How Amazon Pharmacy is thinking about 'the messy state' of weight loss drugs

Weight loss drugs were one of the most talked about topics at AHIP's June 2024 conference in Las Vegas, especially with the Amazon Pharmacy team.

In March, Eli Lilly tapped Amazon Pharmacy as a partner to deliver select medications, including weight loss drugs, directly to consumers' homes. Through the partnership, Amazon will handle a portion of home deliveries for Lilly's anti-obesity drug Zepbound and other medications from the drugmaker prescribed to patients for obesity, diabetes or migraine. The offering is for medications ordered through the manufacturer's new direct-to-consumer platform, LillyDirect. Amazon Pharmacy also offers access to clinical pharmacists for patients with questions about their care. 

Becker's sat down with Amazon Pharmacy's general manager and vice president, John Love, and its chief medical officer, Vin Gupta, MD, to discuss the company's plans for weight loss medications.

Question: How do you both view the future of the GLP-1 market and Amazon Pharmacy's place within it?

John Love: The launch of GLP-1s for the application of obesity has been messy and bad for patients. There's affordability, access and supply chain issues — it's just been an incredibly complicated release. It's hard as a provider because many patients aren't able to get these drugs, and when they are, the costs are astronomical. For a pharmacy, they require titration, and cold chain, next-day shipping. None of that is supported by the PBM or the manufacturer, who are in turn seeing increases in profits. So it's a messy state. 

What you're seeing from Medicare and regulators is that at scale, this is just a huge amount of cost. We really have to look at aligning incentives and find ways to keep people more adherent. That's part of the plan with Eli Lilly with deeper integration and working with their patient services. Ideally, we'd get clean, validated scripts so the patient knows what the benefit is, the affordability issues are addressed upfront, and then we can be accountable for reliable delivery, leading to better adherence and health outcomes.

Dr. Vin Gupta: I worry that we are consigning an entire generation of Americans to feeling like they need to be on lifelong therapy. I think it's dangerous to say that there's this transformative medication and now you have to be on it forever, which is a dominant theme that exists in parts of healthcare today. We're part of a group of stakeholders that can safely prescribe and do it within our ecosystem. And initial data is showing that not everybody has to be on these drugs for life. 

One of the reasons why Eli Lilly partnered with us directly is because we do world class logistics. Our team of clinical pharmacists can triage issues such as side effects or helping a patient locate their order, which are critical questions that a provider doesn't necessarily have time to navigate once the script has left their clinic. 

Q:  Do you think there are low cost versions of these drugs on the horizon?

VG: There's around 50 phase 1 to phase 3 trials happening across different companies right now, including oral versions. After a successful phase 3, usually it's 12 to 24 months to market. 

Q: We've seen recent examples of insurers, health systems, state health plans and self-funded employers dropping coverage of GLP-1s. Is that the right direction to be moving?

VG: The finance and the economics of these drugs are very challenging. It is also very hard clinically. I don't think it should be just on self-funded employers individually figuring this out. We have to figure this out as a society because this is not gonna be the last time we deal with the challenge of an amazing innovation where the list price is extremely high. I think this reality will exist for 24 to 36 months, and then we may have low cost alternatives. As a clinician, we should talk about this with evidence-based tones and a focus on the prescription, and then you start to develop something that might be sustainable.

JL: If there was a straightforward solution, people would be beating the drum. But I don't think removing coverage is the right plan. For diabetic, polychronic patients, there can be material health benefits and huge savings for the health plan. In other cases, it might be very difficult to see an ROI as a health plan. We're going to have to sort out what the copays are, the right pricing models, and how to align with a person's unique health conditions so they can still find reasonable access to the medication. 

It's true there can be side effects or low adherence, the medications are super expensive, and the supply chain has been a disaster, all of which makes it challenging to measure health outcomes. But there are folks who have seen huge health benefits, so we have to shift the population more toward that.

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