November 10, 2023 • 25 mins
In this episode of The Community Check-In, Nicole Dawley, Senior Director of Pharmacy Strategy and Policy at Excellus BlueCross BlueShield, explores the complex world of weight management drugs. Nicole provides valuable insights into the background of the obesity epidemic, the science behind these medications and the importance of integrating them into a comprehensive weight management program.
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(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram
(00:26):
and Facebook. I'm Joel Demonico andwelcome to this week's community check in.
People interested in losing weight have beeninundated with ads on television and social media
and billboards and news articles, celebritiesand pop culture for a variety of weight
loss drugs. As a result,there's probably been a good deal of confusion
(00:48):
and potentially some misuse of these drugs. So to help us better understand these
drugs where and when they can behelpful, we have Nicole Dawley with us,
who is Senior Director farm See Strategyand Policy at excel Us Blue Cross
Blue Shield. Nicole, Welcome tothe Community check In. It's good to
have you. Thank you, Joeappreciate it. Nicole is a licensed pharmacist.
(01:10):
She's been with Excell's Blue Cross BlueShield for a while now, since
two thousand and six, leading ateam that's focused on understanding drug use,
managing the types of drugs that arecovered by Excellis Blue Cross Blue Shield plans,
and establishing programs that help improve memberhealth through more affordable drugs. So
you've got a big mission ahead ofyou, so we're going to take a
very narrow focus this time. Iwant to start out just right really setting
(01:32):
some framework for what we're going totalk about. And I suppose that really
means to have a conversation about theobesity situation, or as many refer to
it in my field in the newsmedia, the obesity epidemic. And I
suppose it has reached that point.So I'm wondering if you could just really
give us some guardrails about where westood so that drugs like these that we're
(01:53):
going to talk about really became kindof necessary or started entering the conversation.
Sure. Sure, so, Yes, it's defined as an obesity epidemic.
It's been around for some time now. If you want to know what the
clinical definition of obesity is, it'sthe CDC defines being overweight or obese as
a weight that is higher than whatis considered healthy for a given height.
(02:16):
It's not it's imperfect, but thebody mass index or BMI, is measure
of body fat based on height andweight. So a BMI of twenty five
to twenty nine is considered overweight,and a BMI greater than thirty is considered
obese. So, for an example, an individual who is five feet eight
(02:37):
inches tall and weighs two hundred poundsmeets the definition of obese. And did
you know that currently more than fortypercent of adults and twenty percent of children
in the US are considered obese.Unfortunately, this number is expected to increase
to more than fifty percent of adultsby the year twenty thirty. Why should
we be concerned about obesity? Onereason is the risk of death associate with
(03:00):
heart disease, kidney disease, diabetes, cancer is greater in those that are
overweight. Not only is having ahigh b a maaya concern, but so
is abdominal fit or more specifically,waste circumference. So you want to you
may wonder how drug therapy has becomepart of the equation to focus specifically on
(03:21):
the golp one. Initially, thesemedications were targeted for a hormone in the
body, golp one, and theywere found to lower blood sugar levels and
diabetics. Examples of the drugs thatare approved to treat diabetes include ozembic and
trulyicity, and in fact, youmay have seen advertisements for these drugs on
TV or heard them on the radio. When the drug are being studied,
(03:43):
it was shown that in addition tolowering blood sugar levels, they all people
who took them also lost weight.The first drug that was approved by the
FDA specifically for weight loss was Sexendain twenty fourteen, and more recently,
wigov was approved in twenty twenty one. An interesting fact is that what govi
contains the same active ingredient as ozebic, but it is a higher strength,
(04:06):
and these two drugs are the onesthat are most commonly talked about in the
media. So based on that,would you say that these drugs that were
going to be discussing more about thatthe impact they had on weight was not
necessarily what they were initially designed todo, and that was an unintended but
(04:30):
very beneficial outcome of it actually beingused in patients to say, oh,
it does this, but hey,we also noticed that it has this additional
benefit. Absolutely, you just explainedit perfectly, and that is what happens
a lot with drug therapy is thatit will be studied for one particular thing
and then found to work in somethingelse. So now, and we've seen
(04:55):
with sex Senda being the one ofthe first that kind of came on the
market little quietly, we govy's beenmaking a lot of inroads and ozempic.
It almost seems that you can't turnon the television without seeing a commercial for
that. They've been very heavily marketed. So how does the drug then,
I guess and maybe just explain ita little bit more in Layman's yours use
(05:17):
a turn GLP one, which I'venever heard before, So we want to
talk a little bit about how doesthe drug category or class support weight loss
as benefit yep, So yes,if you've heard the term GLP one,
that's actually a hormone that's in thebody, glucagon like peptide one. It's
a messenger that tells your brain whenyou're full or satisfied after eating. So
(05:42):
a drug like with govy essentially tricksyour brain into thinking you are full.
