Capital Rx Partners with Virta Health for Diabetes, Obesity Patient Support

The PBM Capital Rx and Virta Health together have launched Rx Reverse, a new program to help members reverse type 2 diabetes and address obesity. Rx Reverse combines Capital Rx’s JUDI, the company’s pharmacy platform to unify pharmacy benefit management operations, with Virta’s solution – personalized nutrition counseling, remote monitoring and one-on-one coaching – to help health plans reduce costs and improve members’ health. 

Sara Izadi, Pharm.D.

“Capital Rx’s technological capabilities position us to provide solutions to employers to provide to their membership,” Sara Izadi, Pharm.D., senior vice president of pharmacy at Capital Rx, said in an interview with Formulary Watch. “As part of this partnership, we can focus on formulary alignment and a cohesive member experience. We’re able to collect data to provide to both the employer and Virtua to ensure a good experience and positive outcomes.”

More than 37 million U.S. adults have diabetes, and in the last 20 years, the number of adults diagnosed with diabetes has more than doubled. Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness, according to the CDC. Obesity is a common disease that is increasing. U.S. prevalence increased from 30.5% during the period 1999 to 2000 to 41.9% during the 2017 to March 2020, according to the CDC. Obesity-related conditions, such as heart disease, stroke, type 2 diabetes and certain types of cancer, are among the leading causes of preventable death.

Related: Semaglutide for Weight Loss: To Cover or Not Cover?

This comes at a time when a new class of drugs — Novo Nordisk’s Ozempic (semaglutide) and other GLP-1 drugs — have become available. Initially, these were approved to treat patients with diabetes, but increasingly they are being used for weight loss. Semaglutide mimics a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake. GLP-1 drugs have become so popular for weight loss that they are being used off-label by people who don’t have diabetes.

“Some telehealth companies are focused on just prescribing with perhaps not a lot of follow up with members,” Izardi said. “There is not a lot of titration for appropriate dosing. So oftentimes, patients are started on these and they don’t have regular check ins and patients may have side effects. When you look at the clinical literature, all of these drugs are studied in combination with diet and exercise.”

These are often high-cost drugs. Novo Nordisk’s Wegovy, a semaglutide product that is approved for obesity, has a price of $1,349.02 per package, or $16,188.24 per year. And more GLP-1 drugs for weight loss are coming. One is Lilly’s Mounjaro (tirzepatide), which is already available to treat type 2 diabetes. Lilly has completed its submission to the FDA for a weight loss indication.

Virta’s approach combines personalized nutrition therapy with coaching and remote medical care with the goal to get people off medication. Virta reports lowering HbA1c for patients with diabetes by 1.3% on average after one year, and 60% of patients enrolled one year attained an HbA1c below 6.5% without using diabetes medications other than metformin. In addition, patients experience an average of 12% body weight loss at two years.

The Capital Rx/Virta program includes three options at an additional cost for plan sponsors:

• Type 2 Diabetes Reversal: Helps plan members achieve lower blood sugar – often to sub-diabetes levels <6.5 A1c – and clinically significant weight loss alongside safe deprescription of diabetes medication.
• Provider-Led Weight Loss: Helps plan members without diabetes who are considered overweight (BMI ≥ 25) or obese (BMI ≥ 30) achieve clinically significant weight loss.
• Type 2 Diabetes Reversal & Provider-Led Weight Loss

“We charge an administrative fee, but there isn’t a huge margin for us here,” Izardi said. “The goal here is to help sponsors save on total cost of care. But the outcomes that you see with obesity and diabetes take years to be realized.”

Izardi said Capital Rx will use its technology capabilities to assess medication costs, medical spend, and even employee productivity. “Sponsors have come to us asking for a solution,” she said. “What we have put in place addresses preventive care, as well as those who are on treatment. What we are working on now is how to incentivize members to participate in the program.”