Episode 49 – CVS Weight Management Program

Mike Stull (0:09)

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With that, let’s get started. So today, we are discussing a topic that’s front and center for many of our clients, weight loss drugs and programs.

And joining me are two experts from CVS Health, Erin Bacon, who’s a strategic executive of new business, and Dr. Lia Rodriguez, vice president of clinical strategy. We’ll talk about how we define obesity, what makes a weight loss program really work, and their outcomes with their weight loss program.

So, with that, let’s get started.

Dr. Rodriguez and Erin, welcome to get us started. Maybe you can tell the audience a little bit about your background. Dr. Rodriguez, we’ll start with you.

Dr. Lia Rodriguez (1:57)

Thanks, Mike, and great to be here. So I am Dr. Lia Rodriguez. I am actually a pediatrician by background.

And so I have really focused on my career on what I consider building generational health, really focusing on improving the lives of children by improving the lives of their caregiver ecosystem. And so really excited to be in the role of vice president of Clinical Strategy at CVS Health, really looking at how we improve health outcomes and driving down health care costs. So, thank you for having me here today.

Mike Stull (0:09)

Yeah, Erin.

Erin Bacon (2:32)

Yeah, thanks so much. So hi, everyone. I’m Erin Bacon.

I am one of the national sales directors for our payor solutions here at CVS Health. I’ve been with the organization about six years now. I’m based in Charlotte and having a lot of conversations right now about how can we align with our clients on strategies for supporting weight management.

So really excited for today’s conversation and looking forward to it.

Mike Stull (2:58)

Great. Well, let’s just start with a little bit of level setting. And Dr. Rodriguez, I’ll turn to you for our first question. You know, obviously, weight loss drugs and weight management programs are at the top of our clients’ minds and their priorities throughout 2025 heading into 2026. So maybe we’ll start with just a definition of, you know, what is obesity and what are some of the updated and latest statistics around its incidence?

Dr. Lia Rodriguez (3:35)

Sure, Mike. Happy to. So, let’s actually start with just that, right?

Let’s start by defining obesity. And I think it’s important to recognize that obesity isn’t just about like weight, right? It’s not just about the number on a scale.

It’s really a chronic relapsing and multifactorial disease, right? So chronic meaning long lasting, relapsing, it comes and goes, and multifactorial multiple aspects, right, leading to this disease state. And it’s characterized by excessive body fat that’s impacting your health.

When we look at the clinical landscape, right, we tend to use the body mass index calculation as as a measure for obesity. So traditionally, we use a BMI of greater than 30 as the threshold for defining obesity. But we also are starting to see in clinical evidence that BMI isn’t the only number that we should be tracking.

So we really need to be looking at other components, body composition, waist circumference, metabolic profiles. There are several factors that are playing a significant role in how obesity is manifesting and affecting various individuals. When we look at the prevalence of this disease state in our, in our American society, it’s really staggering, right?

So when we look across the population, more than 40% of US adults are living with obesity. If we extend that, right, and look at people that would be considered overweight, and therefore at risk for developing obesity, that number is actually 75% of our population. So, these rates have been rising steadily, we’re seeing them increasing in younger populations, we also see them affect disproportionately lower income and minority population.

So really, it’s it’s a public health crisis. It’s not just a clinical issue. And really something that is a focus not just for employers that are trying to figure out how to cover the treatment for this condition, but how we really improve our society’s health.

Mike Stull (5:44)

Yeah, I think from my own perspective, and someone who’s dealt with being overweight, and, and obese, you know, throughout my entire life, I appreciate the multifactorial piece. Because I think it’s, it’s a two way street as well that, you know, obesity isn’t just defined by the weight on the scale, there are many factors to it. There’s also many factors into how a person tries to lose weight.

And so, I know, we’ll, we’ll talk a little bit about that here in a bit. I also know that, you know, when when typically, we think of people with obesity, that it’s linked to a number of other chronic conditions, and maybe talk a little bit about the relationship, whether it’s obesity and cardiovascular disease, obesity and diabetes, or any of the other chronic conditions that tend to be related.

Dr. Lia Rodriguez (6:45)

Sure. And I think you’re absolutely right. When we think about obesity, we really have to think about its impact on other health systems.