This can help you eat less,feel satisfied with smaller meals, which in
time leads to weight loss. Additionally, it's the medication can slow down the
emptying of your stomach, which meansthat food stays in your stomach longer and
it makes you feel fuller for alonger period of time. The reason why
(06:03):
these drugs work so well is becausethey act in multiple ways, so you
basically got a nice combination there ofthe therapy helping you in a number of
different factors, which can long termthen under a doctor's guidance, be helping
to achieve some desired weight loss.And for those people that fit into that
(06:26):
obesity category, getting a jump startcan often be the thing that has maybe
held them back, and a drugtherapy might be just the thing for them
to help kickstart it so they canstart getting into some better, healthier lifestyle
choices and opening up their lives againthat obesity was holding them back from.
(06:47):
Yes, yes, I mean theguidelines are start with those lifestyle modifications and
if they don't work on their own, then yes, drug therapy would be
appropriate to add on. So Isuppose that goes right into our next topic,
drugs like these fitting into the largertrend of weight loss solutions. This
is not a magic pill, andI want maybe to make it clear to
(07:10):
people that it's not just oh,you take this medication and everything suddenly is
is right. This is a toolthat doctors and patients can use in combination
to help achieve a desired outcome.Yes, yes, we do like using
that term another tool in the toolbox. So they really should be used in
combination with a reduced calorie diet andincreased exercise or some type of physical activity.
(07:35):
The goal of adding medication to acomprehensive weight management program is to improve
health and address the medical concerns relatedto obesity. So these drugs should be
really used to promote overall well being, then for cosmetic purposes to lose a
small amount of weight. Nicole Dalleyis the Senior Director Pharmacy, Strategy and
(07:57):
Policy at Excell's Blue Cross, BlueShield. Our guest on this week's Community
Check, and we are talking aboutweight loss drugs. You may be taking
them currently. You may have seenthe marketing for them. They're kind of
ubiquitous. They seem to be allover the place, and as Nicole just
mentioned, it's not a one anddone situation where you take a medication and
(08:20):
all of a sudden weight falls offand things are better for you. It's
part of a tool kit that youand your physician can use in combination to
achieve a desired end. My followup question to that is, well,
let's say you're taking this medication andyou, uh, maybe the side effects
don't quite work for you, ormaybe you decide, you know what I
(08:43):
think I'd like to get off ofthis medication. Is it something that has
to be an ongoing type of aregiment and an ongoing part of a therapy
or if you stop, what happens? It is very patient specific, but
unfortunately for most people, well,you will most likely gain back the weight
that you've lost. So a clinicalstudy actually looked at this. They looked
(09:05):
at people who stopped taking Wagovi andreally what it showed is that one year
later, participants regained two thirds ofthe weight that they had initially lost.
So the goal of therapy drug therapyis to help you achieve a healthy weight
and then maintain that weight. Therefore, there really is an expectation that treatment
could be lifelong. But I can'temphasize this enough. It will always need
(09:28):
to be part of a comprehensive weightmanagement plan that includes those lifestyle changes exactly.
And we're going to keep coming backto that this is not any type
of a magic thing or a onesone and done, or you know,
you take take the pill and everythingis just right as rain. It really
is part of an overall process becauseas you mentioned, when it comes to
(09:50):
managing weight, especially for those whodo need more assistance than others, it
really is part of an overall It'spart of an overall plan. And if
you lose one piece of the puzzlefor some patients, I would suspect if
you lose one piece of the puzzle, they can wind up getting stuck like
they're mired in the mud and theyjust don't go anywhere. Yes, yes,
(10:13):
just out of plain curiosity. Becauseof the fact that Sexenda, as
you mentioned, came on the marketin twenty fourteen, some of the others
we go via ozempic have been relativelynew. I would suspect the data that
you see right now it's still fairlyfresh. Would you consider it that there's
more things that you can learn inyour position to really understand how these drugs
(10:35):
are working within the patient population.Absolutely, you know, looking at what
you see in a clinical study isn'texactly what you will always see in real
world so using the data of peoplewho have been on it now looking at
how long are they able to stayon it? Do they discontinue it?
What's the ovocacy of it? So, yes, that is always something that
(11:00):
always needs to be considered. Whatyou see in that clinical study isn't exactly
what will play out in the realworld, and more real life data will
certainly be helpful as time goes on. And as we mentioned at the beginning
of the program, there's been abig driver in these drugs. What do
you see from your vantage point asto how or what is driving the bus
(11:22):
with the uptick in the use ofthese medications and conversations that people having with
their healthcare providers about getting on thesedrugs. Yeah, I think social media
has really been the biggest influence onthe promotion of these drugs. You know,
I think we've all seen the storiesof the different celebrities that have tried
one of the weight loss drugs.Elon Musk had mentioned using with ov others
(11:46):
had admitted to using the weight lossdrugs to lose weight, Amy Schumer,
Tracy Morgan. But just because acelebrity has tried one of these drugs doesn't
mean that it is appropriate for everyone. They may not necessarily be considered ovis
or and overweight, so use ofthose drugs may not have been appropriate for
them. There's also been a lotof advertising of these drugs from online health
(12:07):
companies vendors, and they advertise onsocial media and they promote the prescribing of
these medications. This is where wedo start to see some misuse of the
drugs. These types of online companiesare prescribing it to anyone even if they
only want to lose a few poundsbefore a big event or a vacation,
or that don't have the BMI thatwould be considered appropriate for use, and
(12:33):
that can ride up into an entirecategory of effects that are unintended and can
can in some cases be not livable, not sustainable. You can't live with
these kinds of things. So Iwant to do talk. I do want
to talk about the side effects ofusing a weight management drug. If someone's
going on and say because they wantto lose, like, oh, I
(12:56):
think I can lose a quick fivepounds because I have an event coming up,
or fill in the name of ashort term goal that you want to
get to. They've got to balancethat potentially against what can happen to the
body and how your body reacts tothese drugs, because not everyone is the
same and their reactions to those drugswon't be the same. Yes, I'm
glad you asked this. As withall medications, there are possible side effects.
