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Clinical Insights Diabetes Drugs and Weight Loss – What’s the Skinny? Download Clinical Insight Weight loss is often at the top of mind for many at the start of a new year, but late 2022 and early 2023 are bringing increased attention to how people lose weight. Social and mainstream media are spotlighting newer medications that can help with significant weight loss. Public interest in using medications to help with weight loss is likely at an all-time high, but despite the attention, questions about these medications remain. What medications are we talking about? The “incretin mimetics”, including GLP-1 (glucagon-like peptide 1 receptor agonist) and the new combined GIP/GLP-1 (glucose-dependent insulinotropic polypeptide receptor agonist) classes of medications, were originally approved for diabetes, but have also shown benefits with weight loss. The drugs getting the most attention are semaglutide (Ozempic, Wegovy) and to a lesser extent tirzepatide (Mounjaro), but there are even more in the class as well. As seen in the Google Search Trend chart from February 2023 below, public interest in these drugs has spiked over the last 6 months. Data Source: Google Trends (https://www.google.com/trends ). Accessed 6/2/23 Do they help with weight loss? As a whole, yes. While not everyone responds to these medications for weight loss, in clinical trials of Wegovy (semaglutide) for weight loss, patients lost between 10% and 17.5% of their body weight, compared with either a weight gain or up to 5% weight loss without the treatment.1 The other drugs in this class approved for diabetes also showed positive effects on weight, with Mounjaro being the most effective. Mounjaro is not approved for weight loss as of this writing but has clinical trial data showing average weight loss over 15%, with most patients losing over 20% of their body weight at the highest dose.2 The manufacturer for Mounjaro received a “Fast Track” designation from the FDA for an approval to use Mounjaro to treat obesity and overweight with weight-related conditions.3 A decision from the FDA (likely an approval based on the data available) is expected sometime in 2023 or 2024. What are the similarities and differences? This is a tricky question, because some of these drugs have the same active ingredient – semaglutide (Ozempic, Wegovy) and liraglutide (Victoza, Saxenda), for example – and same mechanism of action, but are approved for different uses. Ozempic and Victoza are FDA-approved to treat type 2 diabetes, while Wegovy and Saxenda are FDA-approved for chronic weight management. They are the same drug but dosed and studied slightly differently, leading to different FDA approvals and insurance coverage. Mounjaro differs from the other drugs in this general drug family as it is a dual-incretin (GIP/GLP-1) receptor agonist or “twincretin”, meaning it targets two different hormones involved in the pathway. The exact mechanism of action to lower blood sugar and weight with the second hormone (GIP) is not entirely clear, but it is thought to help further enhance the body’s insulin response and energy use.4 Injectable incretin mimetics: Active Ingredient Brand Name Product FDA Approval Tirzepatide Moujaro Diabetes Exenatide Bydureon Diabetes Dulaglutide Trulicity Diabetes Liraglutide Saxenda Weight Management Liraglutide Victoza Diabetes Semaglutide Wegovy Weight Management Semaglutide Ozempic Diabetes The biggest differences are insurance coverage and the price to the patient. The drugs approved for diabetes have traditionally been covered by insurance at a branded copay tier for diabetes treatment. Wegovy and Saxenda are often excluded from coverage because weight management, overweight, and obesity medications are not frequently covered by insurance. Manufacturer savings cards are available to help with out-of-pocket costs, but without insurance coverage lowering copays, the $225 to $500 savings for a month supply of Wegovy is still largely unaffordable, due to list prices around $1600 a month.5 What is the impact of the media hype? Increased media attention has pros and cons. It highlighted that overweight and obesity are chronic health conditions that are treatable with effective drugs, which has been a challenging public and medical perception issue for many years.6 Also, many people will likely get treatment they did not otherwise realize