Obesity drugs are becoming big business, with a correspondingly big price tag. And with these drugs regularly making headlines, questions about whether or not health plans should cover them grow louder.
The highest-profile obesity drug is semaglutide, sold under the trade name Ozempic for diabetes and Wegovy for weight loss. Semaglutide slows gastric emptying so you stay full longer and, according to promotional materials, users see an average total body weight loss of 15% when combined with “lifestyle intervention” – diet, exercise and lifestyle changes.
As public awareness of semaglutide and other obesity drugs increases, so too does the desire for overweight Americans to use them – preferably with their health plan covering the cost. In a recent survey from the Obesity Action Coalition, 44% of people with obesity said they would change jobs to gain coverage for obesity treatment.
However, most health plans don’t currently cover semaglutide for weight loss, for a variety of reasons:
- Cost. A 4-week prescription retails for $1,500 or more.
- Duration. Semaglutide is not a short-term fix. To keep the weight off, users must continue to take the drug.
- Side effects. These can include abdominal pain, constipation, diarrhea, and nausea or vomiting. In more severe cases, usage could result in gallbladder disease, kidney problems and hypoglycemia, and increase one’s risk of thyroid cancer.
- “Ozempic Face.” Semaglutide users who lose a substantial amount of weight can appear gaunt or shrunken in the facial area.
- Unknown long-term effects. While semaglutide has shown positive results in short-term studies, it remains to be seen if weight will stay off over a longer period, even if the user continues to take the drug.
MedBen is not currently recommending that clients cover the cost of obesity drugs. However, should these medications be covered in the future, considerations would likely have to be made for the severity of the obesity and whether the potential for expensive chronic disease care justifies the cost of the drug.
Additionally, any approved coverage will need to be preceded by step therapy (such as medically guided diets or failure of other medications and therapies) or accompanied with lifestyle changes. Several virtual care companies are experimenting with ways to integrate obesity drugs into their online programs, but employers should view these programs with caution as they may operate counter to the objectives of the plan.