Employees Want Weight-Loss Drugs, but How Can Employers Afford the Costs?

Demand for weight loss drugs keeps surging, but these medications come with a cost. Popular therapies such as GLP-1s can cost employers an estimated $1,000 per person per month, likely requiring long-term use. In 2024, organizations have already increased their health plan budgets by 5.2% as a result of GLP-1s. With 52% of professionals reporting a desire for weight-loss drug coverage, employers face a critical decision–how to provide access and improve overall health without breaking budgets. 

What you'll learn About demand trends for weight loss drugs and how to navigate employees' desire for coverage How Anti-obesity medications (AOMs) are shaping the future of weight management Strategies to provide cost-effective access to specialized obesity care How to maximize health outcomes for employees while driving a measurable ROI

Transcription:

Emma Fox (00:09):

Hi everybody. My name is Emma Fox. Not only am I the CEO of E Powered Benefits, I do a couple other things too, but this is actually a topic that is very near and dear to my heart. So I think they wanted to reel me in a little by making me a moderator on this one instead of a speaker. So I'm really excited to hear what our speakers have to say. So real quick, we have Dr. Jon Larson, Stephanie Koch, I said coach. Dang it. And we have Kara there at the end. Real quick, I think I'll do you an injustice if I try to introduce you. So would you take just a couple of moments and introduce yourself, what you do, and some we'll get into the questions right after.

Kara Boley, MA, RDN (00:47):

Sure, sure. So my name is Kara Boley,. I'm a Population Health Management Consultant for USI Benefits Consulting Group, but also I am a Registered Dietician and I have a specialty in adult weight management. So I've worked across the board from just one-on-one nutrition counseling all the way through bariatric surgery and medically supervised very low weight weight loss diet. So I've kind of run the gamut and now I'm more in the consulting space.

Emma Fox (01:14):

Awesome. Steph?

Stephanie Koch (01:16):

Yeah, so good afternoon. My name is Stephanie Koch and I'm the Director of Human Resources for Hendry Marine Industries. And I actually have been in human resources over 25 years and I actually, like Emma, have a personal connection to weight loss. And having been on my own weight loss journey, I've lost a hundred pounds. Thank you. It's a journey and it's tough and we live it every day. But my ultimate goal is because I understand the self-funded healthcare space very well, understand the levers we can pull to be very successful with our employees and what things we need to do. This is near and dear to our hearts because we do see these struggles in our population.

Dr. Jon Larson (02:05):

And Jonathan Larson, one of the things I'm most proud of, I'm a graduate of West Point and after my service in the military, went to medical school, became a board certified emergency medicine physician. Then after practicing, went back to business school and then got involved in health tech and been involved with telehealth since 2012. And now I feel like I'm constantly trying to reinvent myself. I'm now board eligible in obesity medicine. Just need to take the exam.

Emma Fox (02:34):

Well, this is a very well-rounded panel. So we have the consultant perspective, the employer perspective, of course a clinical perspective. Let's start with you Kara. So the whole reason this panel is put together today is that we really are seeing a pretty big demand, especially in the group employer market for GLP ones. A lot of that demand I think is coming from employees who are seeing their doctors. They have this solution to what is a lifelong problem. What are you seeing in the consultant space in terms of this demand and how are you advising your clients?

Kara Boley, MA, RDN (03:09):

Yeah, great question. Probably you guys in these seeds are hearing from employees, are we covering this? How do I get my hands on it? Can I run it through claims? Can I use my HSA card? Right? I'm sure you're hearing all this. We're hearing that as well. What I find with most of my groups that I'm talking to, and maybe y'all are in the same kind of boat, I want to do something. We want to do something we just don't know. How do we get started? We don't. We've got maybe the CFO not to talk bad about our CFOs, but they have something to do, right? So we've got the CFO saying like, Hey, we can't just blow our budget, but the HR people are the levers they want to give. We want to give everyone everything as much as we can. And so it's trying to find that balance of how do we get started? What's the right solution? What's going to work for us with our population with the current benefits that we're offering or what changes do we need to make? So certainly people, I don't know if you guys feel the same, but my groups, they want to do something. They just need help figuring out what to do. So that's what I do is help them figure out

Emma Fox (04:11):

Quick follow-up. Question for you. Are your clients mostly concerned about the cost? I would assume how they're going to be able to afford this. It doesn't seem like whether or not we should provide it. How are we going to afford it? Is that accurate?

