With the prevalence of obesity impacting nearly 40% of Americans, employers are facing a growing demand for more encompassing obesity care benefits, including coverage for GLP-1 medications. Recent survey data underscores the significance of this trend with more than half (51%) of the respondents with obesity saying they would endure a less-than-desirable job to maintain their coverage for obesity treatment. Simultaneously, 44% would switch jobs if it meant gaining access to such benefits. Accolade has been closely following these developments. Our interest is not just about the potential of GLP-1 drugs as a groundbreaking solution for obesity, a complex biosocial health condition. It's about understanding the broader implications for healthcare plan design and the challenges that HR leaders and plan sponsors face.

So, is it time for employers to consider incorporating coverage for GLP-1s into their health plans? This question is multi-disciplinary in nature and might be the most crucial plan design decision companies make this year. To explore this question, I moderated a discussion with Accolade leaders: chief human resources officer Jennifer Hanson, associate chief medical officer Dr. James Wantuck, and senior vice president of shared services Nancy Costlow, PharmD.

While our panelists shared a wealth of information – and we don’t have it all figured out yet – here are five top takeaways from the discussion:

1. Right there with you: Trends with our employees

Just like many employers, we’re grappling with how to balance investments in employee health with our organization's financial sustainability. With more than 2,000 individuals enrolled in our health plan, we’ve traditionally opted not to cover weight loss drugs – a stance shared by approximately 78 percent of other employers. Instead, our focus has been on weight loss and management solutions such as those offered by our Trusted Partner, Virta Health, and bariatric surgery with a pre-authorization.

However, we do cover GLP-1 medications for our employees diagnosed with Type 2 diabetes and we’ve seen a noticeable uptick in the use of these medications since 2021, with Accolade users increasing from 29 to 162 and total costs more than tripling to nearly 500k in the first half of 2023.[1] And this data does not account for self-pay users without a Type 2 diagnosis, which would further increase the current utilization in our population.

With obesity being a significant risk factor for developing diabetes and a contributor to poor health in general, expanding the conditions that are covered by GLP-1s could help us move downstream in providing additional weight management tools to support employees with this health condition before they develop a comorbidity like diabetes.

It’s important to note that we strongly encourage our employees to work closely with their doctors to determine their best treatment options. In doing so, we hope to support our community in taking proactive measures toward their health, thereby redefining the very essence of healthcare solutions.

2. Recognize obesity as a complex chronic condition

We know that obesity is more than just a matter of physical appearance or willpower. It's a complex chronic disease that requires comprehensive intervention and treatment. Employers' understanding of this health condition is crucial to employee health and productivity. Obesity indirectly affects employers through increased absenteeism, reduced productivity, higher workers' compensation, and disability claims. A study found that obesity raises job absenteeism due to injury or illness by three days per year – a significant impact for businesses where working from home or make-up time isn't an option.[2]

And it's not just about the numbers — it's about people. Obesity affects an employee's quality of life in numerous ways, including sleep disruptions and mental health issues. Addressing obesity should be a priority as part of a broader commitment to supporting employees' overall well-being.

Employers should respond by considering comprehensive obesity care benefits as part of their healthcare plans and that could include the decision to include coverage for treatments like GLP-1 medications.

3. How to think about the cost of GLP-1s

The fact is GLP-1s also come with a price tag that is hard to ignore.

From an employee perspective, with many insurance plans not covering them, employees are left grappling with costs that can exceed $1000 per month. On the other hand, the obesity management options more commonly covered by employers like gastric bypass surgery or sleeve procedures may cost less out of pocket for employees but can come with a higher personal cost. Surgeries come with their own set of challenges and risks, including excessive bleeding, infections, and adverse reactions to anesthesia. Surgery is a daunting choice for employees to make.

From an employer's perspective, this presents a conundrum. Covering the cost of weight loss surgeries might seem like a viable solution, but it's important to consider the potential risks and complications. These could lead to extended periods of recovery or even disability, further impacting the productivity and morale of your workforce. Adding GLP-1s as an alternative to surgeries will increase choice for employees and will present a different path forward with obesity management than surgery.

This brings us to the broader issue at hand − the financial implications of obesity for employers. The costs aren't just limited to healthcare expenses or surgical procedures. They extend to increased absenteeism, reduced productivity, and higher workers' compensation and disability claims. In fact, tackling the issue of obesity head-on could be one of the most impactful decisions an employer can make, not just for their bottom line, but for the overall health and well-being of their employees.

Have you ever wondered just how much obesity costs your business? It's not just a few extra dollars here and there. In fact, it's an additional $3,097 per adult. That's before we even start talking about other health issues that often go hand-in-hand with obesity, like diabetes, heart disease, and musculoskeletal problems. Imagine adding another $16,752 to your healthcare bill for every employee with these conditions.[3]

At Accolade, we understand that the thought of investing in a pharmacy benefit like GLP-1s can seem daunting due to the upfront cost. However, we firmly believe there's more to this picture. Our approach to healthcare suggests that these initial expenses may lead to lower overall healthcare spend at the population level as employee health improves over time.