(13:20):
The most common side effects with thisclass of medication is nausea, vomiting,
diarrhea, and these side effects canbe significant, and as I mentioned,
real world data, it's actually showingthat up to fifty percent of the
people that initiate therapy have to stopit because they're having side effects that they
can't tolerate. Other safety concerns includelike low blood sugar, specifically if you
(13:46):
combine it with other medications, Andjust last month, the FDA did issue
a warning regarding WIGOVI and the potentialof intestinal blockage or you know, unable
to pass things through really the intestines. Another thing that we need to be
aware of with these drugs is theresome people should not take them, those
(14:09):
that have a history of certain typesof cancers or genetic conditions. And I'll
just you know, specific to theside of fact, I think, as
with all medications, your first stepreally should be having a conversation with an
established physician that knows your medical historyso that you can consider those side effects,
the safety concerns, and your overallhealth before taking one of these drugs.
(14:30):
Exactly, have those conversations with atrusted healthcare provider, because as you
mentioned, there's a lot of advertisement, there's a lot of push. There
are many more available places where drugslike these can become available without going and
having a conversation with a physician thatyou have a relationship with. I think
in some cases it's you know,if you're if you're a little timid about
(14:52):
that, maybe have a conversation witha pharmacist who gets to know about drug
interactions and things that you can tobe aware of so that you can have
some sort of understanding that look yourpersonal medication history and the things that you're
taking and your other conditions you mighthave. Might say you need to keep
(15:13):
away from this because there might besome interactions that are going to be potentially
harmful for you. Yes, yes, Eddie, pharmacist or should be a
good resource for you, whether itbe your local retail pharmacist, whether it
be a pharmacist at your health plan. They can help you understand are is
drug therapy appropriate for you? Doesn'tinteract with any of the medications that you're
(15:35):
taking. Are there alternative things thatyou could be doing? More of the
community check in we're talking about weightloss drugs is next for everybody who believes
the care they deserve should always bewithin reach, For everybody who wants to
be confident about insurance for the nextphase in life, for everybody who's looking
for the best ways to take careof their employees and their families. At
(15:56):
excel As Blue Cross Blue Shield,we're making care more accessible and affordable in
more ways and for more people inour community, because when we do that,
everybody benefits. Learn more at EXCELSBCBSdot com. Welcome back to the
Community check in. Nicole Dalley isthe Senior Director Pharmacy, Strategy and Policy
at Excell's Blue Cross, Blue Shield. Our guest on the Community check and
(16:18):
we're talking about weight loss drugs.They are they're out there, and they
are being marketed very aggressively towards anincreasing part of our population that it is
categorizes either overweight or obese, andthose numbers continue to grow year over year.
But these medications are still only availableby prescription. They are not over
(16:41):
the counter. As you understand thisclass of drugs and what it can do,
why still the restriction If there isdata to support that it can work,
and you were to put it ona shelf and put the warning on
the box, I suppose that wouldbe enough coverage. But why still the
restrictions to access at this time forthis class of weight management drug? Good
(17:03):
question? As I previously mentioned,the use of these medications is for a
specific patient population. They should beused in conjunction with a comprehensive plan to
provide the best possible outcome. Werecognize that everyone can achieve the desired weight
loss necessary to improve their overall healththrough diet and exercise alone. These are
(17:25):
the individuals that could benefit from drugtherapy. From a health insurance perspective,
we want to make sure the medicationswe cover for our members have been proven
to be safe and effective for thecondition being treated and that they demonstrate positive
outcomes. Again, they should notbe utilized for cosmetic reasons alone, as
these drugs have not been proven tobe safe and effective in those who have
(17:45):
a BMI within normal range unless theyare diabetic. Right, And I think
maybe that's why we're having this conversation, and we would we're going to keep
coming back to this is because themarketing has has been so aggressive, it
can appear like, yes, thisis just some fantastic invention that's going to
(18:07):
take a shot, take a pill, and boom, you're gonna be You're
gonna be into that dress to getready for that holiday party that you have,
or that that class reunion that you'regoing to. But that that is
not the case despite the perception.Maybe that's it is. There's a perception
there that, because of the messagesthat are seen, specifically in social media,
(18:30):
that it could in fact accomplish that. But then the reality of it
is, it's it requires a lotmore thought and a lot more diligence on
the patient's part and on your physician'spart to even know if it's right for
you to begin with. Yes,yep, there is no easy button to
weight loss. If there was.If there was, people in the pharmacy
(18:51):
world would all be rich by nowbecause they'd have the pill and it'd be
safe and everybody could could use it. I want to talk about a little
bit more about availability of these drugsonline. There's a lot more classes,
and this is just one of themthat are available, and they seem to,
as I understand it, tout itthat, hey, if you don't
(19:11):
want to have an uncomfortable conversation witha healthcare provider kind of sort of,
maybe we can get you in hereand talk with one of our representatives and
see if it's okay. What areyou seeing in the online world as far
as is this place is kind ofthe wild West in a way. I
hate to classify like that, butit seems that there's just a lot out
there and you really have to lookunder the hood to find out who you're
(19:33):
buying from and what you're buying.Absolutely, yes, that is very important.