was available to help them lose weight successfully. However, increased off-label use of the drugs for diabetes (Ozempic, Mounjaro, Trulicity, etc.) to help lose weight has led to shortages of medication for those who need it to manage diabetes.7 This causes treatment delays, increases in blood sugar, and impairs adherence to the treatment. Supply issues may also require patients to go to other pharmacies where they do not have a relationship with their pharmacist and drug-drug interactions could be missed due to lack of a full medication profile to review. As these drugs also require gradual dose titration when starting treatment, patients may have to re-titrate their dose if they go without the medication for weeks at a time. What are the pros and cons of using these medications for weight loss? There are always two sides of the coin with using medications to treat disease, and weight management is no different. Some benefits include: high effectiveness ease of use overall good safety and tolerability profile extra benefits for blood sugar and heart disease if someone is at risk On the other hand, concerns include: high cost and limited insurance coverage prior authorization criteria for the drugs only approved for diabetes, which makes access more difficult and could cause people to lose access if they don’t have diabetes not everyone responds to treatment side effects can happen, including GI symptoms, pancreatitis, and gallbladder issues need for ongoing treatment, as many patients will regain weight if treatment is stopped lack of evidence if someone does not have overweight or obesity may worsen body dysphoria or eating disorders for people who are already suffering from them Bottom line We are entering a new age of weight management as the established perception of overweight and obesity is shifting from a “moral failure” to a chronic health condition. Highly effective treatment options, namely the medications described above, help make it easier to think of overweight and obesity this way. However, there are still plenty of concerns and considerations before these drugs can be used for weight loss routinely. Cost, access, and the supply chain all play a role in patients getting successful treatment to help lower weight, improve quality of life, and decrease the burden of weight-related conditions such as diabetes, high blood pressure, high cholesterol, heart disease, arthritis, and others. Hopefully with time, data, and public support, these treatments will be more readily available to those who are appropriate to treat with them. Until then, it is important to understand the nuance involved in the different drugs available and who has access to them in different situations. References McDermid E. A quick guide to the STEP trials. Medicine Matters. https://diabetes.medicinematters.com/semaglutide/obesity/quick-guide-step-trials/18854832 . Published February 2, 2021. Updated November 2022. Accessed February 10, 2023. McDermid E. A quick guide to the SURPASS and SURMOUNT trials. Medicine Matters. https://diabetes.medicinematters.com/tirzepatide/type-2-diabetes/a-quick-guide-to-the-surpass-and-surmount-trials/18478154 . Published October 14, 2020. Updated August 2022. Accessed February 10, 2023. Eli Lilly and Company. Lilly receives U.S. FDA Fast Track designation for tirzepatide for the treatment of adults with obesity, or overweight with weight-related comorbidities. Lilly Investors. https://investor.lilly.com/news-releases/news-release-details/lilly-receives-us-fda-fast-track-designation-tirzepatide . Published October 6, 2022. Accessed February 22, 2022. Kaneko S. Tirzepatide: A Novel, Once-weekly Dual GIP and GLP-1 Receptor Agonist for the Treatment of Type 2 Diabetes. touchREV Endocrinol. 2022;18(1):10-19. doi:10.17925/EE.2022.18.1.10 Wegovy Savings Offer. NovoCare.com. https://www.novocare.com/wegovy/savings-card.html . December 2022. Accessed February 10, 2023. Bendix A. Ozempic and Wegovy add new layers to the understanding of obesity as a chronic health condition. NBC News. https://www.nbcnews.com/health/health-news/ozempic-wegovy-obesity-chronic-health-condition-rcna68831 . February 8, 2023. Accessed February 10, 2023. ASHP Drug Shortages List – Current Drug Shortage Bulletins. American Society of Health-System Pharmacists. https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=CurrentShortages . Accessed February 10, 2023.