Kara Boley, MA, RDN (04:26):

Yeah, absolutely. Cost is a big, big part of it. I have a client who has started offering the all weight management medications, including the GLP ones for weight loss. And I think the perception or misperception is that we're going to offer this and 90% of our employees are going to go for it and then we're not going to have any money. The reality is that doesn't happen. But it is a scary, I think, thing to think about. So certainly money is a huge part of it. Just understanding how does it impact claims and long-term, are we going to actually save money? And some of this is pretty new, so it's still a bit of an unknown.

Emma Fox (05:05):

Stephanie, you're on the employer side of this, so I think you're hearing a lot of the demand pretty directly. And with your personal connection to having your own weight loss journey, what is your perception of this? How are you handling it from the HR seat that you're in?

Stephanie Koch (05:21):

So we're actually handling it in a different way right now. We do cover the GLP ones, but specifically for people who have been diagnosed with diabetes. The other part of that is we are in the process of transitioning from one solution to another that does whole body. So in other words, we want to focus on yes, the diabetic population, but then how do we manage it from a food standpoint, managing nutrition. That's what this whole body program will cover. And the other component in how we're handling it right now is through preventative wellness. So we actually have an onsite primary care doctor's office, and we're a shipyard at the port of Tampa. And our goal is to get it from the ground up. So we want our employees to do those things that are going to help them take care of themselves before it becomes an issue. So we're kind of handling it a little differently, but at some point down the road, most likely we'll put a program together to help facilitate managing it strictly as its own program.

Emma Fox (06:33):

So I am also a consultant and I'm very fortunate that I work in the self-funded space, which affords me a lot of flexibility in what I can and can't do. When these GMPs first came out, it really wasn't a question for me as to whether or not we should provide the drug. If you think about other drugs, when the hepatitis C drug came out, there wasn't a question as to whether or not we would provide that to people with hepatitis. It was how are we going to afford it? And I feel like the GLP one is a very similar argument. However, data has continued to evolve and one of the things that's come up recently alongside the affordability conversation is the adherence. Because unlike something like hepatitis or any of those other drugs that cure a disease, this is a voluntary medication. So John, talk to me about the adherence. It's like 60% of people stop taking this drug even if they have access to it. Is that correct?

Dr. Jon Larson (07:31):

Yes. Yeah, I am assuming the number's right. But yeah, the adherence with a lot of medications can be high. I mean, I'll probably repeat this over and over, but so many things I look as being multifactorial and there's not one easy answer. Some of the reasons, one being cost. I think we're all acutely aware. We've already talked about it multiple times just in the first few minutes here, the cost of it on average, about a thousand dollars a month and now and over time I see this whole space is rapidly evolving. I mean I liken it to the ChatGPT of medicine right now and like the direct active antivirals with hepatitis C, yeah, there's a lot of things people are having to figure out. And every day we're seeing things change in terms of costs and there's different programs set up to try to mitigate the cost.

(08:21):

So cost being one of the big ones and other ones there are side effects. And whenever I talk to a patient about a medication they're going to take and they said, are there going to be side effects? I can't guarantee there's not. Anytime you put a medication into your body, there's likely to be side effects. I mean some of the most common ones have to do with gastrointestinal side effects, be it nausea, vomiting, diarrhea, upset stomach. So that's a part of it too. It's also coverage as well. Changing coverage decisions if you're changing insurance, some insurances if you're not direct to consumer, may change their coverage decision based on that. And another big one that I really want to emphasize is one major part of it is the quality of care. Less than 1% of physicians in the US are board certified in obesity medicine yet now, and I can talk as a physician, physicians basically gave up on this.

(09:21):

They're like, okay, we can tell you to exercise more and eat less or eat better before. But for the first time we have, and actually the first GOP one, I think April, 2005, exenatide was one of the first GLP one. So GLP ones have been around, but now seeing GLP ones at scale. Now these primary care providers, they actually have a tool that they can, in addition to the nutritional advice and exercise advice, they have a tool that's really showing incredible promise in terms of the percent of body weight that people can lose. And thus the comorbidities that go with obesity seeing real change. But with a lot of people having access to it, they may not be trained in medications outside of GLP one. So that may be the only tool they have and maybe they aren't aware that there are a lot of non Kardashian endorsed medications out there that are also impactful as well. So I think one of the big things is working with a physician or physician group that has the training not only in GLP ones, but the full armamentarium when it comes to anti-obesity medications.

