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Digital health companies making a long-term play for the $100B weight loss drug market
09 May 2023
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In 2022, more than 5 million prescriptions for Ozempic, Mounjaro (tirzepatide), Rybelsus (semaglutide) or Wegovy were written for weight management, compared with just over 230,000 in 2019—a 2,082% increase, according to data from Komodo Health.
Disha Narang, M.D., has been focused on diabeteOzempicbeMounjaroattirzepatidere Rybelsusecsemaglutide seenWegovyransformative impact of next-generation weight loss drugs for her patients.
"As we've gotten more approvals for weType 2 diabetes, it's been fantastic. This is a game changer. In the world of weight management and as an obesity medicine specialist, I think it's absolutely essential for patients who sobesity with obesityNorthwestern Medicine Lake Forest Hospitals," said Narang, speaking about weight loss drugs like glucagon-like peptide agonists, or GLP-1s.
The effectiveness of drugs like Novo Nordisk's Wegovy and Saxenda, which are approved for weight loss, as well as the diabetes drug Ozempic has created sky-high demand while off-label use of the drugs also has driven supply challenges in obesitymonths. Pharma giant Eli Lilly also is pushing to get FDA approval for tirzepatide, a diabetes meglucagon-like peptide agonistseightGLP-1smarket in the U.S.
Prescriptions increased by 259% between 2021 anOzempicalMounjarotirzepatideRybelsussemaglutideWegovy
As a physician, Narang is concerned that the buzz around GLP-1s is shifting attention to medication rather than treating diabetes and obesity as chronic conditions that require long-term, holistic care and medical follow-up.
"There's not a quick fix, there's not a magic wand. We haGLP-1sapproach this as we are treating a long-term chronic diseadiabetes saidobesityinterview. "I think one of the things that needs to be understood is that a GLP-1 agonist, whether it's for weight loss or diabetes, it is meant to be on for a while, this is a long-term therapy. If it took somebody 50 years to gain a certain amount of weight, taking this medication for like a month or two isn't going to change that outcome. For these weight loss clinics and various online platforms, 'OK, you've got this drug that's in high demand, but what is your plan for the next 20 years?' This is a long-term therapy that we're looking at."
This trendy new class of weight loss drugs is gaining attention as public health officials and the pharmaceuchronic diseasetarget a growing obesity epidemic. Obesity has nearly tripled worldwide since 1975, and about GLP-1f U.S. adults are estimated to live with odiabetesaccording to Centers for Disease Control and Prevention (CDC) data. The toll is physical and financial, with the medical cost of obesity hitting nearly $173 billion in 2019 in the U.S.
GLP-1 medications support weight obesity sending signals to the brain and body that help regulate metabolismBarclaysp patients feel full and satiated longer. Based on clinical trials, with the use of GLP-1 medications and lifestyle adjustments, patients can anticipate losing 10% to 18% of their body weight, based on the average weight loss in three 68-week clinical trials.
In the past year, many telehealth and digital health companies have jumped into the market, offering prescriptions for GLP-1s as part of an existing weight loss or chronic condition management program, or creating a new service line targeting obesity care.
Telehealth giant Teladoc recently expanded its provider-based care service for employers to include weight management aGLP-1sdiabetes programs. The program is designed to help members lose weight and prevent and manage diabetes by safely optimobesityedications, such as GLP-1 agonists, working in conjunction with solutions and tools that address the foundational pillars impacting cardiometabolic health, the company said.
Telehealthlth is Teladocg out its virtual care services combining diagnostic testing, treatment and ongoing condition manaprediabetespart of this service, the company is offering GLP-1 drugs to qualified patients in itsdiabetesmanagement program.GLP-1
Everly Healths also is moving into the obesity drug market with its recent acquisition of telehealth company Sequence for $132 million.GLP-1 drugs
In January, direct-to-consumer health aobesityness company Ro launched a weight loss program that provides acSequenceGLP-1 medications. Members of the Ro Body program also get access to a personalized provider care plan, diagnostic testing with at-home sample collection and 1:1 coaching from nurses.
"Weight management and weight loss are not new to Ro. We have over 160,000 patients who have partnered with us on their weight loss journey for the past couple of years. But we've been watching the GLP-1 space and just always thinking about what new effective treatments and solutions we can launch for our patients," Melynda Barnes, M.D., Ro's chief medical officer, said during an interview on the sidelines of the ViVE Conference in Nashville, Tennessee. "The Ro Body Program is a comprehensive program that is anchored on GLP-1s as the medical therapy but it's a combination of GLP-1 medication, high-touch provider chronic condition care management, insurance concierge service, at-home lab testing, RN coaching and specific educational curriculum. I think the thing that's really important about GLP-1s is that medications are highly effective, but the highest likelihood of success for treatment is really partnering the medication with high-touch provider care."