Unfortunately, there are companies out therethat are looking to make a profit
by marketing unapproved drugs. Online companies, health spas, compounding pharmacies are offering
their own versions of these drugs fora much lower cost than the FDA proved
drugs. So people aren't naturally interested. They may be seeing ads in their
(19:56):
TikTok feed or other social media platform, but what's important to recognize is drugs
that haven't been approved by the FDAmaybe counterfeit. They may not contain the
amount of drug that it states andcan even be contaminated with unsafe ingredients.
Using one of these unapproved drugs couldbe harmful to your health exactly, or
you don't know exactly where it's comingfrom, and they don't have the same
(20:18):
standards as pharmaceuticals within the United States, so you don't know what kind of
products that you might be getting.Because the Internet connects you to the world,
you have to do a bit moredue diligence. Circling back to a
question that I asked earlier, butI want to come back to it about
the long term benefits of these drugs, and maybe part two of that is
(20:41):
sort of the overall healthcare costs,not just the cost of the drug per
se, but the costs of healthcare for those people who could benefit from
it, and we're talking about thosepeople in the overweight and obese category,
specifically the obese categories. You balancethe drug, taking the drug, the
(21:02):
cost of a drug, the humancost of it, and the long term
effects of living with a condition thatcould be benefited by that drug. This
is the big unknown. There ispotential that the use of these drugs could
drive down total health care costs.They could prevent the heart attacks, joint
replacements, other conditions related to obesity, but this hasn't been proven yet,
(21:23):
so again it's long term study.And since these drugs, this class of
drugs is relatively new in pharmaceutical terms. Are these relatively new when you look
back to say, like sex Sendaas an example, has been around since
twenty fourteen, that's less than tenyears, and the others have less time
than that in pharmaceutical time. Isthe Are these relatively in their infancy?
(21:48):
Yes, I would say so,and there's a lot more in the pipeline.
So there's been other drugs for weightloss historically they haven't been shown to
be as efficacious or work as wellas these drugs. But yes, this
is the category that we do expectto see expand within the coming years,
to have more drugs available, andone would suspect that research and development is
(22:10):
continuing to be done to improve quality, reduce side effects. Perhaps you may
see someone branching off potentially a drugthat exists now and they create a little
bit of a difference to it.It's a whole different drug that works a
little bit different. There's always somethinggoing on behind the scenes, isn't there
absolutely it, could you know,combining it with another medication or tweaking it
(22:34):
a little bit to minimize those sideeffects. Yes, the drug world is
definitely dynamic. Yes, and thedrug world has a lot going on that
advertising doesn't speak to. So ifyou're seeing these drugs, if you're seeing
them advertised, if you're seeing yourfavorite celebrity posting about having great results with
them, that's all well and good, but it starts by having a conversation
(22:56):
about your health and your situation,the medications you're currently taking, what your
body type is, and where youare today with your healthcare provider before you
decide that you're going to go andproceed, and proceed cautiously and with the
guidance of a professional to make sureyou're making the right decision. And our
final few moments here, I wantto just see what would you like to
leave our listeners with Number One,about not only these class of drugs,
(23:19):
but sort of their overall health,weight and journey that they're on that they
may need some help in getting toa better place. In sure, first,
if you're concerned about your weight oroverall health, having a conversation with
your doctor is a key first stepfrom a health plan perspective, if you're
overweight or obese, then use ofthese medications could be beneficial for you,
(23:41):
but they do come with risks.If your doctor determine's treatment is right for
you, you have to be committedto a comprehensive approach to managing your weight
that includes lifestyle modifications and recognize thatthis is a lifelong journey and you have
resources that are available to you.You have of those people that are going
to be able to be trusted andbe on your side. So yes,
(24:03):
there's a lot of noise. Yesthere's a lot of marketing. Yes there's
jingles and shiny packages, but atthe end of the day, if you're
ready to make that decision, thenhave the plan, know how you're going
to work it, with the supportthat you need, and start making those
steps forward and perhaps medication will bepart of it. And we want to
thank Nicole Dawley, who's the seniordirector Pharmacy, Strategy and Policy at excel
(24:25):
Us Blue Cross Blue Shield, forpulling back the curtain on some of these
weight loss drugs that are available tous. And Nicole, thank you very
much for your time and for yourexpertise. Today. Thank you. I
appreciate being part of it. Thanksfor joining us on Community check In,
A presentation of excel Us Blue CrossBlue Shield at iHeartRadio. Podcasts of Community
check In are available on the iHeartRadioapp or wherever you find your favorite audio
(24:48):
content. For more ways to staysafe, healthy, and educated, visit
excel usbcbs dot com and follow onInstagram and Facebook
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram
(00:26):
and Facebook. I'm Joel Demonico andwelcome to this week's community check in.