Pharmacist-lead personalized chronic condition solutions that simplify your Rx experience- enhancing medication adherence, improving outcomes and empowering your personal health journey. Why Everyone Should be Talking About Pharmacist Interventions

Case Study Improving Patient Outcomes with Pharmacogenomics Pharmacogenomics (PGx) combines pharmacology and genomics to study how a person’s genetics affect their response to medications. Despite advancements in healthcare, medication selection often remains a trial-and-error process. For example, in mental health, first-line treatment failure can be as high as 70%. By using PGx testing, providers can prescribe medications more effectively, improving outcomes and reducing the risk of serious side effects, a major cause of ER visits and hospitalizations. This also leads to significant savings for employer health plans. By leveraging the power of pharmacogenomics, Tria Health’s program has been able to provide our clients with improved health outcomes and cost savings. Targeted Outreach to High-Risk Tria Health recognizes the importance of managing costs effectively, which is why we offer PGx testing specifically to high-risk individuals engaged in our Pharmacy Advocate (PA) program. With an already impressive engagement rate of 35%, integrating PGx testing into the program was seamless. We evaluate PGx-implicated medications in use, and assign each individual a score to assess the relevance and value of PGx testing. The genetic test is a simple cheek swab mailed to the patient. Once returned and the test is processed, our pharmacists review the report with the patient and provide direct outreach to their physicians. Given the complexity of the genetic report, this personalized care is crucial to ensuring that both patients and their physicians fully understand the results and their impact on the current and future medication regimens. Delivering a 1.6:1 Return on Investment The results of incorporating Tria Health's pharmacogenomics program with the client were highly successful. High-risk members were successfully identified and targeted, and adverse drug events were identified. Adverse drug events (ADEs) refer to the adverse reactions that may occur due to genetic variations in drug metabolism or drug response. Furthermore, the client was able to achieve a 1.6:1 return on investment, with the cost of the testing being offset by the savings from avoiding adverse drug events. Overall, the pharmacogenomics testing was a beneficial addition to the client's healthcare benefits offering. Current PA Engaged (35% Engagement Rate): 895 PA Engaged & PGx Eligible: 51% PGx Engaged: 34% Adverse drug events avoided per consult (valued at $589 per ADE): 5.2 1 Return on Investment 1.6:1 Patient Success Story - Just the Right Statin for Reducing Cardiovascular Risk This patient had been struggling with statin therapy for years, experiencing severe side effects such as myalgias (muscle pain). Her healthcare providers were unable to explain why she was so prone to statin side effects. As a result, she was not taking any medications to treat her cholesterol, putting her at serious risk for complications. Tria recommended PGx testing for this patient. Fortunately, the PGx results revealed a genetic variation affecting SLC01B1, which is involved in statin metabolism. Her test results revealed that among the several statins available in market, only one can be metabolized by her body. Her Tria Health pharmacist was able to work with her physician to get a prescription for the exact right medication. After starting this new therapy, the patient reported that she had no side effects and was able to reduce her cardiovascular risk. Client Overview This Tria Health client is a government plan with more than 7,000 members. They had been considering offering PGx for a few years, but were concerned about cost. Tria’s ability to target high risk members made it possible for them to offer this program. The average patient participating in Tria's Personalized Medicine Program has a lot to manage. Age: 54 Medications: 14.5 Chronic Conditions: 3.4 Total Conditions: 10.1 Physicians: 3.3 Download Case Study References J Am Pharm Assoc (2003) 2020 May-Jun;60(3):462-469.e4. doi: 10.1016/j.japh.2019.12.004.Epub 2020 Jan 13.

Article Access with Accountability: Managing Anti-Obesity Medications Download Article Public interest in using medications to help with weight loss is at an all-time high. With their success consistently advertised in the media, employers must now find a way to balance employee demand for these medications and the need for responsible usage and cost-containment. Weight loss medications are here to stay, so employers need implement a strategy that can help mitigate off-label usage concerns, and the overall financial impact on the health plan. Are AOMs Appropriate? Medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) offer significant benefits by reducing A1c in diabetes and aiding weight loss in overweight and obese individuals. However, their use demands careful consideration at all stages, necessitating expertise, such as that of a pharmacist, to ensure safe and