platforms want to distribute them. But commercial health plans don’t want to pay for them.

Despite the evidence that GLP-1 drugs will save money in the long run by dramatically reducing the costs associated with treating obesity-related chronic illnesses like diabetes, heart disease, cancer, stroke and more, commercial health plans don’t want to pay for them because it will cost them billions of dollars in the short term before they realize any long-term financial benefits.

Blue Cross and Blue Shield plans are no different. Blues plans don’t want to pay for GLP-1 drugs. But how can they say that, let alone do that, when the rest of the healthcare industry is going bonkers for this new class of wonder drugs?

That’s where the Blue Cross and Blue Shield Association (BCBSA) comes in. The BCBSA is the healthcare trade association that represents the economic interests of Blues plans across the country.

On May 21, the BCBSA through its Blue Health Intelligence research arm published an “issue brief” called “Real-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management.” The 24-page brief is based on claims data from about 170,000 enrollees in commercial Blues plans who were prescribed one of two GLP-1 drugs from January 2014 through December 2023. The two drugs in the claims analysis were Saxenda, a daily injectable that went on the market in 2014, and Wegovy, a weekly injectable that went on the market in 2021.

The analysis of the enrollee claims data found that only 42.2% of the enrollees stayed on their prescribed GLP-1 drugs for 12 weeks or more — the minimum recommended treatment course to experience weight loss. Some 57.8% users bailed before 12 weeks. That’s the excuse, I mean, data point, that Blues plans needed to not cover GLP-1 drugs.

“When patients take medication, we want it to be safe and effective,” BCBSA gushed in a press release. “This study shows most people are unlikely to see lasting benefits. Unfortunately, weight loss isn’t as simple as filling a prescription.”

A lot of national media outlets bit hard on the story like Forbes did on June 20 with this piece: “58% of Patients Discontinue Use of Obesity Meds Before Reaching Meaningful Weight Loss, Study Shows.”

Less than a month after the BCBSA published its issue brief, Bloomberg and other national media outlets reported on June 12 that Blue Cross Blue Shield of Michigan was dropping coverage of GLP-1 drugs in its large group commercial plans starting Jan. 1, 2025. The Michigan Blues confirmed the move, and most healthcare trade media ran the story the next day on June 13.

About a week later, on June 21, the Michigan Blues published a commentary in its MI Blues Perspectives publication on why it changed its coverage of GLP-1 drugs. It cited the rising cost of GLP-1 drugs and the BCBSA issue brief.

“A national Blue Health Intelligence study from the Blue Cross Blue Shield Association finds that more than 30% of patients dropped out of treatment after the first four weeks and 58% of patients taking the medications for weight loss discontinued use before seeing a clinical benefit,” the commentary read.

From a public relations standpoint, this couldn’t have worked out any better. The Blues association gave its member Blues plans the cover they needed to stop paying for GLP-1 drugs. The cover was an analysis that said most patients aren’t adherent to their prescriptions so why pay for them in the first place. As good stewards of your premium dollar, we can’t in good conscience waste your money on unused drugs.

It kind of makes sense, but I’d be less skeptical if things didn’t play out in just the right order. It’s too neat of a package to say it’s all a coincidence.

I’d also be less skeptical if the association’s custom research team didn’t go way back to 2014 in order to include a daily injectable GLP-1 drug in its claims analysis.

I’m not a statistician, but I’ve gotten all kinds of shots, injections and vaccines in my life. I’d much prefer a weekly or monthly injection than a daily injection. It wouldn’t surprise me if more people were likely to stop treatments if their injections were daily rather than weekly. Makes you wonder if they threw the daily injection claims data into the analysis to skew the results. I can think of all kinds of unpleasant medical tests, treatments and procedures from the past that would skew an analysis of claims data.

Anyway, no one likes playing the long game in healthcare. It’s about annual balance sheets and quarterly earnings reports. No likes doing something that will benefit consumers and the system as a whole. It’s about doing what’s best for my segment of the industry and in my particular market.

The only way to change that dynamic is a customer revolution in healthcare. And I’m here for it.

Thanks for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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