Integrating Weight-loss Therapy Into Benefits Coverage 

Obesity (BMI>30) is a global epidemic affecting more than 650 million people worldwide.1It is a major contributor to the development of cardiovascular disease, diabetes, osteoarthritis, certain cancers, sleep apnea, depression, and most recently, COVID-19. The financial burden of these conditions results not only from their dramatic impact on healthcare expenditures for the self-insured employer, but the effect on productivity and absenteeism in the workplace. A 2009 study estimated that the annual cost of “excess” medical spending attributable to overweight/obese individuals was $86-$147 billion while national costs of annual absenteeism from obesity was $3.38-$6.38 billion or $79-$132 per obese person.2,3,4 Unfortunately, these costs are expected to rise, as it is anticipated that by 2030 nearly half of all adults will have obesity, with a quarter qualifying as severely obese (BMI >35).5 

Historically, employers attempt to control spending by implementing solutions that revolve around encouraging lifestyle changes to promote weight loss. However, those that have difficulty achieving their weight-loss goals through comprehensive lifestyle modification alone may wish to seek pharmacologic options. The choice of anti-obesity medication is typically dictated by patient-specific factors such as comorbidities, relative contraindications, and patient-preference. More recently, GLP-1 agonists such as liraglutide (Saxenda) or semaglutide (Wegovy) have demonstrated beneficial glycemic and cardiovascular effects in addition to weight loss in patients with type 2 diabetes, which may present unique opportunities for self-insured employers to control costs associated with this type of patient. Other available options include medications such as phentermine (Adipex-P), diethylpropion (Tepanil), bupropion/naltrexone (Contrave), lorcaserin (Belviq), and orlistat (Alli), which may also provide opportunities for cost-savings when coupled with education and monitoring performed by a pharmacist. 

When comparing the cost-effectiveness of these products, a 2019 analysis found that out of all of these options, phentermine resulted in the most weight loss in the first year and was the least expensive option making it the most cost-effective option.6 However, phentermine is contraindicated in patients with cardiovascular disease or a history of drug abuse. It is also worth noting that weight-loss on phentermine was not well-sustained after the first year whereas semaglutide became the most effective strategy over 3- and 5-year time horizons. Unfortunately, due to its high cost, semaglutide did not achieve cost-effectiveness in this study despite its effectiveness. However, with the right prior-authorization criteria in place, it is still possible that significant cost-savings may be achieved by making it available to a strategically-selected patient population. 

Ultimately, with obesity on the rise as a global public health issue, time will present the urgent need for evidence-based approaches with the ability to control excess medical expenditures and negative impact on workplace productivity. If you are looking for solutions to address the effect obesity may be having on the health of your organization, the Profero Team can help determine if new weight loss therapies are an appropriate addition to your formulary or wellness benefits. If you’re ready to learn more, please reach out to the Profero Team, and find out how we can help!

References:

Obesity and overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Published June 9, 2021. Accessed September 22, 2021. 

 Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-w831. doi:10.1377/hlthaff.28.5.w822 

Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ. Indirect costs of obesity: a review of the current literature. Obes Rev. 2008;9(5):489-500. doi:10.1111/j.1467-789X.2008.00472.x 

 Durden ED, Huse D, Ben-Joseph R, Chu BC. Economic costs of obesity to self-insured employers. J Occup Environ Med. 2008;50(9):991-997. doi:10.1097/JOM.0b013e318182f730 

Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019;381(25):2440-2450. doi:10.1056/NEJMsa1909301 

Lee M, Lauren BN, Zhan T, et al. The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. Obes Sci Pract. 2019;6(2):162-170. Published 2019 Dec 10. doi:10.1002/osp4.390