The new Wegovy pill – the first GLP‑1 weight‑loss medication you can take by mouth – is creating even more interest in a drug category that was already booming.
Many people who weren’t comfortable with injections may now take a closer look, simply because a daily pill feels easier and more familiar. With that growing interest comes a lot of important questions.
As interest expands, employers are facing important questions about overall cost, long term health outcomes, and how GLP 1 coverage fits into their broader benefits strategy.
Health plans and employers are watching this trend closely as more convenient options enter the market. Gary Petruzzelli, Vice President of Pharmacy Strategy & Services at Capital Blue Cross, says the new pill underscores why employers should look at the full set of considerations before deciding on coverage.
“The introduction of an oral GLP 1 will likely increase demand even more, which makes it even more important for individuals to understand all the factors involved – including costs, side effects, and whether these medications are the right fit for their long-term health goals,” Petruzzelli said.
What to Consider about GLP-1 Coverage
GLP-1 coverage can be costly
GLP-1 drugs can cost more than $1,000 per month for an individual, and users of GLP-1s need to stay on the drugs long-term or the weight comes back. Those who stop taking them typically regain two-thirds of the weight they lost within a year. The hefty and recurring cost has led some employers to end or restrict coverage of GLP-1 drugs due to concerns about affordability for both employees and their businesses.
Side effects might affect productivity
It’s well-documented that obesity can be a cost driver in employee healthcare, fueling absenteeism and undermining productivity. But GLP-1 drugs also have concerning and risky side effects – ranging from nausea, vomiting, and diarrhea to depression – that can lead to absenteeism or lost productivity.
Some have trouble staying on GLP-1s
Whether it’s due to high cost, unwanted side effects, or both, the majority of people who start using GLP-1 drugs stop taking them before they see any meaningful health benefit. This can mean a costly expense with no tangible result.
A drug alone won’t keep the weight off
GLP-1 drugs generally are not considered a standalone treatment for obesity, which often requires individual, comprehensive medical strategies and lifestyle changes. Exercise, behavioral changes, and even mental health counseling can be helpful to maintaining a healthy weight – and your healthcare plan can help make the difference.
How Capital Blue Cross Can Help
If you’re an employer considering (or reconsidering) whether to cover GLP-1 drugs for your employees, taking a comprehensive look at your healthcare coverage can help you decide.
Capital Blue Cross, for instance, can provide in-depth consultations to employers who have its group coverage. Capital’s medical experts examine cost and utilization data in addition to population health metrics to help employers identify healthcare-related issues impacting their employees. In addition, Capital can provide details regarding the prevalence of diabetes, high blood pressure and other conditions associated with being overweight to help employers make coverage decisions.
This insight can help businesses identify the most affordable, effective healthcare benefits and programs and better manage and support employee health and wellness.
For individuals, Capital offers tools to lose weight, prevent diabetes, and even manage or reverse Type 2 diabetes. Capital also offers a wellness program that gives your employees financial incentives simply for taking care of themselves.
Medications like GLP-1 drugs might be a helpful tool for some, but there are a host of other health and wellness resources available for your employees – and your business.