People interested in losing weight have beeninundated with ads on television and social media
and billboards and news articles, celebritiesand pop culture for a variety of weight
loss drugs. As a result,there's probably been a good deal of confusion
(00:48):
and potentially some misuse of these drugs. So to help us better understand these
drugs where and when they can behelpful, we have Nicole Dawley with us,
who is Senior Director farm See Strategyand Policy at excel Us Blue Cross
Blue Shield. Nicole, Welcome tothe Community check In. It's good to
have you. Thank you, Joeappreciate it. Nicole is a licensed pharmacist.
(01:10):
She's been with Excell's Blue Cross BlueShield for a while now, since
two thousand and six, leading ateam that's focused on understanding drug use,
managing the types of drugs that arecovered by Excellis Blue Cross Blue Shield plans,
and establishing programs that help improve memberhealth through more affordable drugs. So
you've got a big mission ahead ofyou, so we're going to take a
very narrow focus this time. Iwant to start out just right really setting
(01:32):
some framework for what we're going totalk about. And I suppose that really
means to have a conversation about theobesity situation, or as many refer to
it in my field in the newsmedia, the obesity epidemic. And I
suppose it has reached that point.So I'm wondering if you could just really
give us some guardrails about where westood so that drugs like these that we're
(01:53):
going to talk about really became kindof necessary or started entering the conversation.
Sure. Sure, so, Yes, it's defined as an obesity epidemic.
It's been around for some time now. If you want to know what the
clinical definition of obesity is, it'sthe CDC defines being overweight or obese as
a weight that is higher than whatis considered healthy for a given height.
(02:16):
It's not it's imperfect, but thebody mass index or BMI, is measure
of body fat based on height andweight. So a BMI of twenty five
to twenty nine is considered overweight,and a BMI greater than thirty is considered
obese. So, for an example, an individual who is five feet eight
(02:37):
inches tall and weighs two hundred poundsmeets the definition of obese. And did
you know that currently more than fortypercent of adults and twenty percent of children
in the US are considered obese.Unfortunately, this number is expected to increase
to more than fifty percent of adultsby the year twenty thirty. Why should
we be concerned about obesity? Onereason is the risk of death associate with
(03:00):
heart disease, kidney disease, diabetes, cancer is greater in those that are
overweight. Not only is having ahigh b a maaya concern, but so
is abdominal fit or more specifically,waste circumference. So you want to you
may wonder how drug therapy has becomepart of the equation to focus specifically on
(03:21):
the golp one. Initially, thesemedications were targeted for a hormone in the
body, golp one, and theywere found to lower blood sugar levels and
diabetics. Examples of the drugs thatare approved to treat diabetes include ozembic and
trulyicity, and in fact, youmay have seen advertisements for these drugs on
TV or heard them on the radio. When the drug are being studied,
(03:43):
it was shown that in addition tolowering blood sugar levels, they all people
who took them also lost weight.The first drug that was approved by the
FDA specifically for weight loss was Sexendain twenty fourteen, and more recently,
wigov was approved in twenty twenty one. An interesting fact is that what govi
contains the same active ingredient as ozebic, but it is a higher strength,
(04:06):
and these two drugs are the onesthat are most commonly talked about in the
media. So based on that,would you say that these drugs that were
going to be discussing more about thatthe impact they had on weight was not
necessarily what they were initially designed todo, and that was an unintended but
(04:30):
very beneficial outcome of it actually beingused in patients to say, oh,
it does this, but hey,we also noticed that it has this additional
benefit. Absolutely, you just explainedit perfectly, and that is what happens
a lot with drug therapy is thatit will be studied for one particular thing
and then found to work in somethingelse. So now, and we've seen
(04:55):
with sex Senda being the one ofthe first that kind of came on the
market little quietly, we govy's beenmaking a lot of inroads and ozempic.
It almost seems that you can't turnon the television without seeing a commercial for
that. They've been very heavily marketed. So how does the drug then,
I guess and maybe just explain ita little bit more in Layman's yours use
(05:17):
a turn GLP one, which I'venever heard before, So we want to
talk a little bit about how doesthe drug category or class support weight loss
as benefit yep, So yes,if you've heard the term GLP one,
that's actually a hormone that's in thebody, glucagon like peptide one. It's
a messenger that tells your brain whenyou're full or satisfied after eating. So
(05:42):
a drug like with govy essentially tricksyour brain into thinking you are full.
This can help you eat less,feel satisfied with smaller meals, which in
time leads to weight loss. Additionally, it's the medication can slow down the
emptying of your stomach, which meansthat food stays in your stomach longer and
it makes you feel fuller for alonger period of time. The reason why
(06:03):
these drugs work so well is becausethey act in multiple ways, so you
basically got a nice combination there ofthe therapy helping you in a number of
different factors, which can long termthen under a doctor's guidance, be helping
to achieve some desired weight loss.And for those people that fit into that
(06:26):
obesity category, getting a jump startcan often be the thing that has maybe
held them back, and a drugtherapy might be just the thing for them
to help kickstart it so they canstart getting into some better, healthier lifestyle
choices and opening up their lives againthat obesity was holding them back from.