appropriate utilization across the population. Prescribing entails evaluating potential interactions, contraindications, and warnings related to various health conditions. Moreover, being injectable, these medications require training for proper storage, preparation, and usage. Sustained results require intentional lifestyle modifications. Ongoing monitoring is crucial post-prescription to address tolerability, side effects, drug effectiveness, and the suitability of continued use. Professional oversight, especially during surgeries and the development of complications, is essential, with pharmacists playing a key role in monitoring and support. Beyond Weight Loss and Insurance Challenges These medications have shown to not only help users lose weight but also offer broader health benefits, impacting heart health and reducing the risk of other chronic diseases.1 However, at the member level, navigating insurance coverage is a bit complex. It's important to understand that GLP-1 medications can be approved for type 2 diabetes or for long-term weight management depending on the FDA’s classification, leading to differences in insurance coverage. Usually, diabetes medications are covered, but weight loss medication coverage is not as common. This not only poses challenges for individuals seeking access to specific medications but can lead to greater off-label utilization. Financial Considerations and Lifestyle Impact Given that the prices of GLP-1s exceed those of previous anti-obesity medications, it’s easy to see why employers are concerned about this rising trend in utilization. This financial burden not only affects individuals but also raises questions about employer-sponsored healthcare plans. Employees are wanting these medications, but employers need to ensure proper usage as part of a larger weight management strategy. While these medications can be beneficial for weight loss, it's important not to perceive them as miracle drugs or the sole solution for losing weight. Studies suggest that without making lifestyle changes, it’s likely that individuals will regain weight once they stop taking these medications.2 So if employers choose to offer them, they should do so in conjunction with a weight management program. What to Look for In a Weight Loss Vendor When seeking a vendor for a comprehensive weight loss solution, employers should evaluate how they handle GLP-1 medications. This involves assessing their management of GLP-1 medication utilization and the resources they offer to ensure they’re used effectively. It is crucial for employers to choose a vendor that offers clinical oversight, monitoring the effectiveness, side effects, and tolerability of medications. Additionally, an ideal weight loss vendor should be versatile, addressing various health aspects affected by weight loss. This includes monitoring health metrics like blood glucose and blood pressure for a holistic approach. Lastly, considering individual differences, employers need a solution tailored to treat patients at a personalized level. Navigating GLP-1 Complexity In summary, effectively navigating the landscape of weight loss medications requires employers to consider efficacy, coverage, and individualized care. Beyond promising results, adopting a comprehensive approach entails addressing insurance challenges, financial considerations, lifestyle impacts, and preventive measures. Vital to this process is the collaboration between healthcare stakeholders, ensuring individuals receive the appropriate medications while addressing the broader complexities of the healthcare landscape. As technology and medical research advance, it's crucial for continuous communication and collaboration to improve how we use weight loss medications. About Tria Health Tria Health assists plan members with chronic conditions by addressing polypharmacy issues, leading to improved health. To better understand why individuals don't achieve their clinical goals, Tria Health's pharmacists conduct one-on-one consultations and provide guidance. Through a comprehensive medication and lifestyle review, Tria's pharmacists improve health literacy, close gaps in care and optimized pharmacy utilization. The patient's care plan is always shared with their physician and is considered the basis for future consultations. Additional patient resources are available based on the individual’s needs, including remote monitoring, weight loss management, and personalized medicine (DNA testing). References https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/byetta/faq-20057955 https://pubmed.ncbi.nlm.nih.gov/35441470/

Diabetes Drugs and Weight Loss What's the Skinny? In this webinar, we cover: The difference between diabetes & weight loss meds There is a new class of medication (GLP-1s) that are used to treat diabetes and weight loss. Discover their similarities and differences. The impact of the medication media hype The increased media attention has led to a shift in public and medical perception. Are the benefits worth it? Employer and health plan recommendations Employers should expect an increase in utilization for GLP1s. Find out how to maximize your plan value.

