Employer’s guide to navigating weight-loss medication coverage as market soars

The demand for weight-loss medications has seen an unprecedented surge in the last year, fueled by rising obesity rates and the growing popularity of GLP-1s like Zepbound and Wegovy. According to data from the CDC, obesity currently affects 4 out of 10 Americans – and, even more striking, by 2030, the obesity rate among U.S. adults is expected to surpass 50% in 29 states.

As awareness of obesity-related health risks and the available solutions to address them grows, employees are increasingly seeking comprehensive obesity and weight health care benefits, including employer-sponsored access to weight-loss medications. Per research from Tebra, 52% of professionals want weight-loss drugs covered in their health benefits – with 1 in 16 saying they would be willing to forgo vacation days in exchange for employers meeting this demand.

Currently, only 25% of employers offer such benefits, primarily due to the high costs associated with coverage of these medications, which averages around $9,000 annually after discounts and rebates. However, with the FDA’s approval of certain GLP-1s and rising demands from employees for their coverage, organizations are being forced to make a tough decision: to withhold access to quality treatment or absorb a hit to their bottom line due to the drugs’ exorbitant costs and lack of ROI visibility.

Thankfully, there are pathways for employers to forge a mutually advantageous solution by providing a variety of options within their financial capabilities that range from less-intensive to more intensive options. This starts with implementing a science-backed and proven behavioral lifestyle program as the foundation that can deliver sustained results and positively change lives. From there, if an employee medically qualifies, employers could provide a wide formulary of weight management medications that are safe and effective at a range of costs that are scalable. As employers explore which strategy is right for them, they should consider the following:

The value of personalized behavior change programs

Personalized behavior change programs represent a strategic investment for employers aiming to implement cost-effective weight management initiatives and make a positive impact on their employees’ lives.

Behavior change programs offer a holistic framework that tailors interventions to the unique needs of each employee and targets underlying behavioral and lifestyle factors that contribute to weight gain, such as nutrition habits, sleep and physical activity levels. Programs also incorporate support mechanisms like online nutrition resources, coaching and skill-building.

For example, diabetes programs empower individuals living with diabetes by offering tailored support to cultivate and sustain healthy habits that align with their unique needs, like foods that are less likely to raise blood sugar, and lifestyle preferences. Clinical trial results from the WeightWatchers Diabetes Program demonstrate the effectiveness of tailored lifestyle and behavior changes for the growing population of people living with diabetes.

In a 2023 WeightWatchers study, when empowered with lifestyle support mechanisms–including food plans, weekly virtual workshops, community support and digital support via channels like mobile apps–program participants reported that living with their diabetes was easier.* In fact, 85% said the program lowered their risk of health conditions, while 81% said it helped them lose weight and improve their diabetes. The program produced a 5.7% reduction in weight, a 0.75 reduction in A1c and a 9.8% decrease in diabetes distress (based on a 6-month multicenter study). By integrating such support and aiding employees in addressing weight-health issues early on, employers can positively influence employee health – regardless of whether individuals are at a diabetic stage – while also maximizing their investment in medication coverage and reducing long-term health care costs.

Beyond the reduced costs in comparison to clinical interventions, behavior change programs allow employers to create a culture of health in the workplace. Research from the CDC shows that workplace programs can boost productivity and normal weight employees experience lower levels of absenteeism due to illness.

Implementing utilization controls for weight-loss medications

A one-size-fits-all approach rarely yields successful results. Not only that, but for those living with obesity, they are dealing with a chronic condition that requires a spectrum of solutions depending on the severity and context through one’s lifetime. What may work for one person may not work for another – and employers must keep this in mind as they build out their obesity care benefits.

For those living with obesity, GLP-1s have proven to be a very effective tool in achieving positive weight and cardiovascular health outcomes, and because of this, they have taken the world by storm. According to KFF data, about 7 in 10 adults have heard at least “a little” about weight-loss drugs, with about 19% saying they have heard “a lot” about these drugs. However, just because this new class of drugs is garnering an increased amount of attention does not mean they should necessarily be the first resort.

Medication needs vary from person to person, both in efficacy and price. Therefore, employers may decide to implement a step therapy approach, in which employees are gradually guided through a series of interventions, beginning with less intensive and lower cost weight-loss treatment options like medications such as topiramate, bupropion or metformin, and progressing to more intensive interventions like GLP-1s or bariatric surgery, only if necessary. This allows employers to contain costs by initially focusing resources on more affordable interventions, while also offering greater flexibility and customization based on employees’ unique needs.

In addition, employers may also work with their pharmacy benefit managers (PBMs) and weight health vendors to set criteria for prior authorization and align on how the process can be designed to ensure the most appropriate and effective medications are being prescribed. By establishing such protocols, employers can prevent employees from receiving unnecessary or delayed treatment, reduce their overall medical expenses and ensure employees are getting the surround sound care they need to be most successful on weight-loss medications.

Further, as part of utilization management, employers should ensure engagement in behavioral change programs as foundational and a prerequisite for individuals to access weight-loss medications. The effectiveness of weight health programs relies heavily on employee engagement in behavioral changes. Therefore, employers must establish clear guidelines and incentives to encourage program participation. By fostering a culture of optimal engagement, employers can encourage individuals to make sustainable lifestyle changes, ultimately improving overall health outcomes.

With every employee’s own unique weight health journey, treatments may vary and across time, based on the current clinical findings and the joint decision between the provider and the employee.

Prioritizing data-driven decision-making to drive lasting impact

Data is the cornerstone of any successful weight-health management program. Employers can use health data as a tool to educate their employees, track the effectiveness of interventions over time and make informed decisions to continuously improve their weight health initiatives.

As part of using data, employers should closely examine program engagement metrics. By tracking employee engagement levels, employers can gauge the effectiveness of interventions and make timely adjustments to optimize their program impact and reduce expenditure.

Employers should also analyze data on disease progression and regression rates. This involves examining how their rates compare to the broader industry, whether their people are advancing from a healthy category to an unhealthier one at an increased velocity and how their supported vendor solutions are driving improved health outcomes.

Related: Costco now offers Ozempic, Wegovy through new weight loss program

On an annual basis, employers should leverage plan performance reviews with their consultants and carriers to delve into more granular data – asking questions such as, “For high-cost claimants, how many will persist?” and “For top medical cost drivers such as diabetes, what percentage can be attributed to people living at an unhealthy weight?” Employers should also explore whether employees or dependents are the greater cost drivers to ensure their benefit program is adequately delivering on the needs of covered workers and their dependents. Having this data can strengthen the business case that addressing the root cause of obesity and weight health will lead to significant cost reductions.

Health is wealth: It’s time to implement comprehensive weight benefits

By employers implementing a multi-prong approach to weight health care, including offering weight management medication coverage, it will undoubtedly have positive business outcomes in the long-term, despite what might be perceived as an ineffective cost for employers in the short-term. Neglecting employee health can result in far more significant costs – including increased health care spend, decreased employee retention and satisfaction and higher absenteeism. Employers should think holistically about their investment in comprehensive weight health benefits – not just dollars spent, but the impact long-term.

Dr. Amy Meister, Chief Medical Officer at WeightWatchers