A Heavy Issue
As renewal season approaches, employers are reexamining their health insurance options, with a significant focus on GLP-1 coverage. The popularity of GLP-1 medications is surging, fueled by extensive media attention on their weight-loss benefits.
While these drugs are often seen as a quick solution, there is a significant amount of misinformation about their appropriate use, potential side effects, and long-term implications. Employers must carefully decide whether to initiate or continue GLP-1 coverage for obesity, and they must also provide their workforce with comprehensive education on proper usage. This includes understanding when to start the medication, ensuring clinical support during treatment, and managing the discontinuation process.
FDA Guidelines
Obesity is associated with various health issues, including diabetes, heart disease, stroke, and certain cancers. GLP-1s may help reduce these obesity-related risks. Furthermore, these medications are being investigated for potential benefits in treating other conditions such as Alzheimer’s, liver and kidney diseases, and addictions. For instance, Wegovy, introduced in 2021 for obesity, recently received FDA approval for reducing major cardiovascular events in obese patients with heart conditions.
Due to the evolving use of GLP-1s, it is crucial to follow the latest FDA guidelines. These drugs should only be prescribed for weight loss to clinically obese patients with a BMI of 30 or higher, or 27 with specific co-morbidities.
Adhering to FDA guidelines and avoiding off-label use helps protect individual health and ensures employers’ investments in their pharmacy benefits are safeguarded. While these medications can be cost-effective, off-label use may expose employees to various known and unknown health risks.
Balancing Act: Weighing Benefits and Costs
Without employer coverage, GLP-1 medications can cost individuals around $1,000 per month. Although this initial cost is high, effective weight loss can inspire employees towards healthier lifestyles and potentially reduce long-term healthcare costs for employers.
Providing GLP-1 coverage also boosts employee satisfaction and retention. A 2023 study revealed that companies offering GLP-1 medications in their benefits plans experienced higher employee satisfaction. Consequently, 99% of employers currently covering GLP-1 drugs plan to continue this coverage next year, demonstrating their commitment to employee wellness.
Strategy
Implementing GLP-1 coverage within a pharmacy benefits plan requires a holistic strategy:
- Eligibility: Conduct thorough evaluations to confirm employees’ eligibility for GLP-1s, utilizing prior authorization programs that consider BMI and physician assessments. For those not eligible, refer them to alternative wellness benefits, including lifestyle, nutrition, and behavioral health support. Many third-party programs offer these services alongside GLP-1 prescriptions, often requiring participation in these programs before starting GLP-1s, which increases the likelihood of long-term success.
- Monitoring: Employers should track employees’ use of GLP-1s to ensure they are taken as prescribed, achieving the desired weight loss, and not causing severe side effects. While GLP-1s are generally well-tolerated, any severe side effects should be thoroughly reviewed with the patient and clinician before and during treatment. Third-party vendors or pharmacy benefit managers can enhance the monitoring and education process, helping employers manage costs while fostering a supportive environment for employees.
- Discontinuation: Recognize that FDA guidelines classify GLP-1s for weight loss as maintenance drugs. Employees may eventually need to discontinue the medication. This transition should be carefully managed, with continued engagement in wellness programs to maintain weight loss. Studies indicate that most patients regain weight within a year of stopping treatment, underscoring the importance of ongoing support.
By adopting this comprehensive approach, employers can effectively address obesity and improve employee health through GLP-1 coverage. Offering these medications, along with educational and clinical support through vendor programs, can enhance employee satisfaction and retention while promoting a healthier lifestyle.
