The drug landscape in 2023-24 is becoming more complex than ever, with weight loss drugs like Ozempic driving unprecedented demand. New block-buster drugs are coming, so it's important to have a conversation about how these medications can be accommodated without breaking the bank.
The drug landscape in 2023-24 is becoming more complex than ever. One of the main drug trends that is being dealt with today is the demand for Ozempic and other GLP-1 Agonist therapies. Popularized by social media and celebrity endorsements, this drug represented one quarter of drug spend in 2023.
Now with prior-authorization programs underway, some of the demand for this drug has been curtailed, but its popularity and widespread use has opened a question about weight loss medication coverage in benefits plans.
Traditionally, weight loss medications have been considered lifestyle medications, and coverage is largely excluded or has low lifetime limits applied. But statistics around obesity and the comorbid health consequences are bringing to light how this complex health issue might be better addressed by health plans.
Organizations should consider many sides of this debate:
Future developments in this category: While Ozempic is the most popular drug in this category today, other more effective drugs are well on their way to the Canadian marketplace. Drug developments include more effective weight loss side effects and options and medications where an injection need only be administered once a month versus once per week. Wegovy is already making waves in benefits plans as prescriptions switch to this medication.
The need to take the drug for life: These drugs must be taken for life to maintain weight loss for most patients. With a price tag of $7,000 - $12,000 annually, organizations will need to address how this type of medication should be handled by their plan.
Illnesses that are related to obesity: Obesity is a complex medical condition with many related co-morbidities. Assisting plan members manage weight loss through benefits, on-site fitness programs, by promoting wellness tools and other available tools can have a rippling effect on reducing benefits claims in other areas. However, actual ROI of these investments is yet to be quantified.
The path of least resistance to support weight loss programs of many types is through a Health Spending Account and/or Wellness Spending Account. These accounts give plan members flexibility to invest in what matters most to them.
Even if the HSA is not enough to cover 100% of the weight loss drug, you’ve demonstrated a commitment to your team’s well-being.
Reach out to us today to discuss your plan and changes that you could consider.
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