Webinar Recap: What Employers Need to Know About Weight Loss Medications

Obesity rates continue to rise in the United States, now affecting nearly 42% of the adult population. GLP-1 medications have become a coveted solution for chronic weight management, but how do employers navigate the rising popularity of these medications?

With this in mind, we invited Beckie Fenrick, Pharm D from AlignRX Consulting to shed light on what employers need to know about the effects of GLP-1s in our recent Health Risk Management webinar.

Continue reading for a recap of Fenrick’s presentation.

Obesity in the United States

According to Fenrick, obesity continues to increase in the United States due to several factors:

• The introduction of high fructose corn syrup in food products.
• The increase of sedentary lifestyles.
• The increased consumption of processed foods which contain more salt and sweeteners.

There are many health conditions associated with obesity, including:

• Stroke
• Breast Cancer
• Coronary Heart Disease
• Gallbladder Disease
• Alzheimer’s or Vascular Dementia
• Osteoarthritis
• Chronic Back Pain
• Diabetes, Type 2
• Hypertension

According to Fenrick, because obesity often leads to additional health issues, obese team members cost employers about 2.7% more in health insurance costs than those who are not.

What are GLP-1s?

GLP-1 medications work by mimicking a naturally occurring substance in our bodies called Glucagon-like peptide (GLP-1). GLP-1s were initially approved solely to manage Type 2 Diabetes; however, more recently, a few GLP-1s have been approved by the FDA for chronic weight management.

Due to an uptick in direct-to-consumer advertising, celebrity testimonials, social media influencer promotions, recent studies, and updated diabetes treatment guidelines, GLP-1s are becoming increasingly popular for diabetes and weight loss treatment.

In fact, an encouraging new study found that the GLP-1 Wegovy cut the risk of cardiac death, heart attack, or stroke by 20% compared to the placebo. This positive data will substantially increase the demand for GLP-1 medications.

According to Fenrick, there are 10 GLP-1s available on the market today, three of which are approved by the FDA for weight loss: Wegovy, Saxenda, and Zepbound. The other seven GLP-1s, with the most well-known being Ozempic, are approved by the FDA for diabetes care only.

GLP-1 Utilization Management Strategies

According to Fenrick, employers and plans shoulder a substantial portion of obesity-related expenses. A 2021 Kaiser Family Foundation analysis found the average annual health spending for enrollees with an onsite diagnosis was $12,588, compared to $4,699 for those with no obesity diagnosis.

If the decision is made to cover GLP-1s, Fenrick recommended keeping the following utilization management strategies in mind:

• Many plan sponsors exclude coverage for weight loss. If a plan sponsor does exclude coverage, prior authorization criteria should ensure GLP-1s are being used for diabetes.
• If a plan sponsor covers weight loss treatments, coverage should be limited to those GLP-1s approved for weight loss. Prior authorization criteria should limit use to individuals who are obese or overweight and have additional risk factors.
• Authorization should be limited to a specific period and require pre-approval to ensure the medication continues to benefit the individual.

GLP-1 Cost and Coverage Strategies

If the decision is made to offer GLP-1 medications, Fenrick recommends employers also offer lifestyle management programs to supplement the medication. This way, the employee is learning how to implement better health and lifestyle habits for when they are no longer taking the medication.

Fenrick also encouraged the following solutions to help balance costs:

• Utilize a pass-through pharmacy benefits manager (PBM), which may be more incented to help lower costs.
• Consider a point-of-sale check that requires an approved diagnosis code.
• Consider international filling programs with potentially lower costs for employers by sourcing their drugs through global markets.
• Partner with a PBM that supports manufacturer copay assistance programs. Depending on the program, they can lower costs for both members and plan sponsors.

About the Webinar

This presentation was part of Captive Resources’ Medical Stop Loss Webinar Series — regular installments of webinars to educate medical stop loss group captive members. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect Captive Resources’ positions on any of the above topics.