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Access with Accountability: Managing Anti-Obesity Medications

Public interest in using medications to help with weight loss is at an all-time high. With their success consistently advertised in the media, employers must now find a way to balance employee demand for these medications and the need for responsible usage and cost-containment. Weight loss medications are here to stay, so employers need implement a strategy that can help mitigate off-label usage concerns, and the overall financial impact on the health plan.

Are AOMs Appropriate?

Medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) offer significant benefits by reducing A1c in diabetes and aiding weight loss in overweight and obese individuals. However, their use demands careful consideration at all stages, necessitating expertise, such as that of a pharmacist, to ensure safe and appropriate utilization across the population. Prescribing entails evaluating potential interactions, contraindications, and warnings related to various health conditions. Moreover, being injectable, these medications require training for proper storage, preparation, and usage. Sustained results require intentional lifestyle modifications. Ongoing monitoring is crucial post-prescription to address tolerability, side effects, drug effectiveness, and the suitability of continued use. Professional oversight, especially during surgeries and the development of complications, is essential, with pharmacists playing a key role in monitoring and support.

Beyond Weight Loss and Insurance Challenges

These medications have shown to not only help users lose weight but also offer broader health benefits, impacting heart health and reducing the risk of other chronic diseases.1 However, at the member level, navigating insurance coverage is a bit complex. It's important to understand that GLP-1 medications can be approved for type 2 diabetes or for long-term weight management depending on the FDA’s classification, leading to differences in insurance coverage. Usually, diabetes medications are covered, but weight loss medication coverage is not as common. This not only poses challenges for individuals seeking access to specific medications but can lead to greater off-label utilization.

Financial Considerations and Lifestyle Impact

Given that the prices of GLP-1s exceed those of previous anti-obesity medications, it’s easy to see why employers are concerned about this rising trend in utilization. This financial burden not only affects individuals but also raises questions about employer-sponsored healthcare plans. Employees are wanting these medications, but employers need to ensure proper usage as part of a larger weight management strategy. While these medications can be beneficial for weight loss, it's important not to perceive them as miracle drugs or the sole solution for losing weight. Studies suggest that without making lifestyle changes, it’s likely that individuals will regain weight once they stop taking these medications.2 So if employers choose to offer them, they should do so in conjunction with a weight management program.

What to Look for In a Weight Loss Vendor

When seeking a vendor for a comprehensive weight loss solution, employers should evaluate how they handle GLP-1 medications. This involves assessing their management of GLP-1 medication utilization and the resources they offer to ensure they’re used effectively. It is crucial for employers to choose a vendor that offers clinical oversight, monitoring the effectiveness, side effects, and tolerability of medications. Additionally, an ideal weight loss vendor should be versatile, addressing various health aspects affected by weight loss. This includes monitoring health metrics like blood glucose and blood pressure for a holistic approach. Lastly, considering individual differences, employers need a solution tailored to treat patients at a personalized level.

Navigating GLP-1 Complexity

In summary, effectively navigating the landscape of weight loss medications requires employers to consider efficacy, coverage, and individualized care. Beyond promising results, adopting a comprehensive approach entails addressing insurance challenges, financial considerations, lifestyle impacts, and preventive measures. Vital to this process is the collaboration between healthcare stakeholders, ensuring individuals receive the appropriate medications while addressing the broader complexities of the healthcare landscape. As technology and medical research advance, it's crucial for continuous communication and collaboration to improve how we use weight loss medications.

About Tria Health

Tria Health assists plan members with chronic conditions by addressing polypharmacy issues, leading to improved health. To better understand why individuals don't achieve their clinical goals, Tria Health's pharmacists conduct one-on-one consultations and provide guidance. Through a comprehensive medication and lifestyle review, Tria's pharmacists improve health literacy, close gaps in care and optimized pharmacy utilization. The patient's care plan is always shared with their physician and is considered the basis for future consultations.

 

Additional patient resources are available based on the individual’s needs, including remote monitoring, weight loss management, and personalized medicine (DNA testing).

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