Celebrities are typically at the forefront of diet trends, and recently some have turned to diabetes drugs to shed unwanted pounds. This trend has not gone unnoticed by the public. Because obesity is a chronic condition that has become a major health issue in the United States, with more than 42% of American adults considered obese and another 31% overweight, the demand for diabetes drugs to treat weight loss is at an all time high.
Employers, who are faced with high costs in treating obesity-related chronic conditions such as hypertension and heart disease, are taking notice of these drugs as well. Studies from 2022 show that overweight employees miss more days of work and have almost twice as many workers' compensation claims than those who are of average weight.
All of this has created a dilemma for employers. How do they control costs and still provide the best possible health care coverage that gives members access to these medications?
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A breakdown of diabetes drugs to treat weight loss
Recent clinical studies show that semaglutide, sold under the popular brand names of Ozempic for diabetes and Wegovy for weight loss, can help individuals lose a significant amount of their body weight. On average, adults taking semaglutide can lose up to 15% of their body weight. This is a significant amount that can reduce the risk of additional chronic conditions.
The newest medication on the market in this category is Mounjaro, with the active ingredient tirzepatide. Mounjaro has shown effectiveness in producing larger weight loss results in diabetics. We expect to see approval for tirzepatide for obesity soon.
Additional medications in this drug class, Victoza (approved for diabetes) and Saxenda (approved for obesity), which both have the active ingredient liraglutide, were also studied and showed promising results.
The biggest difference: Insurance coverage
Whether approved for diabetes or weight loss, the drugs are effective, but the biggest difference in these medications is in insurance coverage. The drugs with FDA approval for diabetes have traditionally been covered by insurance at a branded copay tier. Plus, it's important to note that all drugs in this category are expensive, with list prices around $1,600 a month.
Wegovy and Saxenda are often excluded from coverage for weight loss because weight management and obesity medications are frequently not a covered pharmacy benefit. Manufacturer savings cards are available to help with out-of-pocket costs, but without insurance coverage lowering copays, the $225 to $500 savings for a month supply is still largely unaffordable.
What this means for self-insured employers
Weight loss is often looked at as a vanity metric, however obesity is a chronic condition that can trigger upwards of 30 other chronic conditions if not addressed, resulting in greater health care costs for employers in total. While covering the cost of obesity medications, treatment could improve a member's health and reduce the cost of obesity-related health problems.
Yet, the cost of these drugs adds to the financial burden already faced by self-insured employers. Additionally, with the media drawing attention to these medications for weight loss, employees are trying to access these drugs off-label and even consider getting these medications compounded by specialty pharmacies.
A multi-faceted approach is best
The treatment of obesity requires a multi-faceted benefits approach. Weight loss medications should always be accompanied by a comprehensive weight management program. This should include a customized education on lifestyle; behavioral changes required to maintain weight loss; along with expertise regarding the use of medications.
A pharmacist has the expertise to provide clinical oversight to ensure success in a comprehensive weight management program. Plus, a pharmacist can advise on how to tolerate side effects while managing any other medications that the patient may be taking.
To cover or not to cover weight loss meds?
Plan sponsors should consider the importance of providing access to these valuable medications but build in protections to control utilization. If plans incorporate prior authorization criteria for both diabetes and obesity medications, they can ensure the right person is on the right medication for the right amount of time.
In conclusion, diabetes medications used to treat obesity and overweight conditions are an effective weight loss support tool. Combining these medications with a personalized weight management program, that includes an expert in medication management and nutritional and lifestyle changes, can help employers provide the best possible options for their employees. Essentially, it will allow their employees to live healthier, happier lives and be more productive in the workplace.
Dr. Jessica Lea, Pharm D, is founder and CEO of Tria Health, a comprehensive health benefit offered through self-insured employers for individuals with chronic conditions.
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