The growing obesity crisis in the United States is driving a host of debilitating and costly chronic conditions, including premature death. With working-age Americans having the highest obesity rates in the country, employers are now feeling pressure to fund pricey new weight loss drugs that promise a fast and easy track to a healthier population.
Escaping the buzz around “GLP-1s” (glucagon-like peptides), known under their brand names of Wegovy®, Saxenda® and Zepbound™, is impossible given the bombardment of ads, celebrities touting their transformative effect and even South Park offering a wildly satirical take on weight loss medications called the “The End of Obesity.”
But obesity is a serious disease. In the workplace, it increases health plan and workers’ compensation costs as well as absenteeism due to chronic conditions such as high blood pressure and type 2 diabetes. Since data estimate upwards of 45 percent of an employer’s adult health plan population meet criteria for a weight loss drug prescription, these expensive new medications have created a conundrum.
Some companies are now facing employee questions/demands to cover new weight loss medications, fueled by media, and heightened by direct marketing to consumers, providers, and employers. Employers that opted to cover them quickly found these drugs soared to their top five most expensive pharmacy plan costs within 90 days of initiating coverage.
Growing evidence, however, indicates roughly two-thirds of patients discontinue these expensive medications within one year. With approximately 75 percent of the total addressable market (TAM) for the GLP-1 pipeline existing within the commercially insured space, this should signal to employers the need to plan ahead.
GLP-1 medications cost as much as $14,000 to $16,000 annually, and discontinuing treatment can mean lost investment for employers and regained weight for employees. Drug manufacturers’ own clinical trials show that discontinuing treatment can result in a rapid return of the weight.
While early discontinuation of the medications happens for various reasons, including supply chain issues, lack of behavioral changes, cost, and intolerable side effects, demand continues to rise.
J.P. Morgan Research predicts the GLP-1 market will exceed $100 billion by 2030, with roughly 30 million users in the U.S. alone. As more indication approvals happen, coupled with mounting pressure from clinicians and advocacy groups, employer health plan coverage of weight loss medications, for at least some indications, will soon become standard.
While these new weight loss medications are options in the health journey of Americans struggling with obesity, their ultimate benefit remains an open question as sustained use is required to measure their long-term effects. And, with limited longer-term data available, there is still much we don’t know about their potential side effects.
But clearly, GLP-1s have transcended fad. Manufacturers are winning expanded uses from the FDA, which recently granted Wegovy approval as a treatment to reduce subsequent cardiovascular risk among adults without diabetes who are overweight and who previously suffered a major cardiovascular event, including heart attack and stroke. It was the first approval of its kind.
Employers not currently covering GLP-1s beyond diabetes treatment should be planning now to ensure responsible utilization and cost-effectiveness when broader coverage is required. To prepare, here are some considerations:
- Implement a fully integrated utilization management and lifestyle intervention program to ensure appropriate medication use and successful, sustained weight loss for the employees who will benefit most.
- Engage your PBM to learn what options are available to medically manage the medications. Also, ask your PBM to provide the percentage of patients still using the medications after a year. This insight will signal if it’s time for a course correction on coverage.
- Be wary of vendors touting behavioral and/or dietary modification tactics that lead to de-prescribing as their big differentiator as these medications are intended for ongoing use to maintain weight loss benefits. To our knowledge, there are no long-term studies – beyond two years – specific to these medications that support de-prescribing as a broad-brush approach to weight management.
- As these products gain additional indications, they may cease to be considered for weight loss only and may merit coverage consideration as their potential list of FDA-approved treatments grows.
Healthy weight loss is a journey, not a destination. These medications are neither a primary nor a solitary therapy. Lifestyle intervention programs are critical to successful adherence. One without the other will invariably lead to more discontinuation, and lost investment for employers.
Dr. Shealynn Buck, MD is the Chief Medical Officer for Lockton Companies. Robert Kordella, RPh is Chief Clinical Officer for Lockton Pharmacy Consulting.
