GLP-1s: 8 things hospital leaders should know

A blockbuster drug class that includes Ozempic, Wegovy and Trulicity is pioneering avenues in the healthcare industry and redefining obesity care as the weight loss therapy market stretches toward $100 billion. 

Here are eight things health system and hospital leaders should know about these medications:

1. What does "GLP-1" mean?

The acronym stands for glucagon-like peptide-1 receptor agonist. 

The gut hormone prompts insulin secretion, suppresses appetite and promotes a feeling of fullness. GLP-1 drugs mimic these physiological effects. 

2. Which medications are approved?

Although GLP-1 drugs gained popularity after 2020, many medications had been on the market for years before then. Below is a listing of GLP-1 medications available with FDA approval as of May 2024, along with the route of administration and its indications.

Bydureon (exenatide) — The FDA approved the active ingredient in 2005 and approved AstraZeneca's Type 2 diabetes injectable formulation in 2017. 

Byetta (exenatide) — Amylin Pharmaceuticals and Eli Lilly received FDA approval for the active ingredient in 2005, and in 2009 it earned approval for Type 2 diabetes. 

Mounjaro (tirzepatide) — Eli Lilly's injectable Type 2 diabetes drug was approved in 2022. 

Ozempic (semaglutide) — The FDA approved Novo Nordisk's injectable Type 2 diabetes medication in 2017. 

Rybelsus (semaglutide) — The first oral GLP-1 Type 2 diabetes drug was approved in 2019 for Novo Nordisk. 

Saxenda (liraglutide) — Novo Nordisk's chronic weight management injectable drug was approved in 2014. 

Trulicity (dulaglutide) — The FDA approved the active ingredient in 2014, and Eli Lilly's Type 2 diabetes injectable medicine secured U.S. approval in 2020. 

Victoza (liraglutide) — Novo Nordisk's Type 2 diabetes therapy was approved in 2010, and a pediatric, injectable treatment for patients 10 or older was approved in 2019. 

Wegovy (semaglutide) — The FDA approved the active ingredient in 2017, and in 2021 Novo Nordisk received an approval for the weight loss management drug. In March 2024, it was the first and only injectable GLP-1 approved to reduce the risk of cardiovascular death, heart attack and stroke in obese or overweight adults with cardiovascular disease.

Zepbound (tirzepatide) — The active ingredient was approved in 2022 and Eli Lilly's weight loss injectable medication won approval in 2023. 

The eight most popular GLP-1s, in order, are Ozempic, Wegovy, Trulicity, Rybelsus, Victoza, Saxenda, Bydureon and Byetta, according to GoodRx

Read more about the drugs' efficacy here

3. Why are these drugs popular?

Although some of these medications have been on the U.S. market for more than a decade, Ozempic and other GLP-1s gained traction in late 2022 as celebrities clamored for weight loss results and weight loss trends went viral on social media platforms. 

TikTok's algorithm pushed #OzempicWeightLoss into the mainstream. (The social media app recently updated its community guidelines to crack down on dangerous weight loss habits.) 

The uptick in public awareness was mirrored by an increase in prescription rates: Between 2020 and 2022, prescription volumes for GLP-1 medications increased 300%, according to an analysis from Trilliant.

Supply of the drugs, which are mostly approved for diabetes, has waned since late 2022. Patients with Type 2 diabetes began rationing their medications in early 2023 as off-label weight loss approvals increased, and Novo Nordisk limited its output of starter doses to protect continued care for current patients. Zepbound and Mounjaro are in prolonged shortages, and Ozempic and Wegovy supply issues could last years

In the first three months of 2024, Novo Nordisk recorded 25,000 new Wegovy prescriptions each week on average. The demand grew five times since December, the drugmaker said. 

4. How is hospital care affected? 

Hospitals are feeling the effects of GLP-1 uptake, and widespread weight loss could affect hospital strategy and operations downstream. 

The medicines are leading to magnified weight loss programs, more transplants and a decrease in bariatric operations. In some health systems, endocrinologists are leveraging GLP-1s to help patients lose weight. This increases their eligibility for kidney transplants, since transplant departments have strict cutoffs for patients with higher body mass indexes because of an increased risk of complications.

Marc Bessler, MD, chief of minimal access/bariatric surgery at New York City's Columbia University Department of Surgery, said he is seeing a "temporary lull" in operations. As more obesity medications enter the market, experts predict 12,000 fewer bariatric surgeries taking place by 2033, or a 4% decline. Any projected declines in surgeries is significant because elective surgeries are a major source of revenue for hospitals.

In ambulatory surgery centers, GLP-1s are projected to affect spine and orthopedic care, but the extent of their effects is unknown

As hospital departments and ASCs rethink their care strategies for patients taking GLP-1s, debate is swirling about the drugs' safety for perioperative care. In summer 2023, the American Society of Anesthesiologists said some GLP-1 patients were regurgitating and aspirating during surgery. Patients were then instructed to skip a dose before an elective surgery — but critics say there was an overreaction. Researchers at Stanford Medicine in California have echoed their concerns. 

5. How much do the drugs cost, and how is the healthcare industry paying for them?

In 2023, U.S. pharmacies, clinics and hospitals spent $38.6 billion on semaglutide (Ozempic and Wegovy) and $13.2 billion on tirzepatide (Mounjaro and Zepbound). 