(06:47):
Yes, yes, I mean theguidelines are start with those lifestyle modifications and
if they don't work on their own, then yes, drug therapy would be
appropriate to add on. So Isuppose that goes right into our next topic,
drugs like these fitting into the largertrend of weight loss solutions. This
is not a magic pill, andI want maybe to make it clear to
(07:10):
people that it's not just oh,you take this medication and everything suddenly is
is right. This is a toolthat doctors and patients can use in combination
to help achieve a desired outcome.Yes, yes, we do like using
that term another tool in the toolbox. So they really should be used in
combination with a reduced calorie diet andincreased exercise or some type of physical activity.
(07:35):
The goal of adding medication to acomprehensive weight management program is to improve
health and address the medical concerns relatedto obesity. So these drugs should be
really used to promote overall well being, then for cosmetic purposes to lose a
small amount of weight. Nicole Dalleyis the Senior Director Pharmacy, Strategy and
(07:57):
Policy at Excell's Blue Cross, BlueShield. Our guest on this week's Community
Check, and we are talking aboutweight loss drugs. You may be taking
them currently. You may have seenthe marketing for them. They're kind of
ubiquitous. They seem to be allover the place, and as Nicole just
mentioned, it's not a one anddone situation where you take a medication and
(08:20):
all of a sudden weight falls offand things are better for you. It's
part of a tool kit that youand your physician can use in combination to
achieve a desired end. My followup question to that is, well,
let's say you're taking this medication andyou, uh, maybe the side effects
don't quite work for you, ormaybe you decide, you know what I
(08:43):
think I'd like to get off ofthis medication. Is it something that has
to be an ongoing type of aregiment and an ongoing part of a therapy
or if you stop, what happens? It is very patient specific, but
unfortunately for most people, well,you will most likely gain back the weight
that you've lost. So a clinicalstudy actually looked at this. They looked
(09:05):
at people who stopped taking Wagovi andreally what it showed is that one year
later, participants regained two thirds ofthe weight that they had initially lost.
So the goal of therapy drug therapyis to help you achieve a healthy weight
and then maintain that weight. Therefore, there really is an expectation that treatment
could be lifelong. But I can'temphasize this enough. It will always need
(09:28):
to be part of a comprehensive weightmanagement plan that includes those lifestyle changes exactly.
And we're going to keep coming backto that this is not any type
of a magic thing or a onesone and done, or you know,
you take take the pill and everythingis just right as rain. It really
is part of an overall process becauseas you mentioned, when it comes to
(09:50):
managing weight, especially for those whodo need more assistance than others, it
really is part of an overall It'spart of an overall plan. And if
you lose one piece of the puzzlefor some patients, I would suspect if
you lose one piece of the puzzle, they can wind up getting stuck like
they're mired in the mud and theyjust don't go anywhere. Yes, yes,
(10:13):
just out of plain curiosity. Becauseof the fact that Sexenda, as
you mentioned, came on the marketin twenty fourteen, some of the others
we go via ozempic have been relativelynew. I would suspect the data that
you see right now it's still fairlyfresh. Would you consider it that there's
more things that you can learn inyour position to really understand how these drugs
(10:35):
are working within the patient population.Absolutely, you know, looking at what
you see in a clinical study isn'texactly what you will always see in real
world so using the data of peoplewho have been on it now looking at
how long are they able to stayon it? Do they discontinue it?
What's the ovocacy of it? So, yes, that is always something that
(11:00):
always needs to be considered. Whatyou see in that clinical study isn't exactly
what will play out in the realworld, and more real life data will
certainly be helpful as time goes on. And as we mentioned at the beginning
of the program, there's been abig driver in these drugs. What do
you see from your vantage point asto how or what is driving the bus
(11:22):
with the uptick in the use ofthese medications and conversations that people having with
their healthcare providers about getting on thesedrugs. Yeah, I think social media
has really been the biggest influence onthe promotion of these drugs. You know,
I think we've all seen the storiesof the different celebrities that have tried
one of the weight loss drugs.Elon Musk had mentioned using with ov others
(11:46):
had admitted to using the weight lossdrugs to lose weight, Amy Schumer,
Tracy Morgan. But just because acelebrity has tried one of these drugs doesn't
mean that it is appropriate for everyone. They may not necessarily be considered ovis
or and overweight, so use ofthose drugs may not have been appropriate for
them. There's also been a lotof advertising of these drugs from online health
(12:07):
companies vendors, and they advertise onsocial media and they promote the prescribing of
these medications. This is where wedo start to see some misuse of the
drugs. These types of online companiesare prescribing it to anyone even if they
only want to lose a few poundsbefore a big event or a vacation,
or that don't have the BMI thatwould be considered appropriate for use, and
(12:33):
that can ride up into an entirecategory of effects that are unintended and can
can in some cases be not livable, not sustainable. You can't live with
these kinds of things. So Iwant to do talk. I do want
to talk about the side effects ofusing a weight management drug. If someone's
going on and say because they wantto lose, like, oh, I
(12:56):
think I can lose a quick fivepounds because I have an event coming up,
or fill in the name of ashort term goal that you want to
get to. They've got to balancethat potentially against what can happen to the
body and how your body reacts tothese drugs, because not everyone is the
same and their reactions to those drugswon't be the same. Yes, I'm
glad you asked this. As withall medications, there are possible side effects.
