Do your employees need Ozempic? How to include GLP-1s in your health plans

Prescription drugs aren't getting any cheaper, and employers are becoming less confident in their ability to absorb costs on behalf of workers. But does that mean they should start cutting life-saving medications from their benefits roster?

The rising popularity of GLP-1 drugs like Ozempic and Wegovy as a weight-loss solution has tempted many employers to exclude the medications from their plans — as it stands, only 25% of employers cover GLP-1s, according to healthcare navigation company Accolade. While GLP-1s generally refer to a class of drugs that help manage glucose levels in people with type 2 diabetes, the drugs became known as an expensive celebrity weight loss drug after big names like Oprah Winfrey and Elon Musk sang Ozempic's praises. However, it's not a medication that just any employee can take on a whim to lose weight. 

Typically, a patient needs to either have type 2 diabetes or obesity to qualify for a prescription. Meanwhile, a monthly supply of a GLP-1 can cost as much as $1,350 before rebates or insurance. GLP-1s are an investment for both employers and employees, but it might be a worthwhile one with the right guidance in place, says Kristin Hall, VP of clinical programs and patient experience at apree health, a healthcare navigation company.

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"There's no debating the GLP-1 medications have a ton of great proven outcomes for people with diabetes and people with obesity," says Hall. "But the unit price of these drugs is substantially high in the United States. It's essential for employers to focus on behavior change alongside medication so employees can reach their goals."

Hall advises employers to include coverage for GLP-1s, but do so in tandem with weight or diet management programs that prioritize sustainable, evidence-based lifestyle changes that will help type 2 diabetes or obese patients improve their health. This starts with ensuring employees have access to and engage in primary care.

"Primary care providers can gain an understanding of their patient's needs, not only from their medical history but from their culture and socioeconomic background," says Hall. "From there, patients can receive the right level of weight loss recommendation and treatment plans based on evidence-based guidelines."

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It's very possible patients struggling with their weight may not really need a GLP-1. And while patients who are considered overweight either by metrics or appearance often face medical discrimination, a good primary care physician could help facilitate the tests and screenings needed to go beyond surface level into a patient's health. Hall stresses that employers have an inclusive network of primary care providers, especially since they're often the first doctors employees visit when they're trying to better their health. 

"Having a primary care provider as the quarterback at the helm of the employee's experience can help them engage in the [healthcare] ecosystem in a valuable way," says Hall. "It's important that we don't have people taking GLP-1s or weight loss medication without primary care."

Beyond pointing employees to specialists or programs, primary care doctors can ensure the GLP-1 doesn't interfere with an employee's existing medications or treatments. For example, if a patient has high blood pressure and starts taking a GLP-1 for obesity, it may be dangerous for them to continue taking their usual blood pressure medication. Hall points out that a good primary care provider wouldn't let that happen. 

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Hall underlines that GLP-1s can be an essential tool for employees who are struggling with obesity or trying to manage diabetes, but it takes a holistic approach, including primary and preventative care, to make long-lasting health improvements that keep healthcare costs low for employers and employees.

"It's very important to address social determinants of health, like available food choices, food insecurities, and considerations related to social vulnerability," says Hall. "Everyone's journey is different in the healthcare system. But if we can partner with primary care providers and provide care management, nutrition education and coaching, we can support members going along their journey."