And when we look at the numbers, right, we know that obesity is very closely tied to some of the most costly and complex chronic conditions that we see today. So I heard you mention a couple, right? We know that it’s closely tied to cardiovascular disease and diabetes and others.

And the reason for that, right, is that that excess fat that we talked about is really creating this inflammatory response in the body. And that’s driving that impact on metabolic health, right? So, it’s impacting insulin resistance, which can lead to diabetes, it’s impacting your lipid levels, right, like that cholesterol and your triglycerides, which actually can lead to cardiovascular disease, that also leads to higher blood pressure and hypertension.

So again, all of these are, you know, a cascade of effects that happen as that excess adiposity, that excess fat in your body accumulates. But it isn’t just about cardiovascular disease, we see obesity associated with a variety of other conditions, obstructive sleep apnea, which has gotten a lot of attention recently, because of GLP-1s being approved to treat obstructive sleep apnea, again, closely tied with excess, you know, body weight and excess fat, we are also seeing it impacting other conditions like fatty liver disease, reflux, and even certain cancers. I think the other area that is really important to focus on is its interplay with mental health, right? So we know that obesity can lead to depression, but vice versa, right?

When you have depression, you can actually also be more at risk for obesity. So it’s really this difficult cycle that we need to address. And we really need to do so by addressing it with really comprehensive and integrated care.

Mike Stull (8:51)

One of the other areas that I know, when I look at medical claims data, musculoskeletal issues tend to drive a lot of spend under the medical benefit. I mean, I would assume that there’s definitely a link with obesity from that perspective as well.

Dr. Lia Rodriguez (9:11)

Yep, absolutely true. I, you know, mentioning that I am in that population health space, I recognize that musculoskeletal conditions are consistently one of those top drivers of medical costs. They’re also a concern for employers when thinking about employee productivity and absenteeism, etc.

So again, a really, you know, strong area of focus for employers and also an area of concern in the clinical community. And you’re absolutely right. There is this direct link to obesity, right?

So when you have that extra weight on your body, that’s creating mechanical strain on your joints. So we see it impacting knees and hips and your lower, you know, your lower back. This excess weight also helps to accelerate the progression of like arthritis and can lead to chronic pain and disability.

Again, some of those factors that that I’ve mentioned. I think the other part, you know, as we discussed with that mental health cycle, we see a similar impact in the musculoskeletal space, right? So when you have that extra weight and that impact on arthritis, that’s actually making you move less.

When you move less, you’re less likely to be active. So it’s going to make it harder for you to manage your weight. And therefore, again, you’re creating this feedback loop that makes the treatment of obesity and musculoskeletal conditions incredibly complex.

Mike Stull (10:39)

So, let’s talk a little bit about what we, what we do about it. And the GLP-1 drugs represent a unique opportunity to finally help people lose weight using a combination of both lifestyle change and pharmacotherapy. And certainly I know that the pharmacotherapy will help curb appetite, but it’s not necessarily going to make people eat better or change their exercise routine.

So maybe talk to us a little bit about why these lifestyle changes are so important in conjunction with these medications for the maintenance of weight loss.

Dr. Lia Rodriguez (11:21)

Love that question. You know, I think that these medications really are a game changer. I agree with you on that, right?

So they’ve really changed the landscape of obesity treatment, serving as a catalyst in many cases for success, right? They work, as you mentioned, by mimicking a hormone that reduces your appetite. It also helps with, you know, the way that your glucose is regulated, it’s impacting multiple receptors across your body, they’re also being shown to reduce inflammation.

So for many people, this seems like a miracle drug, right? That helps them overcome, you know, their ability to failed attempts to lose weight. But you are absolutely right in saying that they’re not necessarily a miracle drug in isolation.

Medication alone isn’t enough. And actually, not everyone is necessarily going to need that medication. They are a catalyst for weight loss.

But the important change that every person that is looking to make a change to address their obesity or their overweight status is really looking at how you make sustainable lifestyle changes. How do you make sustainable food choices? How do you build strength and stamina so that you preserve the muscle mass that’s often lost when taking these medications?