Emma Fox (10:32):

So I'm going to go a little off script,

(10:36):

And this is for all panelists. So Stephanie, congratulations on your own personal journey. I myself had my own experience, which is why this topic is so personal to me. I spent all of my life being morbidly obese and I lost weight before GLP ones were on the market. I'm not sure, I think I probably would've used them if I could have done so sooner and sort of gained back a portion of my life. But I do credit a lot of my maintenance and I'm sure you do too, to lifestyle, which is really learned behavior. So from an HR perspective, and probably Kara from a broker perspective too, what kind of things do you think need to be partnered with these drugs to ensure that folks are actually getting away from this addiction, from this behavior and sustaining something that's really long-term? ,

Stephanie Koch (11:30):

Yeah I'm actually glad you asked that question because while we're not necessarily working on this for weight loss right now, because like I said, we're doing other things and creating other avenues for our employees to take care of themselves. When I think about GLP ones and the expense related to that medication, I think about a couple things. And I think of it having bookends. So on one side of the equation, prior to an employee getting prescribed this medication, it has to be something that is diagnosed from a psychological or some type of evaluation to get to the root of what is causing that person to have this eating habit or what is it about the lifestyle that's causing them to want to use food as whatever the way they deal with things. And then once that is identified, then it's okay, we have a doctor that's going to prescribe the medication, but they're also going to be along on the journey along with the nutritionist that's going to be managing it for a certain amount of time. Because if you leave it open-ended, that's where the expenses continue to be incurred with a plan from a plan perspective. And then on the back end of it, it's continuing. It's making that employee or their covered family member commit to the specifics related to a program. So to me, it's bookends and there has to be real evaluations and assessments before it's just offered.

Emma Fox (13:00):

Quick follow-up. Question for you, Stephanie. What do you feel about the responsibility of employers to provide that to employees? Do you feel as a leader at your organization, if you're going to provide GLP ones for weight loss, do you feel a responsibility to provide all of the ancillary care to maintain it?

Stephanie Koch (13:20):

I actually do. Yeah, because why would you give? It's giving an employee a tool, but not giving them all of the other resources they need to use the tool, right? So it wouldn't make sense. And that's why I was saying if I were to structure a program, it's going to have bookends and it's going to be managed because it has to have clinical oversight. It can't just be here, take this and good luck. That will not work.

Emma Fox (13:47):

Kara, let's go to you. So assured partners put out a study fairly recently that a group of say a thousand employees, if they were to approve GLP ones for their population for weight loss specifically, it would cost them around $600,000 in healthcare spend. As a consultant, how do you advise on anti-obesity medications, GLP ones or otherwise? How do you help employers mitigate that cost if they decide to cover it?

Kara Boley, MA, RDN (14:13):

Yeah, absolutely. A client specifically, I'm thinking about it. I actually just crunched some numbers today because I'm nerdy like that. But I wanted to see they implemented with a group of employees they implemented, found. So you've got a program that is helping to manage, like we're going to cover the GLP ones for weight loss and all the other tools, weight loss that are available. But you have to be engaged in the found program. You have to hit clinical milestones, you have to make your meeting, make your meetings, you have to do the things, be engaged in the lifestyle piece. And this group, I just looked at January to July 23, January to July 24. We started with found just in March with this group. So it hasn't even been a full year yet with them. And I'm actually seeing a little decrease in medical claims, a slight uptick in pharmacy, but not offsetting.

(15:00):

The decrease is much more significant in that group. And that's just real quick and dirty math, it's not. So I am excited to see what that looks like. But this was an employer group who was just, they wanted to do it and they were ready to pull the trigger, but so scared that everyone was going to be on GLP ones. And we know it's just, and Dr. John will, I'm sure, back me up on this, they're not meant for everyone. They work for people, but they don't work for every single person who wants to lose weight. And certainly there are people engaged in the found program that they don't meet the BMI requirements for a GLP one even. So there's other options available. So it's kind of to Stephanie, to your point, not waiting for everyone to be where they have to have a GLP one or is a candidate for surgery, but trying to catch people a little before then when they're ready to make some changes too.