(13:20):
The most common side effects with thisclass of medication is nausea, vomiting,
diarrhea, and these side effects canbe significant, and as I mentioned,
real world data, it's actually showingthat up to fifty percent of the
people that initiate therapy have to stopit because they're having side effects that they
can't tolerate. Other safety concerns includelike low blood sugar, specifically if you
(13:46):
combine it with other medications, Andjust last month, the FDA did issue
a warning regarding WIGOVI and the potentialof intestinal blockage or you know, unable
to pass things through really the intestines. Another thing that we need to be
aware of with these drugs is theresome people should not take them, those
(14:09):
that have a history of certain typesof cancers or genetic conditions. And I'll
just you know, specific to theside of fact, I think, as
with all medications, your first stepreally should be having a conversation with an
established physician that knows your medical historyso that you can consider those side effects,
the safety concerns, and your overallhealth before taking one of these drugs.
(14:30):
Exactly, have those conversations with atrusted healthcare provider, because as you
mentioned, there's a lot of advertisement, there's a lot of push. There
are many more available places where drugslike these can become available without going and
having a conversation with a physician thatyou have a relationship with. I think
in some cases it's you know,if you're if you're a little timid about
(14:52):
that, maybe have a conversation witha pharmacist who gets to know about drug
interactions and things that you can tobe aware of so that you can have
some sort of understanding that look yourpersonal medication history and the things that you're
taking and your other conditions you mighthave. Might say you need to keep
(15:13):
away from this because there might besome interactions that are going to be potentially
harmful for you. Yes, yes, Eddie, pharmacist or should be a
good resource for you, whether itbe your local retail pharmacist, whether it
be a pharmacist at your health plan. They can help you understand are is
drug therapy appropriate for you? Doesn'tinteract with any of the medications that you're
(15:35):
taking. Are there alternative things thatyou could be doing? More of the
community check in we're talking about weightloss drugs is next for everybody who believes
the care they deserve should always bewithin reach, For everybody who wants to
be confident about insurance for the nextphase in life, for everybody who's looking
for the best ways to take careof their employees and their families. At
(15:56):
excel As Blue Cross Blue Shield,we're making care more accessible and affordable in
more ways and for more people inour community, because when we do that,
everybody benefits. Learn more at EXCELSBCBSdot com. Welcome back to the
Community check in. Nicole Dalley isthe Senior Director Pharmacy, Strategy and Policy
at Excell's Blue Cross, Blue Shield. Our guest on the Community check and
(16:18):
we're talking about weight loss drugs.They are they're out there, and they
are being marketed very aggressively towards anincreasing part of our population that it is
categorizes either overweight or obese, andthose numbers continue to grow year over year.
But these medications are still only availableby prescription. They are not over
(16:41):
the counter. As you understand thisclass of drugs and what it can do,
why still the restriction If there isdata to support that it can work,
and you were to put it ona shelf and put the warning on
the box, I suppose that wouldbe enough coverage. But why still the
restrictions to access at this time forthis class of weight management drug? Good
(17:03):
question? As I previously mentioned,the use of these medications is for a
specific patient population. They should beused in conjunction with a comprehensive plan to
provide the best possible outcome. Werecognize that everyone can achieve the desired weight
loss necessary to improve their overall healththrough diet and exercise alone. These are
(17:25):
the individuals that could benefit from drugtherapy. From a health insurance perspective,
we want to make sure the medicationswe cover for our members have been proven
to be safe and effective for thecondition being treated and that they demonstrate positive
outcomes. Again, they should notbe utilized for cosmetic reasons alone, as
these drugs have not been proven tobe safe and effective in those who have
(17:45):
a BMI within normal range unless theyare diabetic. Right, And I think
maybe that's why we're having this conversation, and we would we're going to keep
coming back to this is because themarketing has has been so aggressive, it
can appear like, yes, thisis just some fantastic invention that's going to
(18:07):
take a shot, take a pill, and boom, you're gonna be You're
gonna be into that dress to getready for that holiday party that you have,
or that that class reunion that you'regoing to. But that that is
not the case despite the perception.Maybe that's it is. There's a perception
there that, because of the messagesthat are seen, specifically in social media,
(18:30):
that it could in fact accomplish that. But then the reality of it
is, it's it requires a lotmore thought and a lot more diligence on
the patient's part and on your physician'spart to even know if it's right for
you to begin with. Yes,yep, there is no easy button to
weight loss. If there was.If there was, people in the pharmacy
(18:51):
world would all be rich by nowbecause they'd have the pill and it'd be
safe and everybody could could use it. I want to talk about a little
bit more about availability of these drugsonline. There's a lot more classes,
and this is just one of themthat are available, and they seem to,
as I understand it, tout itthat, hey, if you don't
(19:11):
want to have an uncomfortable conversation witha healthcare provider kind of sort of,
maybe we can get you in hereand talk with one of our representatives and
see if it's okay. What areyou seeing in the online world as far
as is this place is kind ofthe wild West in a way. I
hate to classify like that, butit seems that there's just a lot out
there and you really have to lookunder the hood to find out who you're
(19:33):
buying from and what you're buying.Absolutely, yes, that is very important.