We're not claiming to have all the answers, but the important part is asking the right questions to guide us through this financial maze. We're focusing on how we can define appropriate use to manage costs effectively, rather than taking a simplistic "yes, cover everyone" or "no, cover no one" stance.

Here are some of the key considerations that are guiding the thinking of our leadership team:

• How can we provide access to GLP-1s without imposing an undue financial burden on our organization?

• What criteria should we use to decide who receives these medications and when?

• How do we offer support to employees during and after GLP-1 treatment?

• And should employees who don't qualify for GLP-1 treatment for weight loss be covered for other reasons?

As GLP-1 usage grows, with trends indicating a shift towards 20-pound weight loss goals even in non-obese or non-overweight patients, it's crucial to focus our conversation around these questions. We also need to acknowledge the significant role social media plays in shaping this narrative.

As we continue to deepen our understanding of the implications of GLP-1s and as more research unfolds, these discussions will take center stage. Defining appropriate use and managing the cost of these treatments will be critical in shaping the future of obesity management.

4. The potential of GLP-1s is far-reaching

In the ever-evolving world of healthcare, GLP-1s have emerged as a game-changer with far-reaching implications. Their impact on diabetes and weight management is nothing short of transformative. These medications have demonstrated remarkable efficacy in managing diabetes and have shown promise in weight management, an area where many traditional approaches often fall short. But the benefits don't end there. GLP-1s have heart-protective properties too. They can reduce the risk of major adverse cardiovascular events in high-risk patients with Type 2 diabetes.[4] Early research also suggests they could treat alcohol and opioid addiction.

But to be clear, GLP-1s are not a magic bullet. Like any treatment, they come with potential side effects. And yes, their long-term cost-effectiveness is still under review. But isn't it worth exploring all options when it comes to our employees’ health?

In the dynamic landscape of healthcare, GLP-1s have certainly carved out a significant niche, but it's crucial to remember that they are part of a larger toolkit of solutions. They represent an exciting development in healthcare, but their long-term cost-effectiveness and overall impact on healthcare outcomes still warrant further exploration. As we continue to navigate the complexities of healthcare, the emergence of GLP-1s underscores the importance of ongoing research, innovation, and keeping an open mind.

5. Doctors should guide use of GLP-1s

In the ever-changing world of employee wellness, HR leaders increasingly recognize the importance of creating a supportive healthcare experience for employees. We at Accolade believe that the best people to decide who will benefit from this drug are the doctor and the patient. A key step in this direction is enabling strong relationships between employees and primary care physicians (PCPs). Having a trusted physician helping your employees decide whether and when to take GLP-1s is critical.

PCPs play a pivotal role in managing complex health conditions as it is their training and their job to provide a holistic and knowledgeable care plan that addresses prescribing and adjusting medications for diabetes, blood pressure, and cholesterol and gives guidance on dietary and exercise modifications. We believe an employee's relationship with their primary care doctor is paramount in navigating the complexities of health issues like obesity and avoiding the pitfalls of turning to online pill mills for a quick-fix solution.

Another crucial aspect of supporting employees dealing with obesity is understanding the importance of behavior modifications, especially for those taking GLP-1s for weight loss. While these drugs alter hunger signals and aid weight loss, their efficacy is significantly enhanced when paired with behavioral changes. These can help maintain weight control even after discontinuing the medication, thus preventing weight regain or a potential rebound effect. Finding the right wellness programs creates a comprehensive offering for employees.

Lastly, do not overlook the support that currently exists within your health plan. Help your employees discover these benefits, including access to nutritionists, dietitians, and physician-led weight loss programs. Remember, these medical interventions can significantly enhance the effectiveness of treatments like GLP-1s. By embracing these strategies, HR benefits leaders can create a more supportive and health-conscious environment for their employees.

While GLP-1s present an exciting way forward in obesity management, balancing their potential with financial feasibility is essential. We need to think about cost, effectiveness, and coverage. We need to ask hard questions and make tough decisions.

So, let's continue to explore, question, and push for better solutions because everyone deserves access to effective, affordable healthcare. Together, we can create a healthier future for our employees. To learn how Accolade can help, contact us today.

For more information, watch our full webinar, An employer’s perspective: How to navigate the opportunities and risks of GLP-1s.

Sources: 1. Accolade internal results/data 2. https://pubmed.ncbi.nlm.nih.gov/33769330/ 3. Centers for Disease Control and Prevention, “Consequences of Obesity,” July 15, 2022. 4. https://pubmed.ncbi.nlm.nih.gov/36039183/