Each GLP-1 medication differs in list price, but monthly costs range from $500 to more than $1,300. After these drugs surged in popularity, many insurance plans shrank GLP-1 coverage because of high costs. CMS does not cover weight loss drugs, and multiple health systems have limited or ended their coverage since late 2023, including Rochester, Minn.-based Mayo Clinic and St. Louis-based Ascension. 

"I think the biggest side effect of these drugs is sticker shock," Eric Tichy, PharmD, former chair of the End Drug Shortages Alliance, told Becker's. "For a lot of insurance plans, it's become the No. 1 expense they have, especially if they cover weight loss — and everyone wants to use it."

As more indications are approved, though, some plans are increasing coverage. The FDA's approval for Wegovy to treat cardiovascular problems widened the target audience, and a few health companies expanded their coverage. CMS does not cover Wegovy for weight loss indications, but it covers the drug for cardiovascular conditions. 

As coverage increased, legislators and the public vocalized more criticisms for list prices of Ozempic and Wegovy.

Weeks after a study showed the manufacturing of semaglutide could cost between 89 cents and $4.73 per month, a Senate committee opened an investigation into Novo Nordisk's prices in April. The committee said Ozempic and Wegovy are "exorbitantly expensive" and asked Novo Nordisk to explain why prices are up to 15 times higher in the U.S. than other countries as of April. 

6. What are expectations for the market's future?  

As demand grows for these medications, drug manufacturers are testing new, stronger formulations. 

The more recently approved GLP-1s are also glucose-dependent insulinotropic polypeptide receptor agonists, such as Eli Lilly's Mounjaro and Zepbound. Anita Courcoulas, MD, chief of Pittsburgh-based UPMC's minimally invasive bariatric and general surgery program, told Becker's she categorizes dual GLP-GIPs as the "second generation" of weight loss medications. 

The "third generation" are experimental therapies that combine GLP-1 and GIP receptor agonists with glucagon and glucagon receptors, or GCGRs. Eli Lilly's drug candidate retatrutide, a GLP-GIP-GCGR, reduced study participants' weight by 24.2% after 48 weeks — the most significant weight loss results compared to other drugs on the market. 

A plethora of potential indications are in the pipeline, including sleep apnea — which might be approved this year for Zepbound — kidney disease, metabolic dysfunction-associated steatotic liver disease, dementia, Parkinson's disease, addiction, anxiety, depression and cancer. More cardiovascular and weight loss uses are also on the horizon

As far as sales, there are no signs of demand waning. Novo Nordisk is currently investing billions of dollars to buy more manufacturing sites to maintain enough supply, and DHL Supply Chain is expanding its network of warehouses because of the "upsurge in the pharmaceutical landscape" due to weight loss and diabetes drugs. 

As more Americans shed pounds, the U.S. economy is expected to bulk up. By 2030, the global anti-obesity drug market could reach $100 billion — 16 times more than its current worth, according to Goldman Sachs analysts. They estimated that, with 30 million users, GLP-1s could add 0.4% to America's gross domestic product. 

7. What about the spillover effects and phenomena?

GLP-1s are not only improving health outcomes related to Type 2 diabetes, obesity and heart conditions; the popular medicines are also affecting food companies and longstanding weight loss businesses, and propelling countries' economies. 

Outside the healthcare industry, Walmart leaders have said shoppers are buying fewer calories, and junk food companies are switching tactics and promoting healthier options in the hope of retaining consumers. Experts have also predicted airlines could save on fuel in the near future because of lighter passengers. 

The efficacy of medication-induced weight loss has posed challenges for legacy weight loss brands that focused on diet programs, meal plans, physical locations and subscription models. In April 2023, WeightWatchers bought a telehealth company that digitally prescribes weight loss drugs like Ozempic in a $132 million deal. The next month, diet and weight loss business Jenny Craig filed for bankruptcy.

GLP-1s are reshaping business and company value, with pharmaceutical companies climbing to new heights. About a century after Novo Nordisk opened shop, the drugmaker overtook luxury brand LVMH Moët Hennessy Louis Vuitton as Europe's No. 1 largest company by market capitalization. 

On the consumer side, some patients have reported rare and strange side effects, including "Ozempic face" — when a person's face seems to deflate because of dramatic weight loss — malnutrition, less "food noise" and bizarre dreams. Muscle mass loss and subsequent pain have also been reported. 

More patients are also increasingly asking their physicians for weight loss medications to prevent pregnancy complications. Little is known or confirmed about how GLP-1s affect fertility and pregnancy, but because obesity and being overweight are risk factors for pregnancy issues, some patients are seeking GLP-1s to avoid preeclampsia and preterm birth. 

Patients have also attributed unplanned pregnancies to GLP-1s. The phenomenon, dubbed the "Ozempic baby boom," could be because obesity medications affect the absorption of contraceptives or since weight loss can improve chances of pregnancy.

8. What is unknown?

As researchers explore interactions between GLP-1s and pregnancy, others are investigating the benefit-cost ratio and long-term safety profile of these drugs. If patients don't continue taking the medications, they could experience weight regain. 

Tim Schaffner, MD, bariatric surgeon at Bon Secours in Hampton Roads, Va., told Becker's the "ultimate question" is whether patients taking GLP-1s keep the weight off. Alfred Trang, MD, medical director of general surgery for Livonia, Mich.-based Trinity Health Mid-Atlantic, agrees.

"I am concerned that the medication slows down gastric emptying, and so to what extent, how permanent it is, these things we don't know yet," Dr. Trang said. "The studies out there, the [longest] study was only about 68 weeks. What happens when the patients are taking them for five years? For 10 years? We just don't know."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars