TOPLINE

A remote program using patient navigators and pharmacists — not physicians — managed obesity medications for 75 adults with overweight or obesity. The model worked, but ran into real-world barriers: drug shortages, insurance gaps, and heavy prior authorization paperwork. Among those who completed the program, satisfaction was high, with two thirds preferring remote care over in-person visits.

METHODOLOGY

• Researchers evaluated the feasibility and effectiveness of the Supplementary Anti‑Obesity Medication Integration into a Longitudinal Obesity Study (SAIL) — a fully remote program led by pharmacists and patient navigators for obesity medication management.
• A total of 75 adults (mean age, 51 years; 83% women; mean BMI, 35.6) were enrolled in the SAIL study from 99 eligible respondents drawn from the digital lifestyle intervention program. All participants met the criteria of having a BMI ≥ 30, or ≥ 27 with at least one weight-related comorbidity, and had either gained weight or failed to lose at least 7 lb after lifestyle coaching.
• Pharmacists, operating under a Collaborative Drug Therapy Management agreement, initiated and titrated obesity medications according to algorithm-driven protocols, with nutrient-stimulated hormone-modulating therapies (including GLP-1 receptor agonists) as first-line treatments. Nonclinically trained navigators served as the primary points of contact for follow-up, side-effect monitoring, and patient education.
• Patients exited the program after reaching their maximum tolerated dose, running out of covered medication options, or needing a care transfer — with all participants then referred to specialty weight-management care. To surface what worked and what didn't, researchers held separate focus groups with the program's pharmacist and its navigators.
• The primary outcome was the proportion of participants prescribed at least one obesity medication at any point during the program.

TAKEAWAY

• Among 12 program completers who responded to an exit survey after reaching the maximum tolerated medication dose, all agreed that the program helped advance weight-related goals; eight (67%) preferred remote weight management when given a choice between in-person and remote care.
• Focus groups with program staff identified key implementation challenges across five domains — medication availability and access, insurance coverage, patient education and medication use, unique patient population considerations, and program adaptability.
• Program staff identified severe, ongoing medication shortages as a primary barrier, requiring extensive phone outreach to local pharmacies to secure prescribed drugs. The prior authorization process for insurance created a substantial administrative burden, with pharmacists spending 3-90 minutes per authorization and up to five authorizations required per patient for dose escalations.
• Patient education demands were substantial, with navigators conducting 15- to 20-minute remote visits to review medication storage, injection technique, dose escalation, and anticipated side effects for injectable therapies. Participants were engaged and well-informed and often expressed strong, specific preferences for once-weekly therapies that were sometimes shaped by positive experiences among family members or friends.

IN PRACTICE

"The final results of this novel healthcare delivery intervention will inform the feasibility and effectiveness of remote, algorithm‐ driven, navigator‐ and pharmacist‐led management of obesity medications," the authors of the study wrote.

SOURCE

This study was led by Bryn Falahee, Brigham and Women's Hospital, Boston. It was published online in Obesity Science & Practice.

LIMITATIONS

The program primarily enrolled individuals already inclined toward digital interventions and did not include a prospective control arm. Enrollment was reduced from the planned 200 to 75 participants due to funding limitations. The program was conducted in a single healthcare system by an experienced remote care team, limiting its generalizability.

DISCLOSURES

The SAIL program was sponsored by Eli Lilly, while the parent program from which patients were enrolled was funded by the Patient-Centered Outcomes Research Institute (PCORI), with additional support from a PCORI Dissemination and Implementation Award. Some authors reported receiving consulting fees, grants, or research support; serving as advisers or speakers; or holding other ties with various pharmaceutical companies, including the study's funding agency.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.