(15:48):

So I think the jury's still out on what we're going to see with cost savings. It's not going to be, oh, we started this and tomorrow we're saving, or we're spending this much, or we're saving this much. Because you will hear people say, well, cholesterol meds will decrease our blood pressure meds, and likely those will with someone losing weight, changing lifestyle habits. But we all know those are $5 a month prescriptions. You're not making a million dollars because someone just cut back on their cholesterol medication. But certainly bigger picture, you're looking at workers' comp claims, MSK concerns, there's a much bigger picture to look at when it comes to what's the cost going to look like.

Emma Fox (16:30):

This is really fascinating because what I'm hearing you really break down is that there's all of this consequence, some of it, quite a good consequence for allowing GLP ones as a method of weight loss. Right? And we had a really good prep call before this panel, and Kara and I sort of lamented over some of the strategies of consultants, which was that I've heard a few consultants go out to employers and say, well, a good strategy for cost mitigation is to wait until someone's BMI is at a certain level and then approve GLP ones. And my response to that was never underestimate the desperation of someone who's lived with obesity their entire life, that they wouldn't make their BMI eligible for GLP ones. But also there's really not any other disease state in which we say, well, let your disease get this bad before we will provide you the medication. Are you having conversations like that with new clients?

Kara Boley, MA, RDN (17:30):

Yeah, this is a topic that comes up. Every new client meeting, every current client meeting, the revisiting, well, we don't know what to do yet. We'll revisit again. Can we talk next month? What else? Because it is changing so fast too. Absolutely. Seeing a lot of my clients are looking at the bigger picture and wanting to do the right thing and helping them with a good partner, helping them understand you don't have to go from nothing to everyone's on GLP ones. There's a great middle of the road. There's things that you can phase in and kind of go in stages to be able to get people where they need to go. But a lot of my clients are just right there on that. They're ready to do something and they do see the bigger picture. And just remembering, I think it takes a lot of retraining our brain because for so long, I've been in the weight management space for a long time.

(18:18):

For so long it's been move more, eat less, duh. Right? And it hasn't been thought of as an actual chronic condition, something that people are managing because probably I'm not alone on this stage or anybody here saying, oh yeah, we can losing the weight. Sure, let's eat the grapefruit diet. Or whatever fun diet people did, you can stick to that it there's an end date, but it's the maintaining, it's the long haul that really matters. And I think that's what the employer groups are really looking at is the long haul. Absolutely. What are we going to do to help keep supporting people and the lifestyle, all that plays a role.

Emma Fox (18:57):

Again, I'm going to go off script a little because I feel like this has so much potential, but Dr. Larson, we talked about this very briefly. How important is the mental health discussion when we're talking about GLP ones for weight loss, for people who have lived with obesity their whole lives? Is that a really important aspect?

Dr. Jon Larson (19:16):

Oh, absolutely, absolutely. And I think what we've talked about here is it's not just one panacea, it's not one pill. And in my lifetime, I remember as a resident at UC, Davis talking about opioids and how they weren't addictive, and pain is the fifth vital sign. And it was like, well just give them out if somebody's with pain. And so I think for a very complicated multifactorial problem, like pain, we wanted one pill. And I think with obesity, I don't want to get in that rut where it's like just the GLP one is the only answer. It's not like Kara said, 30% of people are non-responders to GLP ones. They aren't for everyone. So it's really providing that personalized care that's not just medication, but it's the nutrition, it's the exercise, it's the mental health component, it's the community of other people experiencing the same weight loss journey, weight care journey.

(20:13):

That's hugely important. So I don't ever want to come at it just as it's just GLP ones and we're done. And we're seeing so much in terms of literature and studies coming out to the earlier discussion about prevention. So right now, BMI is the best. That's what we use right now to categorize folks, tier folks. And so A BMI of 25 to 29.9 is considered overweight. 30 and above is considered obese. And yeah, do we need, and so the FDA indications for GLP ones, it's BMI of 27 with an obesity related comorbidity or A BMI of 30 or greater. And so I can see that spectrum being expanded to how can we prevent. Recently with Tirzepatide, there was a study showing in 94% reduction in diabetes for adults with pre-diabetes who are overweight or obese. So how could we start maybe a little sooner, maybe 25, 26 and prevent them from developing type two diabetes in all the comorbidities that go along with obesity.

Emma Fox (21:23):

Dr. Larson, one more follow-up question. You and I talked about this real briefly, but there are some very early studies and data coming out that GLP ones are effective on other disease states or other chronic conditions aside from obesity, what are you seeing in your realm?

Dr. Jon Larson (21:40):

Yes. Yeah. Yes. And we're also seeing patients who are on GLP ones that no longer have an appetite for alcohol. Maybe they were big drinkers before. And so yeah, we're going to continue to, I think, see other potential applications. I mean, a lot of those indications aren't ready for primetime, but I think it's an exciting time to be in medicine. There's not very many times in medicine, and you mentioned the Hep C with the direct acting antivirals. Yeah, that was a crazy time just seeing that evolve. But I think for a disease that affects by 20, 30, 50% of the population, I mean that's huge. And we're going to continue to see additional indications and additional medications coming down the pipeline in our lifetime, at least in my lifetime.

Emma Fox (22:31):

I think it's fascinating. I am really excited to see where this goes. Stephanie, you are sort of an HR warrior. For anyone who doesn't know Stephanie, she is a leader at a very large organization in Florida, and she has made a very incredible name for herself in these conferences, giving the HR perspective. But I think one of the challenges in your position is that you're constantly being sold to by vendors who claim that they can solve this problem for you, and you are in charge of those decisions whether or not you utilize a certain vendor for this or not. So for anybody in the room that's in your position or similar, how are you vetting these solutions to be credible? Who are you relying on?

Stephanie Koch (23:16):

So essentially what I have found since 2016, since I've gotten in what I consider the disruptive healthcare space, so it's outside of the BUCAs and had the broker breakup and had to make changes inside of my own HR career, I've also learned that the data inside of a healthcare plan speaks volumes about what specifically you should be doing for your organization. And for us, we look at whether or not the vendor partner really understands our company, do they understand our company's value proposition? Do they really understand the employees? And really importantly, is it multi-language because we have English, Spanish, Vietnamese. So there are those certain things, but also, again, it's back to the data. What is the data saying and speaking to us as far as what issues can we solve or what problems can we solve? Because at the end of the day, it's about keeping our employees and their family members healthy, and it's also having an impact on their livelihood because that in turn is an ROI of what we invest in them for how productive they are. They come to work. So essentially it's the big picture of their employment.

Emma Fox (24:37):

So Kara, this is sort of the same question to you because I know for me as a consultant, I'm constantly fielding requests for vendors who have the solution, and you have to recommend this to folks like Stephanie. How are you making sure that there are guide rails in place for these solutions? And do you recommend anybody?

Kara Boley, MA, RDN (24:58):

Yeah, definitely. Our team does a pretty good job of trying to keep, no offense to the vendor providers, but trying to keep Stephanie safe from thank you. We try to be the go-between and help in that realm. But yeah, we're asking good questions. Dr. John mentioned the obesity certified. That's a big deal. So primary care physicians can hand out all kinds of medications, but do they know how to do the appropriate follow-up on the medication or the other? We've had a lot of anti-obesity medications that have been available for a long time, but that were never rarely being prescribed, also not often being covered. But just a little side note, when I was looking at our data today, I saw Allie on there, ally, Allie, do you guys remember that one? Still there? Still there. You probably haven't seen a commercial in a while, but there were four people on it is what I saw.

(25:59):

So those are still out there. So we're kind of looking at what's in the toolbox of the vendor partner. Are they prescribing GLP ones for everybody or found? Do we say, well, no, we need to see what's going to be meaningful, what's going to be impactful? We could start here and then maybe if things need to change as we go. So having a variety of tools in the toolbox. And then also what's the future plan? Okay, so we implement and in two or three years we've got great outcomes. What are you doing to help people maintain? Or what does that look like? How are you growing in that maintenance sort of lifestyle support as well? Do you offer things for the person who is at maybe the 27 and a half BMI or the 26th maybe doesn't have any comorbid conditions, but what wants to do something now, maybe even medication's, not a thing, but do you have a lifestyle program for that person as well as the person who might be ready for something more? So trying to look at the whole big picture.

