Everybody is talking about weight-loss drugs.

When it comes to anti-obesity drugs, employers are facing what feels like an insurmountable challenge. On the one hand, they want to provide a comprehensive drug benefit that supports employees’ health needs. On the other, as always, they need to manage cost. And therein lies the struggle.

The demand for pharmacological solutions to address the obesity epidemic can come at a steep price. Although these medications have been approved for several years, the recent media attention has brought these issues to the forefront.

As you review options for anti-obesity medications, your ability to effectively manage your drug benefits program has become even more challenging. For example, semaglutide, is both an anti-diabetic and anti-obesity injectable drug. The main difference is the amount of semaglutide being prescribed. For antidiabetics, the brand name is called Ozempic, and it is available in 0.5 mg, 1 mg, or 2 mg dosages of semaglutide. For anti-obesity, the brand name is Wegovy, which can titrate to as much as 2.4 mg of semaglutide. The price of these drugs can vary widely, making it ever more important for employers to manage their drug benefit program with an eye towards cost.

Employers should ensure that employees who seek out these drugs meet the clinical criteria for type 2 diabetes or obesity, that their comorbidities are being co-managed to ensure their safety, and that less expensive drug therapies have been tried in advance of the more expensive alternatives

As you explore your options and the effects on your benefits program, consider the following in your analysis:

1. What is the prevalence of type 2 diabetes and obesity across your membership?
   • Obesity is a risk factor for high blood pressure, high cholesterol, coronary artery disease, stroke, cancer, osteoarthritis, sleep apnea, and more.
2. Do you have a prior authorization and proper clinical/medical necessity protocols in place to assess the appropriateness of the request for anti-obesity drug coverage?
   • Employers should work with their PBM vendor to review the current clinical criteria and implement utilization management (i.e., prior authorizations, step edits) as necessary.
3. Do you offer a comprehensive adjunct weight loss support program incorporating lifestyle and behavior changes, and nutrition education?
   • Consider implementing a wellness program to ensure sustainable and long-term success of your employees.

Optimatum can help you navigate this complex topic and work with you and your vendor to arrive at a practical solution for your plan and employees.

Our Employer-sponsored Health Care Practice provides vendor management solutions for the HR supply chain. We work with your HR vendors to optimize your benefit plans, processes, and systems, which often results in savings or trend mitigation without cost shifting or decreasing benefits.

Optimatum is a vendor management firm that focuses exclusively on the HR supply chain with turnkey solutions that improve the financial, operating performance, transparency and accountability of HR Benefit programs while still maintaining existing vendor relationships.

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