Michele Page, RPh, MBA
Clinical Director, Client Services
Will GLP-1 weight loss drugs become more prevalent in workers’ compensation?
Glucagon-like peptide 1 (GLP-1) receptor agonists medications, originally designed for diabetes management, have skyrocketed in popularity over the past year as effective drugs for weight loss and obesity. These drugs help individuals control blood sugar, boost weight loss and improve blood pressure. GLP-1 drugs are administered by injection and pose common side effects such as nausea, vomiting and diarrhea, as well as other more severe issues, including pancreatitis and gastroparesis. Longer-term side effects are unknown. If these drugs are stopped without appropriate behavior modifications, appetite will return, and weight will be regained. Unlike bariatric surgery, GLP-1 drugs are intended for extended use, requiring ongoing financial commitment.
Obesity is highly prevalent in the United States, with nearly three in four adults aged 20 or older being classified as overweight or obese. Obesity also plays a role in increased costs for workers’ compensation claims due to longer recovery times and periods of missed work.
According to From Day One, a Forum on Corporate Values, employees want weight-loss drugs offered through their employer health plans. With the development of stronger drugs like Ozempic (semaglutide) approved for type 1 diabetes, and the recent approval of Wegovy and Zepbound (tirzepatide) specifically for weight management, a sharp increase in demand is now seen. This is especially true as more research emerges that shows that these drugs may also reduce the risk of cardiovascular disease, stroke and potentially bring about other long-term health benefits.
A survey found that up to four in 10 employers intend to cover GLP-1 drugs in 2024, up from 25% of employers that previously covered the medications. Yet, these medications are expensive, as much as $1,500 per month.
A recent review of Enlyte Pharmacy Solutions workers’ compensation prescriptions dispensed shows a 14.2% increase in the dispensing of GLP-1 drugs from 2021 to 2023, along with a corresponding 13.2% increase in the drug spend for GLP-1 drugs during the same period.
Drug Information
Tirzepatide (Zepbound, Mounjaro) is a GLP-1/GIP-1 receptor agonist approved as an adjunct to diet and exercise in adults with a BMI of >/= 30 or >/= 27 with at least one weight-related comorbid condition.
Annual Wholesale Acquisition Cost (AWP) = $13,778
Semaglutide (Wegovy) is a GLP-1 receptor agonist approved as an adjunct to diet and exercise in adults with a BMI of >/= 30 or >/= 27 with at least one weight-related comorbid condition.
Annual Wholesale Acquisition Cost (AWP) = $17,537
There’s currently not much written about the coverage of GLP-1’s in the workers’ compensation space. However, it makes sense that since some injured employees can be prone to weight gain due to their injury (along with lack of mobility resulting from pain or injury), employers may see requests for these drugs to reduce weight and subsequently improve quality of life.
Although it’s impossible to determine how these drugs will be prescribed in workers’ compensation in the future, it’s likely that we’ll see an increase in the prescribing, and therefore, the cost of paying for these drugs in the coming years.
This information is meant to serve as a general overview, and any specific questions should be more fully reviewed with your health care professional such as the prescribing doctor or dispensing pharmacist.
Do you have a workers’ compensation or auto related pharmacy question? Send us an email at AskThePharmacist@enlyte.com.
To read more Ask The Pharmacist articles, please visit enlyte.com/ask-the-pharmacist.
References:
https://www.nhlbi.nih.gov/health/overweight-and-obesity
https://www.fiercehealthcare.com/payers/employers-increasingly-open-glp-1-coverage-analysis-reveals