Employee Benefits

Five Things to Know About GLP-1s

What employers need to know about GLP-1 drugs for weight loss.

May 18, 2023

Consumers looking to medications to solve obesity issues

Although heart disease and stroke remain the leading causes of death in the United States, the topic of overweight and obesity has received a lot of attention recently. One emerging approach to weight management involves the use of medications traditionally prescribed for Type II diabetes as a weight management tool. Social media influencers, including Remi Bader, Michael Rubin, and Elon Musk, have helped raise awareness and generate interest in this approach. Specifically, a class of drugs known as GLP-1s has shown promising results for weight loss, with many participants losing 5-15% of their body weight in a year (although the extent of weight loss can depend on factors such as patient obesity and medication dosage). An evidence-based review of these medications found that FDA-approved drugs do promote weight loss when compared to lifestyle changes alone.

FDA-approved drugs to promote weight loss

The medications do require a prescription and are typically administered through a self-injection pen on a daily or weekly basis. It is important to note that the FDA approval for these medications is specific to chronic weight management in individuals with at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol. The medication is intended to complement a reduced calorie diet and increased physical activity. The medications work by mimicking a hormone that targets areas of the brain responsible for regulating appetite. However, as with all medications, there are potential side effects to consider, and a medical consultation is necessary to determine whether the benefits outweigh the risks. Research suggests that weight regain is likely once an individual stops taking the GLP-agonist, and there is limited research on the long-term effects of these medications.

Implications for Employers

As the buzz and interest around these medications grows, employers may begin receiving questions or even requests to have the medications covered under medical plan benefits. Currently, most fully insured medical plans and self-funded plans exclude coverage for weight loss medications. This raises the question of whether these medications should be covered for certain populations, such as adolescents or younger adults, to help manage weight early on and prevent or offset obesity later in life. Preventing obesity at a younger age can also reduce the risk of comorbidities and complications associated with related conditions. By expanding access to these medications, we may be able to address obesity earlier and improve long-term health outcomes.

These drugs rank fourth in total drug expenditures in the U.S., with a total of $10.7 billion spent in 2021. This represents an increase of over 90% from the previous year, according to a study published in the American Journal of Health-System Pharmacy. The list price of these medications is estimated to be $1,000 or more per package, with either daily or weekly self-administered injections required. While these medications have the potential to drive up insurance premiums for both employers and their workers, the costs associated with obesity are also substantial. The CDC estimates that medical costs for adults with obesity are $1,861 higher than for adults at a healthy weight. Given the potential size of the market and the high per-person costs, the total costs associated with these medications are significant.

While weight loss medications may offer a middle ground between lifestyle changes and surgical interventions, they should be approached with caution. According to Dr. W. Scott Butsch, MD, an obesity medicine specialist, weight loss achieved with these medications may not be maintained once the medication is discontinued. As such, these medications are intended for long-term, chronic use to manage obesity. Moreover, these medications should only be prescribed by healthcare providers who specialize in obesity management and can offer appropriate, non-judgmental care. It's important to recognize that chronic obesity is a disease that requires ongoing treatment, much like other chronic conditions.

Five important things you need to know about GLP-1s for yourself and your employees:

1. GLP-1s are a class of medications used to treat type II diabetes and weight loss.

The main differences are how they were approved by the FDA and the dosage of each medication.

2. While the results from the GLP-1 clinical weight loss trials are notable, it’s important to note that these studies included 150 minutes of exercise per week and a restricted caloric diet alongside the medications.

3. GLP-1s can have potential risks and are not always tolerated well.

Side effects and risks may include nausea, vomiting, and other drug interactions.

4. Working with a clinical pharmacist and having a medication review will help eliminate unnecessary medication use of other diabetes medications, offsetting the financial impact for the plan.

5. If using GLP-1s for weight loss, these medications should be combined with a weight loss program to ensure long-lasting behavior change; taking the medication alone will most likely not results in sustainable weight loss.