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The growing obesity crisis in the United States has fostered a host of debilitating and costly chronic conditions, and even 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 track to a healthier population.
Obesity in the workplace 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 the 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 health plan costs within 90 days of initiating coverage, according to Lockton’s data.
Escaping the buzz around “GLP-1s” (glucagon-like peptides), better known under their brand names of Wegovy, Saxenda, and Zepbound, is impossible given the bombardment of ads and celebrities touting their transformative effect.
The reality is the benefit of these new weight loss drugs in the health journey of Americans struggling with obesity 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 the quest for fast fixes to lose weight isn’t new, nor is repurposing of drugs used for treating other issues that offer weight reduction as a side effect. Unlike diet pills that acted to suppress the appetite, these new drugs slow the passage of food through the digestive system and reduce food cravings.
While they are a welcomed option to the toolkit to reduce obesity and related chronic illnesses, they’re not a panacea. Any effective treatment plan needs to address biology and behavior simultaneously.
Here are some considerations for assessing coverage of new weight loss drugs:
Commercially insured Americans are the focus. Approximately 75 percent of the total addressable market (TAM) for the weight loss drug pipeline exists within the commercially insured space, according to a recent Goldman Sachs analysis
Drug manufacturers are directly appealing to employers to cover these drugs (https://www.novonordiskworks.com/ (opens a new window))
Read behind the hype: News stories touting weight loss drugs reducing major adverse cardiovascular events, like heart attacks and strokes, don’t tell employers the full story related to their insured population. Real-world users of new weight loss drugs tend to be females in their 30s to mid-40s with no previous history of heart or vascular disease. Conversely, participants in the study behind the headlines were in their 60s, had previous history of heart attack, stroke, or peripheral vascular disease, and just under 30 percent were female. So, more research is needed before concluding the efficacy of these new drugs in preventing heart and vascular disease in the broader population with obesity.
To spend or not: Drug manufacturers’ own research shows that when someone discontinues these medications, their weight quickly returns to the unhealthy range. Real-world data, including our own, indicates 60 to 80 percent of users abandon them in the first year. Any health benefit and positive return on investment are likely lost.
Why the fast abandonment? Our data indicates potentially unmanageable side effects in those using weight loss drugs, causing an increased use in anti-nausea drugs and emergency room visits. This, coupled with reports of severe stomach and intestinal problems, raises questions about the sustained risk-benefit of these new weight loss drugs. Answers require more data.
Employers should keep in mind that these new weight loss drugs are intended to be an adjunct to lifestyle modification, not a primary therapy without supporting intervention. Recently, programs have launched coupling the new drugs with lifestyle changes and support. This change may provide a road map to the healthier population these new weight loss drugs portend.