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The good, bad, and ugly of medications used for weight loss: What employers need to know.

The good, bad, and ugly of medications used for weight loss: What employers need to know.

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The prevalence of obesity in the U.S. is over 40% and growing. Obesity and increased central adiposity (the accumulation of fat in the lower torso around the abdominal area) are associated with increased morbidity and mortality. In fact, obesity has surpassed smoking as the number one cause of preventable disease and disability, including Type 2 diabetes, hypertension, stroke, cancer, heart disease, and sleep apnea.

We are fortunate to have new medications that may decrease obesity, the highest cause of chronic illness in the population. Or maybe not so fortunate? It depends on how you view the full picture.

Current approach to treating obesity

Even though obesity is a chronic condition, it is not how the disease is currently treated. Weight loss medications are prescribed to less than 3% of eligible people in the U.S., and the average duration of therapy is less than 90 days. This treatment length isn’t sufficient to realize the full benefits these medications offer and doesn’t support long-term weight maintenance.

When people stop taking anti-obesity medications, there is generally subsequent weight regain and a recurrence in excess weight-related complications, so the drugs may need to be taken long-term, like drugs for any other chronic condition. However, the high demand for these medications has created significant supply shortages over the past year, causing many people to be without treatment for significant periods of time.

Plan coverage

An increase in prescriptions and the overall expense of these drugs has prompted insurance plans and self-insured groups to consider whether providing coverage for these medications is sustainable. Besides cost, sponsors need to consider the long-term efficacy and potential side effects of these medications.

As plan sponsors evaluate all the treatment options available to treat chronic conditions such as obesity and co-morbidities it’s important to consider the pros and cons of the weight-loss medications on your plan. These can be divided into three categories.

Weight-loss drugs

Most prescription weight-loss drugs work by making you feel less hungry or fuller. Some do both. The exception is orlistat, which affects the way your body absorbs fat. In addition, there are two classes of type 2 diabetes drugs that not only improves blood sugar control but may also lead to weight loss. These drugs are called glucagon-like peptide 1 (GLP-1) agonists and sodium glucose cotransporter 2 (SGLT-2) inhibitors.

Six weight-loss drugs have been approved by the U.S. Food and Drug Administration (FDA) for long-term use and these include:

  • Bupropion-naltrexone (Contrave)
  • Liraglutide (Saxenda)
  • Orlistat (Xenical, Alli)
  • Phentermine-topiramate (Qsymia)
  • Semaglutide (Wegovy)
  • Setmelanotide (Imcivree)

Diabetes drugs

Diabetes drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels and regulates the brain’s hunger signals by emptying the stomach slower. As a result, this helps with feeling satisfied with fewer calories and leads to weight loss.

Diabetes drugs in the GLP-1 agonists class are generally taken by a shot (injection) given daily or weekly or orally and include:

  • Dulaglutide (Trulicity)
  • Exenatide extended release (Bydureon)
  • Exenatide (Byetta)
  • Semaglutide (Ozempic, Rybelsus)
  • Liraglutide (Victoza)
  • Lixisenatide (Adlyxin)
  • Tirzepatide (Mounjaro)

Sodium glucose cotransporter 2 inhibitors

Along with helping to control blood sugar and boost weight loss, GLP-1s and SGLT-2 inhibitors seem to have other major benefits. Research has found that some drugs in these groups may lower the risk of heart disease, such as heart failure, stroke, and kidney disease. People taking these drugs have seen their blood pressure and cholesterol levels improve. It is believed that these improvements are due to weight loss.

A second class of drugs that may lead to weight loss and improved blood sugar control is the sodium glucose cotransporter 2 (SGLT-2) inhibitors. These tablets/ pills include:

  • Canagliflozin (Invokana)
  • Ertugliflozin (Steglatro)
  • Dapagliflozin (Farxiga)
  • Empagliflozin (Jardiance)
  • Bexagliflozin (Brenzavvy)

A holistic and long-term approach to coverage

The decision to initiate drug therapy should be patient-centric and made after a careful evaluation of the risks and benefits of all treatment options. However, if the decision to cover weight loss products is made by plan sponsors, it is recommended that a holistic approach is offered to plan members (including offering and ensuring compliance with wellness incentives/requirements, adopting prior authorization on these products, etc.)

Whether by way of lifestyle modification alone, lifestyle efforts plus medication, or lifestyle efforts plus surgery, the benefits reported with 15%-20% weight loss are notable. These outcomes include discontinuing or reducing the dosage of multiple chronic condition medications as a result of improvements to multiple weight-responsive co-morbidities. They also report positive benefits to mood, sleep, mobility, pain, and energy. There have been no detrimental outcomes reported to demonstrate weight loss due to medication is less effective than weight loss due to successful bariatric surgical intervention in conjunction with lifestyle modification.

More time and studies will confirm this hypothesis, but in the meantime, employers should consider the overall cost and associated benefits of this long-term therapy.


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