Obesity is complicated: How best to cover, or not cover, the new weight loss drugs

This seems like a golden age for those struggling with weight. The arrival of Ozempic, Wegovy, and other GLP-1 agonists is offering hope where there was none. It’s also presenting employers across our country with a tough decision: how best to cover, or not to cover, such high-demand, high-cost drugs/?

The headlines make it all sound so simple, an easy “yes, definitely,” but the best counsel is actually to take a beat and zoom out. Before handing over the syringe, companies debating whether or not to cover for these medications should study the big picture first, and look at the facts as we know them.

 For a huge swath of the US population, about 40% of us, there now exists a therapeutic approach outside of surgery that could make life remarkably better. It could help people achieve a lower body mass index (BMI), live healthier and happier, and, to the benefit of their workplace, perhaps even more productively. That’s the big picture. Now for some of the facts.

On the upside, clinical studies have demonstrated 5%-15% weight loss on average in patients using the medication as directed and in the setting of comprehensive support for weight loss. For those patients who do experience weight loss, there is evidence that medical conditions associated with obesity such as diabetes, fatty liver disease, high cholesterol, and hypertension also improve.

On the downside, these drugs do all this at huge cost. They are priced at as much as $1,000 or more per person per month and must be used for life. Multiply that by the 100-135 million Americans who will qualify for these drugs, and it adds up. Preliminary modeling shows that at current prices, coverage of these drugs could conservatively drive employer spend up by 25% annually.

Also, the medication’s side effects, which leave some feeling a profound full-ness, nausea, and more, may lead some to discontinue the treatment. Yet, however they feel, not all people respond to GLP-1 agonists. That 5-15% mentioned earlier was the average weight loss at 6-12 months across a number of clinical trials. A few studies showed weight loss up to 20% in some people. But studies have also shown that a significant percentage of people may not achieve even 5% weight loss. Clinical decisions must account for situations where these medicines don’t result in a significant benefit, as well as when they do.

So yes, covering these drugs may offer companies the chance to radically change and improve the health of their employees, and the health of our country. Or not. It depends on how the drugs are utilized. To give these medications the best opportunity to have the best effect, employers must think comprehensively and long-term.

Related: Despite high prices, covering effective weight-loss drugs may save money in long run

Employers should resist an over-rotation to serve up isolated point solutions, as the new multitude of pop-up pill-and-shot providers would suggest. Like any health issue, weight is multi-faceted and best treated as a multidimensional issue. It’s not just about whether you buy the Ben & Jerry’s, or take a pill or a shot. For weight loss to be successful, healthy, and sustainable, it must incorporate dietary education and lifestyle changes, calling upon multi-disciplinary support and a diverse set of solutions, including meds as needed. Our health is dependent on more than just the amount of calories we eat. It also depends on the quality and nutritional value of those calories.

Employers should remember this is bigger than an immediate drug discussion or decision alone, especially when we don’t have long-term data on drug performance. This has to be about longitudinal care with a trusted clinician which is vital for long-term success, especially in situations where new medications are used as part of an overall management strategy. The GLP-1 agonists, specifically, are life-long medications and, like all long-term medications, require ongoing monitoring and vigilance.

 Weight was once, wrongly, treated as a moral issue and now it’s becoming a medical one. It’s even more than that. Obesity is a complex condition involving the interplay of physiologic, cultural, societal, and psychological elements. Medical treatment is important, of course. But addressing the broader factors is the only way to make this a real golden age for millions. Tackling issues of the local and industrial food supply chain, public policy relating to food and nutrition, accessibility of affordable healthy foods, socioeconomic inequities leading to the diminished general health of populations, and cultural norms around food must also play a role in addressing this public health issue.

A pill or shot alone can’t change all that.

Todd Thames, M.D. is a board-certified family physician and Vice President of Clinical Affairs at Included Health.