Unfortunately, there are companies out therethat are looking to make a profit
by marketing unapproved drugs. Online companies, health spas, compounding pharmacies are offering
their own versions of these drugs fora much lower cost than the FDA proved
drugs. So people aren't naturally interested. They may be seeing ads in their
(19:56):
TikTok feed or other social media platform, but what's important to recognize is drugs
that haven't been approved by the FDAmaybe counterfeit. They may not contain the
amount of drug that it states andcan even be contaminated with unsafe ingredients.
Using one of these unapproved drugs couldbe harmful to your health exactly, or
you don't know exactly where it's comingfrom, and they don't have the same
(20:18):
standards as pharmaceuticals within the United States, so you don't know what kind of
products that you might be getting.Because the Internet connects you to the world,
you have to do a bit moredue diligence. Circling back to a
question that I asked earlier, butI want to come back to it about
the long term benefits of these drugs, and maybe part two of that is
(20:41):
sort of the overall healthcare costs,not just the cost of the drug per
se, but the costs of healthcare for those people who could benefit from
it, and we're talking about thosepeople in the overweight and obese category,
specifically the obese categories. You balancethe drug, taking the drug, the
(21:02):
cost of a drug, the humancost of it, and the long term
effects of living with a condition thatcould be benefited by that drug. This
is the big unknown. There ispotential that the use of these drugs could
drive down total health care costs.They could prevent the heart attacks, joint
replacements, other conditions related to obesity, but this hasn't been proven yet,
(21:23):
so again it's long term study.And since these drugs, this class of
drugs is relatively new in pharmaceutical terms. Are these relatively new when you look
back to say, like sex Sendaas an example, has been around since
twenty fourteen, that's less than tenyears, and the others have less time
than that in pharmaceutical time. Isthe Are these relatively in their infancy?
(21:48):
Yes, I would say so,and there's a lot more in the pipeline.
So there's been other drugs for weightloss historically they haven't been shown to
be as efficacious or work as wellas these drugs. But yes, this
is the category that we do expectto see expand within the coming years,
to have more drugs available, andone would suspect that research and development is
(22:10):
continuing to be done to improve quality, reduce side effects. Perhaps you may
see someone branching off potentially a drugthat exists now and they create a little
bit of a difference to it.It's a whole different drug that works a
little bit different. There's always somethinggoing on behind the scenes, isn't there
absolutely it, could you know,combining it with another medication or tweaking it
(22:34):
a little bit to minimize those sideeffects. Yes, the drug world is
definitely dynamic. Yes, and thedrug world has a lot going on that
advertising doesn't speak to. So ifyou're seeing these drugs, if you're seeing
them advertised, if you're seeing yourfavorite celebrity posting about having great results with
them, that's all well and good, but it starts by having a conversation
(22:56):
about your health and your situation,the medications you're currently taking, what your
body type is, and where youare today with your healthcare provider before you
decide that you're going to go andproceed, and proceed cautiously and with the
guidance of a professional to make sureyou're making the right decision. And our
final few moments here, I wantto just see what would you like to
leave our listeners with Number One,about not only these class of drugs,
(23:19):
but sort of their overall health,weight and journey that they're on that they
may need some help in getting toa better place. In sure, first,
if you're concerned about your weight oroverall health, having a conversation with
your doctor is a key first stepfrom a health plan perspective, if you're
overweight or obese, then use ofthese medications could be beneficial for you,
(23:41):
but they do come with risks.If your doctor determine's treatment is right for
you, you have to be committedto a comprehensive approach to managing your weight
that includes lifestyle modifications and recognize thatthis is a lifelong journey and you have
resources that are available to you.You have of those people that are going
to be able to be trusted andbe on your side. So yes,
(24:03):
there's a lot of noise. Yesthere's a lot of marketing. Yes there's
jingles and shiny packages, but atthe end of the day, if you're
ready to make that decision, thenhave the plan, know how you're going
to work it, with the supportthat you need, and start making those
steps forward and perhaps medication will bepart of it. And we want to
thank Nicole Dawley, who's the seniordirector Pharmacy, Strategy and Policy at excel
(24:25):
Us Blue Cross Blue Shield, forpulling back the curtain on some of these
weight loss drugs that are available tous. And Nicole, thank you very
much for your time and for yourexpertise. Today. Thank you. I
appreciate being part of it. Thanksfor joining us on Community check In,
A presentation of excel Us Blue CrossBlue Shield at iHeartRadio. Podcasts of Community
check In are available on the iHeartRadioapp or wherever you find your favorite audio
(24:48):
content. For more ways to staysafe, healthy, and educated, visit
excel usbcbs dot com and follow onInstagram and Facebook
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