Officials are asking about GLP-1 coverage. What should employers do?

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The Ozempic zeitgeist has leaked from doctors’ waiting rooms and pop culture forums into virtual break rooms. If employees are asking about GLP-1 coverage – in the pursuit of overall weight loss, not just to treat diabetes – HR may need a plan.

In a recent Digital Health New York session titled “The Economics of Obesity: Making Coverage Work”, Several healthcare experts have covered what HR needs to know about these niche benefits.

The question of cost

Elina Onitskansky, CEO of Ilant Health, raised the question of financial viability, for workers, sponsors and the healthcare system as a whole.

“How do you make sure you’re capturing value?” Onitskansky asked. Workers need to receive proper GLP-1 treatment and eventually be able to leave it behind without any problems, she said.

Unfortunately, Onitskansky added, the cost of “obesity-related conditions, (like) diabetes, cardiovascular disease, musculoskeletal problems, are rising dramatically in terms of cost.”

AJ Ally, director and pharmaceutical management consultant at Milliman Consulting, emphasized the importance of choosing coverage carefully. Often times, when an employer’s coverage strategy is not aligned with pharmacy benefit management service providers, he said, there ends up being “cognitive dissonance” down the line, “where potentially employers may opt out.”

The challenge of maximizing ROI

In a recent chat with HR Dive, ADP Human Resources Division Vice President Tina Wang said the best way to maximize ROI on benefits is to use employee surveys. Wang recommended asking employees, “What do you need or think the company or organization can provide?”

This is particularly useful when it comes to non-traditional benefits, Wang said. Ask the question, get feedback; then organizations “can decide what fits their culture and also their budget.”

For GLP-1 treatment in particular, employers “need to ensure that coverage is combined with a patient engagement program, behavioral health modification, or nutritional therapy program,” Ally said during the Digital Health New York session.

ROI is medical, not just financial

Matthew Percia, director of wellbeing and engagement at consultancy NFP, said it was important to consider the “long-term ramifications of the drugs themselves”. Questions he raised:

• How long do people need to take GLP-1s?
• What support is there to ensure they do not continue to regain their previous weight?

It is crucial that employers understand, Percia said, the global impact that GLP-1 will have on workers in the coming years.

Ally said patients need to lose 10 to 20 percent of their body weight and see sustained weight loss for there to be ROI from the drug.

Lifestyle: the holistic approach

Percia highlighted the importance of taking a holistic approach as an employer, focusing on exercise and nutrition. This can include calorie counting, healthy eating and providing registered dietitians “to talk to a patient in a polite way to make sure they have the right tools and support they need,” he said.

It can also mean facilitating food or meal delivery services. Percia said sleep hygiene, mental health and addiction may also be linked to obesity.

Overall, Percia emphasized, healthcare should be both physical and psychological, working together.

“You have to look at this from a holistic perspective and understand all the different components that can impact and create someone with obesity,” Percia said. Employers need to find different ways to provide additional services, tools and resources “to ultimately ensure that the employee and patients taking these types of medications are successful in the long term,” Percia said.