Document Type

Presentation

Publication Date

7-24-2024

Abstract

Obesity has emerged as a significant health concern, with increasing prevalence rates impacting morbidity and mortality. In recent years, the FDA has approved several medications for weight management, including phentermine/topiramate, bupropion/naltrexone, liraglutide, and semaglutide. Despite the availability of various prescription weight loss medications, their real-world effectiveness remains uncertain. In November 2023, a new promising injectable medication, tirzepatide, received FDA approval to treat obesity. This study investigates the potential pharmacy budget impact of tirzepatide into a U.S. commercial pharmacy benefit plan for an employer group with 10,000 adult members over a 5-year time horizon. The model encompasses all injectable weight loss medications, namely liraglutide, semaglutide, and tirzepatide, and incorporates Wholesale Acquisition Cost data and projected rebates, as well as projected obesity prevalence and adoption rates. Sensitivity analyses were conducted to estimate the impact of variability in net costs, adoption rates, copays, and market share. The study results show that the addition of tirzepatide on a drug formulary would yield an increase of $117,523 in total pharmacy expenditures over 5 years, equivalent to $0.20 per member per month (PMPM). Sensitivity analyses demonstrate high sensitivity to realistic variations in tirzepatide and semaglutide net costs, estimating potential PMPM impacts ranging from -$0.45 to $0.84. These findings emphasize the critical importance of monitoring real-world variation in net cost to inform optimal formulary and utilization management strategies. This framework allows decision-makers to balance rebate opportunities with formulary and utilization management strategies to optimize the pharmacy budget.

Language

English

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