A Change in Healthcare Education and Provider Awareness

In a video interview with Pharma Commerce, Colin Banas, MD, DrFirst’s chief medical officer, describes have many Americans face significant challenges in accessing GLP-1 drugs due to their high cost. Despite the growing popularity and usage of these medications, which were originally developed for diabetes treatment, the price remains largely unchanged. Even with insurance coverage, patients often encounter co-pays or out-of-pocket expenses upwards of $500 to $600, making the medications unaffordable for many. Research indicates that once out-of-pocket costs exceed $100, medication adherence drops dramatically, further limiting access.

Additionally, insurance companies frequently require patients to try other medications first, a process known as step therapy, which can delay access to GLP-1 drugs. The drugs' weight loss benefits have garnered attention, but insurance companies still primarily cover them for diabetes treatment, leaving individuals seeking them for weight loss without coverage options. Moreover, as ongoing research uncovers more potential benefits of GLP-1 drugs—such as their positive effects on cardiovascular disease, Alzheimer's, and chronic kidney disease—insurance policies have not yet adapted to these expanded uses. As a result, many Americans who could benefit from these drugs for conditions beyond diabetes find that coverage is not available.

Banas also comments on patients turning to direct-to consumer (DTC) platforms following insurance denials; rumors of DTC advertising being banned; and much more.

A transcript of his conversation with PC can be found below.

PC: What are your thoughts on the rumors that RFK Jr. could potentially ban DTC advertising?

Banas: As a provider it might be mixed, but there's actually an interesting consequence of DTC ads, and it is conversation and it is education, meaning, as a provider, I am also exposed to what my patients are being exposed to. I see the advertisement at the Super Bowl, or the flyer in the magazine or the web page. A lot of these therapies, a lot of these drug classes, are brand new and accelerating so quickly that it is actually very hard to keep up.

In a roundabout way, if I see that, and if I'm bombarded with it as a provider, I actually take that as a cue to, ‘oh, I need to educate myself,’ not necessarily on that drug in particular, but on that therapy class. The reason is, ‘wow, there's something new that's out there. I should be on top of it,’ and, ‘oh, I think I'm going to get questions about this.’ I do think that's an interesting side effect of DTC.

The other thing I'll say about RFK—there are a lot of things on pause right now. There's a lot of trepidation, especially in the health IT world. What is going to happen with existing road maps, around interoperability, around some of the CMS initiatives that providers are participating in? I will say it does seem to be a tech-forward administration, and so I do think there's going to be advances—maybe even accelerations—in artificial intelligence, hopefully in interoperability, and the digitization of the medical record. Because a lot of these things can't be accomplished without data, and you can't get the data unless you're collecting it, aggregating it, and using it in an appropriate way.