Hims & Hers, a competitor in the direct-to-consumer health space, has not yet dipped its toes into weight loss and obesity medications but has signaled that it plans to in the future. The company reGLP-1y added five new members to its medical advisory board including specialists in obesity medicine and menopause.GLP-1sGLP-1s
Hims & Hersag on weight loss drugs like Wegovy, which can cost more than $1,000 a month per person without insurancobesity challenge for a cash-pay business like Hims & Hers, noted Patrick Carroll, M.D., Hims & Hers chief medical officer.obesity
"We really recognize that obesity and weWegovyanagement are a public health challenge. We will offer a comprehensive program in the future. I think our challenge Hims & Hersat the whole drug category is cHims & Hersin itself. There are long-term safety side effect issues and there are challenges with cost," Carroll said. "There are significant supply chain issues and challenges with insurance coverage. When we offer a program, it's really going to be holistic and will include evaluation, counseling and medications but not just GLP-1s as there are generic medications out there that have been very successful in managing weight loss."
Studies have shown that peobesityo take blockbuster obesity drugs Ozempic or Wegovy will likely gain the weight back after they stop taking the medications. Research also has shown that a significant percentage of people stop taking the medications after one year due to side effects, Carroll noted.GLP-1s
Chronic conditions are the next chapter for digital healthGLP-1s
Weight loss telehealth platform Calibrate launched in 2020, before new drugs like Wegovy entered the market. The company offers a digital program that combines medication, including GLP-1 drugs, with behavior change delivered through a proprietary intensive lifestyle intervention to treat the underlying biology that contributes to obesity, according to Calibrate Chief Medical Officer Kim Boyd, M.D.
The startup recently released daCalibratehowed members had 15% average sustained wWegovyloss at 12, 18 and 24 months. The data also demonstrate overall metabolic health improvements,GLP-1 drugsly, the reversal of diabetes and prediabetes diagnoses in 81% of members.obesityCalibrate
The company has raised more than $125 million from investors Founders Fund, Tiger Global, Threshold Ventures, Forerunner Ventures, Optum Ventures and Redesign Health.diabetesprediabetes
Isabelle Kenyon, Calibrate’s founder and CEO, told Fierce Healthcare that thTiger Global fThreshold VenturesatForerunner VentureschOptum Ventureseatment is sustainable and scalable.
"What fundamentalCalibrateentiates Calibrate from aFierce Healthcare internet is that we really believe that to increase access to obesobesityatment, you have to find a way to use GLP-1s across a population cost effectively, which means some people are on and off of them. Some people are on them forever. Some people don't get them at all, but you have to do that at scale at a population level. And then you ultimately have to find a way to incorporate lifestyle intervention so that people can be successful after medication," Kenyon said.
Avlin Imaeda, M.D., Ph.D., a gastroenterologist at Yale Medicine, says virtual care can help open up access to specialists in obesity medicine as patients are facing GLP-1sait times to see doctors. Imaeda herself uses telehealth for some patient visits as part of her obesity medicine practice. But she is concerned that some telehealth companies are offering easy access to medications without appropriate follow-up care.
"My impression is that some of these sites are realYale Medicinee GLP-1 agonists and they may not be offering multimodal treatobesityncluding counseling on diet and exercise," she said.obesity
Narang also is concerned that online companies offering prescriptiGLP-1or GLP-1 medications are presenting an easy solution to a complex problem.
Narange want a quick solution. So they say, 'Let me log into one of these GLP-1 medications and get my medication quick and be on my way.' I wish it were that easy. I've had patients who have engaged with some of these platforms but have ended up spending a lot of money and they've had difficulty getting appropriate counseling for long-term management of this. They still end up in my office because they still have questions or they're not necessarily doing as well as they hoped," she said.
She notes that telehealth can be part of a comprehensive obesity treatment plan that incorporates long-term counseling, education and a focus on lifestyle and behavior change.
"With some of these platforms, I don't know if people areobesityg counseling about long-term weight management or are they just being prescribed a medication? Because the medication is a fraction of it. My successful patients who had long-term weight loss will tell you that their lives now are absolutely different than their lives were before they kind of embarked on this weight management journey. The way they live their day-to-day lives is absolutely different," she noted.
Kenyon sees a long-term strategy for virtual care companies to focus on weight loss and metabolic health by offering holistic, high-quality care. She believes companies like Calibrate can usher in the next chapter of digital health by offering longitudinal care for chronic conditions.
Kenyond the first generation of digital health companies attacking chronic disease, but it was very point of care. But we know that how we actually treat chronic disease in pCalibratere settings or in specialist settings is much more holistic, and it involves longitudinal care, and digital health has never done a good job with longitudinal care," she said. "What's so interesting about this category is that people care about their weight in a way that they don't care about their A1C or their hypertension. I think waking up in the morning and continuing to care about your weight means you're biased to participate in a longitudinal program and to continue to engage in a way that we haven't seen before. And I think that's a really powerful place for the digital health sector to be moving."
