How to Make Weight Loss Drugs a Part of Employee Wellness

Over the last decade, the U.S. Food and Drug Administration has approved five drugs to treat obesity, and certain medications originally approved to treat diabetes have been approved to help facilitate weight loss and management.

These drugs are expensive, costing as much as $1,400 a month, and necessitate long-term dosing. However, the costs of obesity are enormous: Up to half of new diabetes cases in the U.S. are linked to obesity,¹ and obesity costs the health care system nearly $173 billion annually.²

It raises the question of whether employer health plan sponsors should cover this new class of drugs to treat obesity.

The then-and-now of weight loss drugs

The new medications, called GLP-1 agonists,³ appear to produce better long-term results than earlier medications with greater safety.

With appropriate management, these weight loss drugs can help support employee wellness programs and produce a positive return on investment for the health plan. The payoff for reduced obesity rates is not only reduced long-term medical expenses, but in improved workplace productivity and reduced disability and workers’ compensation insurance costs.

Deciding whether to cover weight-loss drugs

Health plan sponsors with a review of current plan coverage rules for weight loss products, inquiring with the pharmacy program administrator on the following:

• Coverage rules. The administrator will answer questions about rules governing coverage, including whether GLP-1 drugs are already covered or excluded; if they are covered with mandatory clinical review; what’s the clinical criteria for coverage; whether prior authorization is required and if coverage can be tied to participation in a wellness program.

• Cost reporting. Get year-to-year costs for covering the weight loss category overall as well as for GLP-1 meds for diabetes. Knowing the average cost per prescription is also important, as is the brand discount and guaranteed minimum rebate for weight loss drugs.

Set objectives for the strategy moving forward

Goals and best practices should include setting objectives, reviewing options and setting up reporting to measure and monitor success.

To do so, consider the following best practices:

• Base prescription drug coverage decisions on maximizing employee wellness and health.
• Document coverage of weight loss drugs to set employee expectations about what they will pay for GLP-1 drugs.
• Tie prescription drug coverage to incentives or participation in programs designed to support long-term success.
• Track weight-loss progress assessments against approval durations for GLP-1 medications.
• Monitor claims to track utilization, trend and spending on weight loss and diabetes drugs with potential for off-label use.

HUB International’s team of consultants can help you manage the issues facing benefits programs, including the rising costs of specialty drugs.

¹ American Heart Association, “Up to half of new diabetes cases in the U.S. linked to obesity,” February 10, 2021.
² Centers for Disease Control and Prevention, “Overweight and Obesity,” July 14, 2022.
³ Mayo Clinic, “GLP-1 agonists: Diabetes drugs and weight loss,” accessed on January 18, 2023.