Tria Health's services are available through your employer’s health plan. We will help support you in managing your health, medications and healthcare budget 30 Minutes Could Change Your Life & Save You Money Tria Health's services are available through your employer’s health plan. We will help support you in managing your health, medications and healthcare budget. Ask your human resources department today and see if you're elligible for Tria Health! Get Started Today! $250 Average amount a Tria Health member saves per year. 2 96% Members who were satisfied or extremely satisfied with their healthcare experience with Tria Health. 1 1.5 Medication related problems identified upon initial consultation with a Tria Health pharmacist. 2 Personalized Care Just For You! At Tria Health, we understand that no health journey is the same and that each patient has different obstacles to overcome. We have the tools and resources available to customize your care plan to fit your needs. Your Tria Health Toolkit: Dedicated Pharmacist We assign each member a dedicated pharmacist who understands how to achieve the maximum benefits and minimize side effects of your medications while avoiding drug interactions. Health Devices Data points provided from remote monitoring devices can be instrumental in helping you understand more about your health and give you motivation to make the changes you need. They also provide our team at Tria Health necessary information to personalize medication decisions and lifestyle adjustments. Mobile App With Tria Health’s mobile app, members can access their personalized care plan, medication list and even create a medication schedule. Members will also have access to their health device dashboards. Coordinated Care Team 1 Over 98% of recommendations made by Tria Health's pharmacists were accepted by an individual's physician. Tria Health ensures your care team is working together and helping you make the best decisions for your health. See How It Works Ready to Get Started? Schedule an Appointment I cannot thank you enough for this service. Tria Health is like a second set of eyes on my health. Appreciate the service. - Rhonda T. View More Tria Triumphs Citations 1. 2024 Tria Health Patient Satisfaction Survey 2. 2024 Tria Health Book of Business Statistics Citations

In this webinar, we will revolutionize your approach to diabetes management. We'll be debunking common myths and equipping you with strategies for providing more effective diabetes and medication management. Debunking Diabetes Myths: Separating Fact from Fiction Diabetes affects a lot of people. For most plans, it is one of the highest costing conditions, especially with the increased utilization of GLP-1 medications. Learn about some myths associated with diabetes management and how you can develop plan strategies to provide better diabetes and medication management. Four Common Myths Associated with Diabetes Myth #1: "I’m overweight, so I’m going to get diabetes." Discover the truth about the relationship between weight and diabetes risk and learn practical strategies for maintaining a healthy lifestyle. Myth #2: "I have to completely change my diet to control my A1c." Explore the real impact of diet on managing A1c and learn valuable tips patients can take for making sustainable, effective dietary choices. Myth #3: "I’ll keep getting new medications added to manage my diabetes." Gain insights into medication management for diabetes and discover strategies for achieving stability and balance in your plan. Myth #4: "I’m going to be on medications for the rest of my life." Uncover the nuances of diabetes medications and understand when they are truly necessary, as well as how to potentially reduce reliance on them.

Our pharmacist phone consults start off with a thorough review of a member's medications. You're Only a Phone Call Away From a Healthier You! Pharmacists and certified health coaches assess a member’s motivation for lifestyle changes and provide recommendations accordingly. Custom Care Plan Tria Health’s pharmacists will work with the member to develop a personalized care plan and offer any additional support needed to help them live a happier, healthier life. Info Blood Glucose Meter Blood Pressure Cuff Bluetooth Scale Tria Health Devices: Preventative Care We make sure all members are meeting disease/age-recommended preventative care. Health Devices Pharmacists determine whether a health device is clinically necessary. Readings from these devices prompt messages to improve education and drive behavior change. Our pharmacist phone consults start off with a thorough review of a member's medications, including prescription, over the counter, and vitamins/supplements. Habits & Lifestyle Medication Review Info Vaccinations Blood Pressure Screening Examples of Preventative Care: Care Coordination & Follow-up Communicating recommendations to a member's care team is essential, along with ensuring follow-up appointments for continuous care. Receive the Personalized Care You Deserve People with chronic conditions take different approaches to their health care based on their background, behaviors and beliefs. Tria Health's care model supports the unique needs of each individual and provides them with an achievable path to better health outcomes. Get Started Today! 