It is possible for employers to balance anti-obesity GLP-1s access with costs

The skyrocketing popularity of pricey new anti-obesity drugs puts employers in a bind. They must decide whether to broadly cover GLP-1s for everyone who qualifies or limit that coverage. Some even consider shutting off access to the life-changing drugs completely. But that would be a mistake. Cutting GLP-1s from the formulary isn't the answer to curbing obesity costs.

Obesity is a disease
For one, it's unethical and even medically irresponsible to deny obesity treatment. Obesity isn't a trivial cosmetic issue; it's a disease — and was designated as such by the American Medical Association over ten years ago. Valued employees deserve top medical care that includes clinically validated obesity treatments like GLP-1s. If employers don't cover the care people deserve, those employees will be motivated to find coverage elsewhere. After all, many companies and plans now cover GLP-1s for treating obesity.

Secondly, it's tough to say how much money (if any) employers save by denying obesity treatment. Obesity is an expensive condition. Its downstream effects cost the U.S. economy over a trillion dollars annually. Without treatment, people with obesity are more likely to develop diabetes, heart disease, cancer, back pain, and many other expensive conditions, racking up costs in emergency room visits, inpatient visits, outpatient visits, disability, and absenteeism. 

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The health equity question
Obesity expenses compound exponentially — especially when you consider how quickly the condition is growing in the U.S. and across some segments faster than others. Experts predict that 50% of U.S. adults will have obesity by 2030, and one in four will have severe obesity, with higher rates in marginalized communities. Black and Hispanic Americans are 1.3 times and 1.2 times, respectively, more likely to have obesity than non-Hispanic whites. States with 35% of people living in poverty have 145% more people with obesity compared with wealthier states. 

We risk exacerbating those inequities even further if employers don't offer more coverage for GLP-1s. Already, prescriptions for Ozempic and Wegovy show up more frequently in wealthier and healthier enclaves of the country —  soon accessible at upscale gyms. If only the most affluent, who already have many social determinants of health in their favor, can afford these new weight loss medications, where will that leave the rest of us? There has to be a more equitable way to approach coverage.

Read more:  Employees want weight loss drugs Ozempic and Wegovy. Can employers afford them?

Obesity management solutions offer access and affordability
Before plan sponsors jump to slashing GLP-1s from the formulary, they should consider more innovative tactics like partnering with health tech. Some obesity management solutions are coming to the market that offer a middle path. They provide a smooth prior authorization process for employers and providers that mitigates cost trends while delivering equitable, evidence-based access and care to employees. 

Cost-effective obesity management solutions use "obesity step therapy," which involves starting with nutritional and behavioral support before trying less costly anti-obesity medications and "stepping up" to more potent GLP-1s for a smaller percentage of people who need them. These solutions help pair the right care with the right patient at the right time. 

Rather than relying on infrequent primary care physician (PCP) appointments to prescribe pricey anti-obesity medications and manage the accompanying side effects, obesity management solutions offer care teams made up of registered dietitians, health coaches, and prescribing physicians to coordinate care and fully support people day in and day out — between those episodic PCP appointments. 

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Behavior change is foundational to treatment
Employers are right to be wary of opening the floodgates to pricey GLP-1s for their populations.  Only in rare cases should we use GLP-1s as a first-line treatment for obesity. They're potent drugs that come with significant side effects. They really should only be carefully prescribed alongside robust behavioral change support. 

In fact, the FDA only approves the use of GLP-1s when prescribed alongside intensive lifestyle interventions, including calorie reduction and increased physical activity. The behavior change component is a big reason why obesity management solutions are becoming so popular. Their on-staff registered dietitians can deliver medical nutrition therapy — or personalized nutrition care plans — alongside the drugs to help people lose weight safely and sustainably.

What's best for your bottom line
There's no question that employers want what's best for their people. And they want what's best for their bottom line. But those inclinations don't need to be mutually exclusive. The market is moving towards innovative, flexible options that allow employers to build around their populations' changing needs. Obesity management solutions founded in nutritional and behavioral change support that use step therapy when prescribing anti-obesity drugs offer employers a way to provide comprehensive, clinical care to their people while containing costs.