In light of all the attention that weight loss drugs have received lately – as well as the pricing havoc these drugs have been causing in some pharmacy plans – the following news items have caught our attention:
- North Carolina says its health plan will no longer help its employees pay for their weight loss drugs. The state cited its $168 million annual cost “with minimal savings on medical costs” to offset the spending.
- On November 8, the FDA approved the drug Zepbound (with an active ingredient called tirzepatide) for chronic weight management in obese or overweight adults. This is the agency’s second such authorization of a weight loss drug following the approval of Wegovy (semaglutide) in 2021.
- A new survey finds that up to 4 in 10 employers intend to cover weight loss drugs in 2024, up from the 25% of employers that currently cover the medications. Over 80% of human resource decision-makers say that they would be interested in expanding coverage.
So we find on the one hand that drugmakers continue to introduce new weight loss drugs – or more accurately, repurpose existing diabetes drugs for weight loss use – and more employers may soon cover them. Conversely, a major public employer is dropping its coverage due to the high cost not being balanced by corresponding plan savings.
MedBen Rx’s comparative effectiveness partner TruData is recommending that pharmacy plans exclude at launch Zepbound from coverage until more data is available, similar to previous guidance for other weight loss drugs. High prices are certainly a factor in these recommendations, but we also take into account the fact that the drug must be taken indefinitely to continue working… though whether the weight will stay off even when using the drug is still an unknown.
However, if your plan does cover weight loss drugs, MedBen Rx will work with you to examine potential options and implement a strategy that addresses employee needs. That likely means covering the drug only for those who meet certain criteria regarding weight and the risk of developing one or more chronic conditions. Further, the drug should ideally only be covered if other medications or therapies have failed (aka “step” therapy) or as part of a broader program of lifestyle changes.