50% of patients do not take their medications as prescribed 1 Not taking medications the right way causes them to be ineffective As medication experts, our pharmacists use their knowledge of medication composition, properties and interactions to achieve maximum benefit, minimal side effects and to avoid drug interactions. Our pharmacists are also experts at communicating this specialized knowledge to patients, physicians, and other health care providers. Our Care Model Works Because We address the primary treatment method for chronic conditions Chronic conditions are primarily managed through medications. Tria Health utilizes pharmacists because pharmacists are medication experts who understand how to achieve maximum benefits and minimal side effects of medications while avoiding drug interactions. Our communication ensures your care team is on the same page Most medication-related problems arise simply from a lack of communication. Our pharmacists not only ensure patients fully understand their treatment plan, they also communicate any recommendations directly to a patient's physician. Recommendations are customized We understand that no health journey is the same and that every patient has different obstacles to overcome. We have the tools and resources available to customize your care plan to fit your needs. Learn More About Tria Health's Validated Results Trevor W. Trevor called into a consultation, reporting that he had recently been diagnosed with atrial fibrillation. He started on a blood thinner that prevents strokes in the setting of atrial fibrillation. However, this medication comes with risk as any blood thinner can lead to bleeding complications. Prior to taking the blood thinner, Trevor was on a medication for arthritis pain. This medication is very expensive, almost $30,000 per year. Furthermore, long-term use of this medication can lead to an increased risk of bleeding complications, specifically bleeding stomach ulcers. With the addition of the blood thinner, his arthritis medication became a potentially dangerous choice for Trevor. Tria Health's pharmacist reviewed the risks with Trevor and he was able to switch to a safer over-the-counter alternative for arthritis pain. View More Tria Triumphs Citations 1. Medication adherence: WHO cares? - PubMed (nih.gov) Citations

There were multiple factors impacting this patient's blood sugar... < Back Tria Triumph 126 Previous Next

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Tria Health provides one all-encompassing solution to prevent and manage chronic conditions. We improve health and reduce costs, guaranteed. Healthy Members & a Healthier Bottom Line Tria Health provides one all-encompassing solution to prevent and manage chronic conditions. We improve health and reduce costs, guaranteed. Contact Us 7 1.7 Tria Health assesses HEDIS® and T-MED metrics in order to identify gaps in care, and then works with members to close open care gaps over time. ℠ We HEDIS ® During our one-on-one member consultations, Tria Health’s pharmacists capture Healthcare Effectiveness Data and Information Set (HEDIS®) metrics, which are a standardized set of healthcare measurements, varied by different chronic disease states, used to determine if a member is effectively managing his or her disease. T-MED ℠ ℠ Our pharmacists also capture other Tria-proprietary Medication Effectiveness Data (T-MED ), both pharmacological and nonpharmacological (e.g., lifestyle metrics, barriers to adherence, and condition management education), which are also critical and provide a more comprehensive measurement of effective condition management. Our Results are Validated. Tria Health’s Pharmacy Advocate Program was independently validated by the Validation Institute to determine health care cost reduction for members engaged in the Tria Health program. The Validation Institute validated a 41% reduction in in-patient hospital cost and 59% reduction in emergency room costs in a matched cohort study. To view the full report, click here. Emergency Room Visits Lower for Tria Health -41% 89% % Change: 2017-2019 37% 14% % Change: 2018-2019 -48% 38% % Change: 2017-2018 Hospital Costs Lower for Tria Health -59% 94% % Change: 2017-2019 -32% -24% % Change: 2018-2019 -46% 185% % Change: 2017-2018 Talking to a Pharmacist Results in Closed Care Gaps 391 519 H ype r t ension 75.3% 418 687 H ype r lipidemia 60.8% 185 110 C AD 59.5% 221 376 A sthma 58.8% 31 50 C OPD 62% 3,148 1,501 Diabet es 47.7% G aps Open Upon I nitial C onsult G aps Closed F oll o wing C onsults Pharmacists Close Care Gaps Clinical care gaps are based on HEDIS® and T-MED ℠ measures, clinical practice guideline recommendations, and established evidence-based assessments. Results of this 5-year retrospective study illustrate that inclusion of Tria Health pharmacist interventions assisted in closing over 50% of the open clinical care gaps across the chronic conditions investigated. To view the full report, click here. Want More Info? View Tria Health Results Trevor W. Trevor called into a consultation, reporting that he had recently been diagnosed with atrial fibrillation. He started on a blood thinner that prevents strokes in the setting of atrial fibrillation. However, this medication comes with risk as any blood thinner can lead to bleeding complications. Prior to taking the blood thinner, Trevor was on a medication for arthritis pain. This medication is very expensive, almost $30,000 per year. Furthermore, long-term use of this medication can lead to an increased risk of bleeding complications, specifically bleeding stomach ulcers. With the addition of the blood thinner, his arthritis medication became a potentially dangerous choice for Trevor. Tria Health's pharmacist reviewed the risks with Trevor and he was able to switch to a safer over-the-counter alternative for arthritis pain. View More Tria Triumphs