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Some sub-analyses of large clinical trials suggest that GLP-1RA and sodium-glucose cotransporter 2 inhibitor combination therapy may provide more significant reductions in heart failure hospitalization and renal composite events than each alone

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--- Here are some potential actions covered in the article for payers and employers to take as a result of this shift: Update formulary tiers and step therapy policies (consider the impact on comorbidities) Support members transitioning off GLP-1s after reaching their goals Create differentiated access pathways based on patient risk profiles Monitor realworld outcomes beyond A1C (cardiovascular, renal, adherence) Model the downstream impact on generics and legacy therapies --- Commercial plans are accelerating GLP-1 uptake and favoring the simplicity of a single therapy

However, its future trajectory is far from linear as many uncertainties remain, e.g., acceptance of obesity as a chronic disease, budget impact faced by payers and health systems willingness and ability to pay, the readout of further cardiovascular outcomes trials after the high profile results of 2023s SELECT trial for Wegovy, or new entrants challenging first generation therapies with alternative mechanisms of action (MoA) to address shortcomings such as gastrointestinal tolerability, current drugs being injectables, or the durability and quality of weight loss which distinguishes between fat and lean body mass

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