GLP-1s Are Flipping the Script, Says Doug Long | 2024 Asembia

For years, the growth in spending in specialty drugs relative to so-called traditional drugs has been a well-documented trend in U.S. drug expenditures and more-than-welcome news at the Asembia meeting, which is devoted to specialty drugs and pharmacy. Doug Long, MBA, has been one of the prime narrators of that story in his many presentations featuring a voluminous slide decks at the Asembia gatherings and other meetings.

Doug Long, MBA, takes the stage at the Asembia meeting Las Vegas tnis morning.

But in his presentation this morning at Asembia, the IQVIA vice president used dozens of facts and figures to show the soaring use and expenditure on the glucagon-like peptide 1 (GLP-1) agonists for diabetes and weight loss.

“We've never seen anything like this in the past. If we thought that the hep C market was a tsunami. This is a mega tsunami,” said Long.

The GLP-1s include semaglutide, which is sold as Ozempic as a diabetes drug and as Wegovy as a weight drug, and tirzepatide, which is sold as Mounjaro as diabetes drug and as Zepbound for weight loss.

Long showed a ranking of drugs by sales that listed longtime sales leader Humira (adalimumab) in the top spot at $34.2 billion in sales — before any discounting — for the 12 months prior to December 2023. Ozempic was ranked second ($26.8 billion); Mounjaro, ninth ($13 billion); and Wegovy ($7.8 billion) at 15th. Long’s chart showed Ozempic’s sales as having increased by 78.7% and Mounjaro’s by 368.8%.

Definitions of specialty drugs vary some. IQVIA’s version that they are medications used to treat chronic or rare diseases and possess additional distribution, care delivery or “cost characteristics”that require special management. GLP-1s, which have a list price that is in the neighborhood of $1,000 a month before any discounting, are not considered specialty drugs.

According to IQVIA’s sales data, sales revenue for specialty drugs started to surpass sales for traditional drugs in 2022. That is still the case, according to IQVIA’s data, which are widely cited and used in the pharmaceutical industry. Prescription drug sales in the U.S. for the 12 months prior to February 2023 totaled $734.7 billion, of which $358.2 billion was for traditional drugs, which works out to 49.4%. But fueled by GLP-1s, the 14% growth in spending on traditional drugs — the drug spend — exceeded the 13% growth in spending on specialty drugs in that period, Long noted.

Long shared of stream of facts and figures to document the soaring sales of the GLP-1s. IQVIA’s data shows that U.S. drug sales increased from $647.6 billion in 2022 to $733.3 billion, an $85.7 billion difference. Long said that GLP-1s accounted for just under one-third(34.2%, or $29.3 billion) of that increase.

Because of the GLP-1s, obesity is now the fourth highest disease area when ranked by drug expenditures, trailing only cancer, diabetes and immunology (drugs that treat rheumatoid arthritis, psoriasis and other autoimmune disorders), Long told the large audience at the meeting’s general session. Worldwide sales for the obesity drugs reached $14 billion in 2023 and may increase by nine times that amount, or $131 billion by 2030, he said.

The sales figures have not gone unnoticed among drug developers. Long said there is now an“obesity gold rush,” with more than 60 companies racing to develop more than 120 weight loss drugs.

Long noted that there are approximately 100 million people who are obese or overweight. The diseases associated with obesity and being overweight increase with age. People 65 and older who are obese have, on average, 4.9 comorbidities. “It is going to be interesting to see is what happens as these drugs are used more, what impact they are going to have on cardiovascular disease, cardiovascular disease drugs, and so forth. Only time will tell,” said Long.

Medicare has an explicit prohibition on covering weight loss drugs. But developments this spring opened the door to some Medicare coverage. In March 2024, the FDA approved a new indication for Wegovy to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. Shortly afterward, CMS said Part D plans could add Wegovy to their formularies because of the new indication.