Stephanie Koch (26:55):

I was just going to make one other comment because something you just said, just spark something. So for us, like I said, it's all about results and data. When we select a vendor, trust me, we hold 'em accountable for the specific things that we're trying to achieve within certain timelines. It's not just, oh, that's okay. No, it's not okay. If you are committing to helping us meet a certain objective, we are going to hold you to that objective and make sure that you understand and we're very clear about what we need and want. And we get a lot of feedback from our employees. And that's another really critical piece because if we set expectations for a vendor partner and it is related to how they relate to our employees and we don't get great feedback, well, that in itself is in the negative column. So those are things that we look for. But accountability on the vendor space is very important to us.

Emma Fox (27:50):

Dr. Larson. Kara brought up a really good point, which is that there have been anti-obesity medications available prior to GLP ones that really haven't been heavily utilized. I learned about this as I kind of delved into this topic, but there's a particular drug very affordable that's prescribed prior to bariatric surgeries. Are there compromises? Are there alternatives? Why is everybody suddenly so crazed around the GLP ones? Is it their efficacy? What is it?

Dr. Jon Larson (28:19):

Yes, yes. I think efficacy is a big part of it. So what we're seeing with GLP ones after 12 months, seeing on average 10% body weight loss, but the next point being 91% of our members who have lost 15% more of their body weight. So 91% of our members who have lost 15% more of their body weight did so on non GLP one medications. So GLP one medications, yeah, the efficacy is good, but also metformin, and let me contextualize this a little. So 5% loss of body weights considered clinically significant weight loss. And so when you look at GLP ones with 10%, but metformin, you're seeing on average about 5%, topiramate, about 4.6%. And so yes, there's other medications, and that's part of what we pride ourselves on is that we're not just a GLP one shop. So our chief medical officer, Ika Kumar, she's very prominent in the obesity field.

(29:26):

So all our protocols, all our training is based around, first let's look at the patient, let's see what they've tried in the past, let's see what their medical history is. It's not just a, you want a GLP one, here we are, send 'em out. Well, based on your profile GLP ones, we're not going to recommend that. And this is what we're recommend to start with. And then a lot of medicines, sometimes it is trial and error, seeing what kind of side effects you have, how your weight loss goes on that particular medication, just recognizing that there are other medications other than GLP ones that are out there. And so part of what we bring too is the flexibility to work with whatever formulary or medication toolkit that company has. And it's not so if you come to us, it's not, well, you got to do GLP ones. It's it we're able to adapt around different formulary designs.

Emma Fox (30:21):

So let's bring it back around to the conversation of cost mitigation, because I think what I've learned over the last few months of doing these conference circuits and speaking on GLP ones is that what this argument really comes down to is whether or not you believe that obesity is a disease, and if you do, it's sort of a no-brainer that you would provide a medication to cure a disease. I still think the jury's out on that a little bit. I still think there is some discussion as to whether or not this is a choice. Is it an addiction, is a disease? So that's been part of the conversation. A lot of what's come up though has been how do we afford it? Let's say that Stephanie believes that GLP one should be available for all weight loss. How much are these plan components contributing? Because we have things like the PBM that you use.

(31:12):

Well, there's rebates. It could depend highly on where those rebates are going as to whether or not you could mitigate part of this cost. If we're in a self-funded environment, could you source these drugs from an international pharmacy? I happen to know, there's actually a GLP one manufacturer in the audience who is a fantastic resource, and I'll share secretly her name with you later, that is working on direct pay solutions. So it does feel, Kara, like things are coming up to make this more affordable, to make this more accessible. What kind of strategies are you implementing so that the cost isn't quite as scary so that employers like Stephanie can bring it into their plan?

Kara Boley, MA, RDN (31:52):

Yeah, I think a lot of it is building in a program, and Stephanie said they're kind of getting started with this already, but a program found where my groups are saying, you have to be engaged. You don't just get to get your prescription. We'll check back in three months and see how you're doing three more months, three more months. It's a higher level of accountability and a higher level of engagement. And check-ins that coaching the community support in the groups, all that makes a difference for sure. But not having guardrails, because most PBMs already have the prior authorization process in place where you have to lose a certain amount, have done all X, Y, and Z. It's kind of complicated and very lengthy and tiny print, but it's there. So a lot of 'em have these prior auths in place, but that doesn't mean there's nothing really to stop the primary care doctor from saying, check, check, check, done.

