A HEALTHY YOU
Balancing the Expense of Today’s New Weight Loss Drugs and Workforce Wellbeing: How Employers Can Respond
Obesity has long been the focus of workforce wellbeing programs, and we are not winning that battle.
Data suggest that half the world’s population – or over 4 billion people – will be obese by 2035! As much as half the new diabetes cases in the U.S. are linked to obesity. It has connections to 50+ chronic illnesses such as musculoskeletal problems and cancer; costing the health care system nearly $173 billion annually and accounting for 47.1% of the total cost of chronic diseases nationwide.
Let’s be clear, this obesity epidemic is complicated and can’t be simply boiled down to a “history of poor choices around diet and exercise.” Personal responsibility always plays a role but we have engineered the need for daily movement out of our lives using technology, and created obesogenic environments that seem to make becoming overweight or obese the path of least resistance.
Medical advances over the last decade delivered five medications that have been approved by the U.S. Food and Drug Administration for use against obesity. Other newer medications have been developed to treat diabetes that also have been helpful for weight loss and management.
The good news is that these drugs have been shown to work. The hard truth is that they are also expensive – costing up to $1,400 a month before discounts. Compounding that issue is the fact that they necessitate long-term dosing because of how they work in our brains and bodies.
Employers are paying the price for the obesity epidemic as evidenced in pharmacy and medical claims, but the impacts reach well beyond the claims. According to the Journal of Occupational and Environmental Science, productivity loss stemming from obesity ranges from $271 to $542 per employee.
It raises the question: How do employer plan sponsors balance the cost of these new drugs with the challenges of addressing a growing obesity epidemic?
Considering Today’s Weight Loss Drugs
The new medications are called GLP-1 agonists or specifically, Orlistat, Phentermine-Topiramate, Naltrexone-Bupropion, Liraglutide and Semaglutide. They are not in the same category as previous generations of weight-loss pharmaceuticals such as amphetamines.
No medication is a substitute for diet, exercise, emotional self-regulation, and lifestyle changes, but with proper management, this new class of weight loss drugs has proven to produce better long-term results than earlier solutions. Taking them for a year, the Mayo Clinic writes, can cut 5% to 10% of a patient’s total weight; maintained, it can lower blood pressure, blood sugar levels and triglyceride levels.
These results are associated with meaningful reductions in health-related costs. The data suggest that covering the new class of weight loss drugs can be part of a data-driven wellbeing strategy that produces a positive return on investment for the employer. The payoff for reduced obesity rates can also be found in improved workplace productivity, employee happiness, and reduced disability, workers’ compensation and various other medical costs; all elements of a comprehensive population health management initiative.
A Guide to Decision-Making
To cover or not to cover? The decision starts with a review of current plan coverage rules for weight loss products, ensuring documentation as to whether they are excluded, covered or covered with mandatory clinical review and integration with lifestyle improvement programs that include behavioral counseling, physical activity and nutrition support.
From there, information should be gathered from the pharmacy program administrator on two fronts:
- Coverage rules. It’s key to discover how clinical appropriateness is determined and effectiveness is measured and monitored. The administrator should answer questions about the rules governing coverage, which, if any, GLP-1 medications are already covered, and how plan sponsors should weigh adding coverage to the plan. They also should dig into such other issues as the clinical criteria for coverage, whether prior authorization is required, and whether coverage can be tied to lifestyle management.
- Cost reporting. It’s also important to compare year-to-year costs for covering the weight loss category overall along with the costs of GLP-1 medications for diabetes. Average cost per prescription is also important, as is the brand discount and guaranteed minimum rebate for weight loss drugs.
Best Practices for Moving Forward
The insurance market and risk management solutions are evolving, and a client-specific, vendor-specific approach is required if you want to take a more balanced approach to improving the wellbeing of people who are obese. Still, goals and best practices should include reviewing key data, setting objectives, reviewing options and setting up reporting to measure and monitor success.
Following are five essential best practices will stand employers in good stead:
- Prescription drug coverage decisions should be designed to support employee wellness and health overall – including achieving and maintaining a healthier weight.
- Clearly documenting coverage of weight loss drugs will set expectations of the extent to which the plan versus the employee pays for GLP-1 drugs.
- Remember, behind every prescription request is a person who doesn’t want to be obese. Consider linking drug coverage to participation in lifestyle management coaching/programs that are designed to support long-term success.
- Coordinate with the program administrator to tie weight loss progress assessments with approval durations for these drugs.
- Evaluate the success of your efforts to improve health and lower cost by tracking medical and pharmacy utilization trends related to weight loss and associated co-morbidities such as diabetes and musculoskeletal challenges.
About the Author
Philip Swayze is the Vice President of Health & Performance for global insurance brokerage HUB International’s East Region. In this role, he provides strategic wellbeing consulting support to HUB clients from Maine to Maryland. He works closely with the HUB Employee Benefits Team, and other Health & Performance Consultants on client program design and implementation. Philip is one of the four leaders of HUB’s National Health & Performance practice.
Prior to working with HUB, Philip managed his own wellness consulting and strategic marketing practice. He has more than 20 years of experience working in consulting, sales, product development, marketing, and communications within the healthcare field. Over the years, he has worked for HealthNEXT, Abacus Health Solutions, Plus One Health Management, The Health & Wellness Institute, Blue Cross & Blue Shield of Rhode Island and PR firm, Manning, Selvage & Lee.
Philip stays active in the health and well-being field through his work with the Health Enhancement Research Organization (HERO) where he has been a Think Tank member for the past 15 years. He is the co-chair of the Mental Health Workgroup, an Executive Steering Committee Member for the Small-Mid Size Employee Wellbeing Workgroup and a contributing member to the Employee Experience Workgroup. Philip is also an award-winning volunteer, Board Member and Programs Committee Co-Chair with the Worksite Wellness Council of Massachusetts.
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