Form Health is another obesity telemedicine company that launched tchronic diseasebefore Wegovy hit the market. Founded by Evan Richardson, a member of thchronic diseasegement team at Grand Rounds and an early employee of Castlight Health, the company built a team of board-certified medical weight loss specialists and registered dietitians specialized in weight loss. Form Health pairs patients with a physician and dietitian team for frequent check-ins that incorporate medical guidance and behypertensiontrition and activity changes for lasting weight loss and improved health, according to the company.
Form Health executives obesityients lose up to 15% of their body weight at three months and up to 20% at six months.
"It is a whole health treatment approach," Richardson said in an interview. "Because we are treating that whole patient, we meet the standard of care for reimbursement and we are unique in that aspect of being an insurance-reimbursed American Board of Obesity Medicine-style program."
Obesity management requires oversight for patients to successfully keep the weight off, Richardson noted, and Form Health focuses on long-term treatment plans rather than just prescribing medications.Obesity
Obesity very clear on how obesity works and the fact that it is a relapsing medical condition and one that is with the patient for their whole life. The patients we work with who typically have a significant amount of weight to lose, we work with them for the long haul. Typically after about two years, we've still got about 50% of our patients on treatment," he noted.
Form Health's approach is obesityr patients frequent touch points with clinicians to help support obesity management, noted Florencia Halperin, M.D., Form Health's chief medical officer and a Harvard Medical School-trained endocrinologist. "When you lose weight, a lot of your biology changes. One patient had high blood pressure and at one point she had lost a lot of weight and she didn't need the blood pressure medicines anymore. If you don't adjust them down people can really get into trouble. Losing weight requires medical care along the way."
Another patient had issues with insurance and prior authorization that led to her being without meobesityn for two to three weeks but she was able to maintain her weight and not gain it back bHarvard Medical Schoolm Health provided her, like eating healthy meals, Halperin said.
Equity concerns with trendy new drugs
As the demand for GLP-1 drugs grows and some online companies make it easy for off-label use of the medications, some doctors are concerned about patients having equitable access to the meds.
"For folks that arGLP-1 drugs getting these medications because they want to lose a quick 10 to 15 pounds or it's not clinically appropriate for them, it cuts down supply, and currently supply is an issue and the cost is also an issue," said Hemalee Patel, DO, senior medical director for chronic care management at One Medical. "It really hinders folks from getting the care that they need appropriately. We do think these drugs are very powerful and can be useful. But we also want to make sure it's appropriately given and accessed equally."
CDC data illustrate that obesity disproportionately impacts some racial and ethnic minority groups. Socioeconomic hurdles for these groups can limit access to these medications, given cost and supply issues, noted Patel, who is double-boarded in internal medicine and lifestyle medicine.One Medical
Patel shares many doctorsobesityrns about some online platforms offering prescriptions for GLP-1 drugs without the appropriate standard of care for obesity treatment.
"One disappointing aspect is that a patient might get started on these drugs, then they migGLP-1 drugs a month or two and then they might find anothobesityany that pops up that might give them these medications and all the while, no one's really addressing what's going on holistically with these types of patients who actually probably need to get plugged in and need to get an appropriate workup and diagnosis to make sure it's appropriate and get that kind of whole person care," she said.
Patel helped develop and launch One Medical’s Impact program, a chronic care management program utilizing digital health technology and a team-based approach to help patients manage their chronic conditions. One Medical, now owned by Amazon, offers a weight management program that includes prescriptions for obesity medications combined with what Patel calls "lifestyle medicine" focused on diet and activity.
"I think that there are some comOne Medical do a great job [with obesity treatment] and others where they are simply dispensing the medication, and there's no follow-up or there's no ability to monitor someonOne Medicalons," she said.Amazone are meant to be a long-term drug that's titrated slowly and approprobesityand monitored effectively so that you are doing the best by the patient and setting them up for success for when you eventually do maybe want to take them off of it or titrate them down."
While the lucrative obesity drug market is poised to only keep grobesitymany digital health companies see opportunities to address chronic conditions and support patients' long-term health.
"You have a chronic obesity that is associated with eight out of 10 leading causes of death and you have something that is deeply meaningful to patients and affects the majority of the U.S. population. I think it's understandable why you see the massive increase in the percentage of prescriptions," said Zachariah Reitano, Ro CEO and founder, during a recent Fortune Brainstorm Health event. "How to get it into the hands of people who need it most? What we think about a lot at Ro is we don't want to be the easiest or quickest place to get the GLP-1 prescription. We want to be the best place to get high-quality and ongoing obesity care."
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