How do you manage other areas of your life coping with stress, addressing your ability to maintain connectivity with your community, again, all of these lifestyle changes are really crucial for that sustainable way to keep that weight off and truly treat obesity as a clinical condition. So again, I think that we really appreciate the development of these drugs, so that they can serve as a tool in the shed right in the same way that bariatric surgery has served as a tool in the shed for clinicians to treat obesity. But at the core of that treatment, we always have to be thinking about what are the key lifestyle changes that need to be made.

And then I think really important, Mike, is making lifestyle changes has been hard, right? It’s been historically hard for years. If not, then actually, I don’t think we necessarily would have seen the importance of the development of these drugs.

But having, you know, evidence-based programs that really work with a person in a personalized way that helps them identify the barriers that they have to making those changes and then making those incremental changes so that they can sustain that lifestyle modification is really key when considering any clinical approach to treating obesity and overweight.

Mike Stull (14:10)

So, Erin, let’s shift to that clinical approach and the programs that are set up to help individuals lose weight. So generally speaking, you know, as you look across all of the different models of programs out there to help people, what are some of the key components of all good programs? And then what are some of the things that might differ from program to program that differentiate them?

Erin Bacon (14:40)

Yeah, absolutely. And so Dr. Rodriguez talked about how nuanced this weight management care space is, right? It’s really important that any good program is kind of holistically looking at their members to understand there’s different pieces and there’s not going to be a one-size-fits-all approach that’s going to work for everyone.

And so that’s where I think it’s really a good thing that this is a saturated space, right? It’s important that as an employer, you’re finding a program that is going to really fall in line with those overall strategies or goals that you have. And so, with a good program, what a lot of the programs out there right now are doing is first and foremost finding some kind of clinical support model to do exactly that, right?

To use some element of behavioral coaching to wrap around that member from that holistic view. They’re all also kind of using that combination therapy that Dr. Rodriguez mentioned of making those lifestyle changes either for those who are on an anti-obesity medication or not, but providing that support there. And then having some kind of digital tool.

We understand it’s the 21st century, right? We’re not all just going to the prescriber’s office to have that engagement. We really need to meet members where they are to really encourage or incorporate that long-term behavior change.

So where are some of the differentiators? So first and foremost within our program, we really focus on using medical nutrition therapy. So going beyond just historic coaching models, it’s important that you’re first and foremost using kind of that backed clinical support model, but then also in the way that it’s delivered.

So we’re leveraging registered dieticians. They’re practicing at really the top of their license. They have on average over 10 years of experience.

They’re obesity certified, and they can really format or develop that established relationship with that individual to help support all of those different important factors Dr. Rodriguez mentioned, right? Whether that’s cultural preferences, dietary sensitivities, food allergies, all of those nuanced pieces are really important. And that matched primary registered dietician can help work through that member through each of those different pieces.

It’s also really important to note that the space is continuing to evolve, right? There’s new indications that are coming to market. And so it’s really important that with a good program, you’re using that highest level of clinical rigor that as those new indications come to market, we can quickly support those.

Dr. Rodriguez mentioned sleep apnea, CBD, those are all supported through our program. And as those new indications come to market, you really want to make sure that partner that you’re using for these solutions is taking that into consideration and evolving in that way. Our program is also diagnostic.

So it’s really important tying back to that holistic support that we’re not trying to find kind of that one size fits all for members. And then what’s also really important is in this space, really those configurable benefit integration options. There’s a lot of clients that really want to find a strategy that can not only wrap around their members clinically, but they can also help with them in the financial space.

And so that’s something we’re really striving to make as positive of a member experience as possible, really working on that existing strategy for new utilizers, making that something that doesn’t lead to a really negative member experience. Then the employer is dealing with a ton of phone calls from their members. So those are all things that are really important.

And then within that space, of course, having tangible savings. We really want to make sure that if we’re delivering on a program that our clients are seeing those tangible results. And we are delivering that currently with our program through pharmacy claim savings.

And I think it’s really important as you’re thinking about savings to also think about that holistically. There’s a lot of different levers you can pull in this space that can potentially have rebate impact, right? There’s some things that are going to have higher rebate impact than others.

And so it’s really important as you’re making those kinds of decisions that you’re partnering with your PBM partners or things of that nature to have those conversations about what would that rebate impact be as you’re making kind of that holistic decision on which solution to really go for and help support your clients and your members.

Mike Stull (18:58)

You started to talk about some of the results, and you recently published some good results. Maybe some of the first results that we’ve seen from your specific program. Give the audience a little taste of or maybe a reminder of what some of those outcomes were.

Erin Bacon (19:19)

Yeah, absolutely. And I think you can really think about those savings in sort of three different buckets, right? You’ve got the member engagement and what that looks like.

You’ve got the clinical results and then the actual financial results for the clients as well. So, in terms of the clinical or the engagement space, what we’re seeing today is our weight management program is now available to more than three million members that are part of the CVS plan. We have over 55,000 members who are currently enrolled in our program and we’re seeing a 92%-member satisfaction.

So, some really high success from those 55,000 members who are enrolled. What we’re seeing for actual engagement is that our members are interacting with their assigned registered dietitian monthly through a virtual visit that they can schedule in the app. We’re seeing weekly chats with their RDs.

They’re logging their biometrics weekly, meaning, you know, stepping on the scale, recording their weight, all while continuously engaging in our app, our health optimizer app that leverages FDA cleared technology. Now in the clinical space, Dr. Rodriguez talked about how important that this medication is not a silver bullet, right? These are things that members have to be taking in combination with lifestyle changes.

What’s interesting with our program is we’ve actually seen about 70% of our members who are coming in or saying they actually hadn’t tried any kind of weight management program before going on one of these medications. And so, what that means is the primary group of those individuals on one of these medications aren’t going to get that highest clinical efficacy of the drug. And so, what we’ve seen with those population kind of that 70% coming in, not making those behavior changes by pairing them with an RD, introducing those behavior change elements, lifestyle support exercise, we’re able to see 13 times incremental weight loss in that population.

Now for those individuals who are coming in, they were having moderate success prior to enrollment. We’ve been able to see an average of 20% weight loss for those individuals. And we’ve been able to supercharge their weight loss as well through the program.

Now, when it comes to members who are coming off of an AOM, you know, we aren’t currently recommending a one size fits all deprescribing approaches. That’s not the current FDA recommendation for these drugs. However, there are members who, you know, the medication is clinically ineffective.

Maybe they aren’t able to tolerate the side effect profile. Maybe their physician says you’ve reached this certain weight. We’re ready to get you off the drug.

And so, for those numbers, we are able to continue to support them with that lifestyle behavior type approach. And we’ve seen a maintained 94% of weight loss after six months for that group of individuals. Now, in terms of the actual savings or spend that we’ve seen spend reduction for our clients, first and foremost, if you compare kind of CVS Caremark clients who are covering the anti-obesity medications, and then those who are covering with our weight management program, those clients have spent up to 26% less on GLP-1s for weight loss.

So that’s a metric that actually we’re also continuing to look at. We’re seeing that now hovering even closer to 40% less spend. So, it’s really something that we’re definitely really proud of.

Our clients are really excited about those metrics. And then we’re also seeing a four-to-one ROI for those clients as well. That’s made up primarily of direct pharmacy savings.

So, some really significant results across the board, not only in the member experience space, but also clinically and financially as well.

Mike Stull (22:55)

Yeah, I think it’s important that for clients that are going to invest in covering these medications that they get the most out of them. And so making sure that the drug is working most efficiently and efficaciously is super important on the front end. And then, like you said, that’s been the question since the beginning.

What do we do when someone gets to that target weight? Are these drugs that need to be continued forever? Or how do we make sure that that investment in the medication doesn’t just get wasted away because someone hasn’t made the lifestyle changes?

So, I think some really, really good information that’s come out in the outcomes. And I’ll tell you; I was sitting on a plane when I read the release and I immediately shot questions over about, you know, tell me a little bit more about the time period. Tell me a little bit more about, you know, the results almost sound too good to be true.

But certainly, we’ve validated that, you know, these are good results. So really appreciate you sharing with those and congratulations on the success so far. So, I think, you know, if you’re like me and been around for 20 years, you’ve seen weight loss programs and wellness programs over the 20 years.