(32:43):

Here's your prescription, never checking back in. And just getting these auto refills, which could be very expensive groups that have members on high deductible health plans, that part can be a little expensive too. So then you're kind of like, you think of social determinants of health, and are we still not helping people that we should be helping? Because the cost is just so there's all different strategies depending on the employer group, what's available, which PBM, because some are, as you all know, better to work with and more fun to work with than others. So yeah.

Emma Fox (33:13):

Okay, I'm going to ask you sort of a somewhat personal question, and that is that one of the things I've heard a lot around the GLP one argument from the consultant perspective is whether or not there's an ROI does, there have to be an ROI. If we're managing a disease state, we don't look for ROIs for cancer care or chronic condition care. What we do is we fund healthcare to control these disease states. Does it have to have an ROI?

Kara Boley, MA, RDN (33:45):

Mean, I was born into the world of just wellbeing, so I was born into feet on the street. Let me teach you some classes and do right, and I've always heard value. That's all I ever think about. So I have these conversations with my clients, like I said to you all earlier, realistically, if we get people off cholesterol and blood pressure meds, cool, $10. I mean, it's so little, but what are we looking at? I have some groups that are thinking of like, well, if you have high turnover, this isn't something you'd want to do, then you're paying for someone else's employee to get healthy. I have other groups who think, well, we have high turnover, but is this a retention tool? Is this something that will keep people here or a recruiting tool? A recruiting tool, absolutely. So it depends. Depends on who's at the table sometimes how involved they are.

(34:30):

And CFO has different outlooks. They're looking, their brain most of the time is not to be ripping on CFOs, but you know what I mean. Their brain is going right toward money and Okay, I'm going to spend this, but how much am I going to get back? What we try to discuss is the bigger overall picture. As we mentioned earlier, work comp, ms. K, mental health absenteeism, sick days, all of that stuff. I think with huge, huge groups, you can probably get down to nitty gritty dollars, but I think for most of our groups they're overlooking at the RO, I think their goal is to just not break the bank.

Emma Fox (35:07):

And I think you bring up a really good point, which is that it so is multifaceted because it's someone's general disposition, their quality of life, the way that they feel about themselves, which sort of bleeds into the mental health conversation. Stephanie, I know you're getting pressure, right? You manage very large organization. What are you thinking is the forward future state for you guys and what is going to tip you over to start applying GLP ones for weight loss if you do do it?

Stephanie Koch (35:39):

So I would anticipate probably in the next year we are going to start putting a more formal plan together. We're just not in a space right now to do it, but I am interested in learning that resource from you because if anything, for us, we want someone to put the guardrails up and really help support our employees so they can really manage their weight loss journey and that it's sustainable. That is the key thing, that they don't just lose the weight and go backwards. So that is something we'll look at in the next year, most likely. We're just not there yet.

Emma Fox (36:13):

Dr. Larson, final thoughts. How should employers be looking to approve, include, and ultimately measure the success of adding GLP ones to their health plan?

Dr. Jon Larson (36:25):

Sure. Yes. A wise man once told me, no decision is a decision when it comes to covering this. And let me just interject before I go down that route that it is a disease. And I feel like when we talk about mental health, we used to consider that that's not a disease. Pull yourself up by your bootstraps, you'll be fine. Exercise, do these other things. But I feel like culturally, we're starting to get to the point where we recognize obesity is a disease, but in terms of outcomes, looking at weight loss at six months, at 12 months, and then to Stephanie's point, what's happening after 12 months in terms of keeping that weight off? And then as Kara had talked about, looking at medical claims, looking at pharmaceutical claims. And so yeah, I think the earlier we can intervene, stay away from bariatric surgery, stay away from type two diabetes, all these other comorbidities that just add and add costs, and it can be a difficult thing to quantify, but hopefully we as a society can come together and say, okay, maybe that employee leaves. But I think as a whole, in the end, we'll be much better if we're able to curb this epidemic of obesity.

Emma Fox (37:31):

Wonderful. Guys, you've been absolutely fantastic. For those of you in the audience, we will all be around for questions afterwards, and I hope you've enjoyed this discussion. I hope you'll continue it on at your respective organizations. Thank you so much. Thank you.

Dr. Jon Larson (37:44):

Thank you everybody.