At recent MedBen University roundtables, MedBen President & CEO Kurt Harden examined how the growing public awareness of two diabetes drugs with a desirable side effect – significant weight loss – means that these $1,000-per-month medications are not always being used for their intended purpose. 

“Many people who are using Ozempic or Mounjaro are doing so not necessarily to lower their A1C, but because they want to lose weight.” Harden said. “There are people who are following social media accounts on how to get approved for Ozempic with the goal of weight loss, not to treat diabetes.”

Ozempic maker Novo Nordisk and Mounjaro maker Eli Lilly recently introduced, respectively, Wegovy and Zepbound… the same diabetes medications rebranded as obesity drugs. But because most employers don’t cover weight loss medications, some patients continue to look for a workaround.

“If your plan covers weight loss, the doctor will prescribe Wegovy… but if your plan doesn’t cover weight loss, the doctor will prescribe Ozempic,” Harden noted.

MedBen is not currently recommending that clients cover the cost of obesity medications, and Harden said MedBen Rx is working to ensure that clients aren’t improperly paying for these drugs.

“When it comes across as a prior authorization from a physician, we’re sorting out those who want to lower A1C versus those who are trying to lose weight,” Harden said. “And when there are denials, we’re checking if the patient had diabetes to begin with, and if other medications have been tried first.”