Employer Considerations: Weight Loss Medications and Pharmacy Benefits
Weight loss has always been a hot topic of conversation. It seems like everywhere you turn people are trying to lose weight and make healthier decisions. As part of this, some people look to weight loss medications. But, is this really the way to go? Maybe, maybe not.
In the U.S. 42 percent of adults are considered obese (having a Body Mass Index [BMI] greater than 30 as defined by the Centers for Disease Control and Prevention [CDC]). By 2030, that number is projected to rise to 50 percent (1 in 2 U.S. adults).
So, what’d I’d like to talk about are the medications available, why there’s so much focus on them right now, and what you as employers should consider when determining the pharmacy benefits you offer.
When Did the ‘Hype’ Begin?
In 2005, a class of medications called glucagon-like peptide 1 (GLP-1) agonists hit the market for the treatment of Type 2 diabetes. These drugs mimic the action of a hormone called GLP-1, which works by reducing appetite and feelings of hunger, slowing the release of food from the stomach, and increasing feelings of fullness after eating.
Since then, nine GLP-1 medications have come to market. Due to the recent celebrity endorsements and media coverage, you likely have heard of Ozempic and Wegovy (both semaglutides).
Ozempic was approved in 2017 for the treatment of Type 2 diabetes, while Wegovy was approved in 2021 for chronic weight management. However, of the 9 GLP-1s available, only two products have been FDA-approved for weight loss — Wegovy and Saxenda — both Novo Nordisk products. These products are relatively expensive, costing approximately $15-$17k per patient per year.
Later this year, Eli Lilly’s product, Mounjaro, is anticipating FDA approval for weight loss, which in combination with a pipeline of competitor products expected to hit the marketplace over the next few years, should bring competition in this therapy class. So, not only are drug manufacturers looking to produce the best medication but, more importantly, they’re looking to obtain the highly coveted “covered” status by health plan sponsors.
Do These Weight Loss Medications Work?
Studies have found people using these semaglutide medications and making lifestyle changes lost about 33.7 pounds (15.3 kilograms) versus 5.7 pounds (2.6 kilograms) in those who didn’t use the drug.
Most weight loss medications are intended to be used along with diet and exercise and are meant for children >12 and adults with BMIs >30.
Here is the thing, though. Some of the medications used for weight loss have some unpleasant side effects, and patients who take them may be on them for the long haul as stopping will make their appetite and the previously lost weight return.
Why All the Buzz Around These Medications?
A growing number of off-label prescriptions use the newest treatments for Type 2 diabetes (GLP-1s) for weight loss.
According to an article published by RXBenefits, celebrity promotion, social media trends, direct-to-consumer advertising, and growing telehealth platforms have taught Americans that medications like Ozempic and Mounjaro can be used for weight loss. And the demand for these medications has grown exponentially in a short amount of time.
Since going viral, these diabetes treatments are flying off the shelves as people flock to physicians looking for off-label prescriptions in hopes of achieving fast weight loss results.
What Is Off-Label Prescribing?
Off-label prescribing occurs when a healthcare provider prescribes an FDA-approved medication to treat a disease or medical condition not included in the FDA approval. It isn’t uncommon for a medication to be used off-label, as no laws say that a provider can’t prescribe in that way. In fact, more than one in five outpatient prescriptions written in the U.S. are for off-label therapies.
Using Ozempic, a diabetes management drug, for weight loss is an example of off-label prescribing, as it is only approved for Type 2 diabetes management. Most of the time, Ozempic will be a covered medication under the pharmacy benefit, but if a plan sponsor doesn’t have the right kind of use management in place, any of their members could get Ozempic, whether it be for Type 2 diabetes or weight loss.
What Do Employers Need to Consider about Weight Loss Medications?
So, as a plan sponsor, what do you need to consider when it comes to offering weight loss medications through the pharmacy benefit plans you offer your employees? Here are a few thoughts:
- Move from a traditional pharmacy benefit manager (PBM) to an acquisition cost-plus PBM.
- Consider a Carve-Out solution to your PBM’s standard offering.
- Consider prior-authorization and utilization management criteria that serves your needs.
- Consider coverage as an employee retention and talent attraction tool.
Additionally, a non-negotiable, in our opinion, is that this type of pharmaceutical support should be offered in combination with lifestyle/behavior support. The medication alone will not be the long-term cure; it has to be coupled with behavior change. This behavior support can be provided through a proven weigh-management vendor, connection with a registered dietitian, or following the research.
Need help connecting to these resources or implementing custom solutions? We have experts on hand in both the Pharmacy space as well as the Clinical Wellbeing space, and we’d love to sit down and talk with you about what you need for your employee population. Contact us today!
Published on: 06.29.23