And sometimes I think they become a nice to have a check the box, like for those people that are interested, here you go. But always tough to put quantitative results around them. I guess my final question for both of you is, you know, again, these programs have been around for a long time.

So, what’s different now?

Dr. Lia Rodriguez (24:58)

So, I’ll take it, Mike, from a clinical perspective. And then I would love for Erin to give her perspective in terms of how clients are facing these, right. So, when I think you’re absolutely right, right, weight loss programs have been around for decades, and people, you know, have gone on, you know, fad diets and have tried different things.

And unfortunately, the sustainable changes didn’t necessarily come from that. What I think has changed is the science as a whole, right, we have a much better understanding of the neurobiological challenges that people face when, when, when, you know, on this obesity cycle. So, we better understand the neurobiology of hunger and how you feel fullness.

And so now we have these medications that can target some of those neurobiological changes that are happening, like I said, to catalyze some of these things, right. We also, I think, have access to data and digital tools. And these are things that are allowing for us to deliver a more personalized experience.

It also shifts it from an episodic model where you would either go to like a meeting or a session, or you saw your doctor once a month, or once every six months to discuss this, to having access to guidance information and accountability at all times, right. And especially what I like to say in those moments that matter, right, you’re, you’re at your company picnic, and you need to figure out what’s the best food choice that’s there that won’t interfere with, with your, with your dietary plan, etc. Access to these digital tools for real time evidence-based information is really a game changer.

And last but not least, I think the other area, and this is one that I really appreciate is really this holistic approach that we’re taking a really whole person care approach. In the past, I think that in many ways, obesity was seen as a disease of willpower, right, there was a lot of shame associated with this. And it was about, you know, how you looked or how you didn’t have the willpower not to like, eat, or you didn’t have the stamina to exercise.

And we now understand that there’s a far more multifactorial situation that we need to be taking into account. So we are now able to shift from this shame based aesthetic approach to addressing obesity, to really focusing on addressing the, you know, obesity and overweight as as a clinical condition, but also really focusing on the downstream effects, right, like really focusing on that chronic disease prevention, focusing on the, you know, global health impacts that it has, when you’re able to make sustainable behavioral changes, address the neurobiological components, and achieve the sustainable success. So again, I really think that that paradigm shift is a game changer, long overdue for a lot of folks that have battled, you know, overweight and obesity for so long. And I’m really excited that, you know, we are a part of that paradigm shift with our program.

Erin, I think you might have some perspective in terms of how employers or those who pay for healthcare might be seeing things differently.

Erin Bacon (28:17)

Absolutely. So, I think historically, weight management programs were those that clients were putting in place as really kind of that voluntary enticed offering for their members to really enroll as they’d like to see fit, right. And I think really the introduction and the continued rise of GLP-1s for weight loss has introduced this challenge for employers of how do we balance offering, you know, these clinical wraparound solutions in the space, understanding the significant cost problem that we have with these medications.

And so this has really posed an opportunity with this new kind of introduction of benefit integration, where clients can really ensure that they’re kind of putting these solutions in place with the strategy and the understanding that they want to make sure they’re getting the highest clinical efficacy of this investment that they’re making for the members and that those members who are on one of these medications are able to truly optimize those, pairing them with a registered dietitian, pairing them with these clinician teams.

And so I think it’s been a really important and kind of interesting space to watch this evolve as clients do have these options to partner with vendors like their PBM space, like a program like ours, where they really can combine not only that clinical success for their members, but also pair that with a guaranteed ROI, making sure we’re really providing kind of that population risk stratification as well to get that highest clinical efficacy and the greatest support for their members.

Mike Stull (29:47)

Well, it’s certainly an active space. I don’t see it slowing down anytime here soon but thank you both for joining us today and sharing information about how you see this space and how your solutions are meant to address it.

Erin Bacon (30:04)

Absolutely, thanks for having us.

Dr. Lia Rodriguez (30:06)

Thanks for having us, Mike.

Mike Stull (30:07)

Thanks again to Erin and Dr. Rodriguez for sharing their insights and keeping us up to date on the evolving weight management landscape.

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