Obesity is clearly a national problem that impacts employee health and productivity, as well as health plan costs. Enter the wave of pricey new GLP-1 weight-loss and diabetes medications ꟷ a cost driver for plan sponsors and potential panacea for members.
Physicians have observed that GLP-1s appear to help curb hunger. These drugs also slow the movement of food from the stomach into the small intestine. As a result, users may feel full faster and longer, so eat less.
Are these drugs the long-awaited “magic” pill (or injection) to greatly reduce the prevalence of diabetes, heart disease, musculoskeletal problems, and other serious conditions that tend to follow-along with obesity? Or might they actually lead us in the opposite direction?
The idea of taking a pill to improve health without any adverse side effects (short-term or long-term) is a pretty irresistible proposition. Even if it were expensive, we could certainly rationalize a high price tag with the longer term physical and fiscal benefits. We’re talking increased productivity, as well as avoided illnesses and the associated surgeries, hospitalizations, and other treatments that may entail.
The Flip Side
But there might also be another side to the story (Isn’t there always?). You may be familiar with the Law of Unintended Consequences ꟷ a frequently observed phenomenon in which any action has results that are not part of the actor’s purpose.
The consequences may or may not be foreseeable or even immediately observable and they may be beneficial, harmful, or neutral in their impact. There are a few types, but the most relevant to our discussion is when an intended solution makes a problem worse.
What if the magic pill takes the pressure off of our food industry to eliminate highly processed, unhealthy substances from our diets? Or on a personal level, will it make us less likely to be active and choose healthier food options? Call us cynical, but there’s actually a fair amount of evidence that supports this viewpoint.
A fascinating glitch in human psychology called self-licensing is where we often justify an unhealthy decision (like eating a donut) because we did something healthy (lost weight, exercised, etc.). It’s all detailed in a study entitled, Vicarious Goal Fulfillment: When the Mere Presence of a Healthy Option Leads to an Ironically Indulgent Decision.
Another group of researchers gave smokers placebo pills described as Vitamin C. The result? Participants actually smoked more than the control group. In yet another study, subjects given placebo pills described as “dietary supplements” were more likely to choose the buffet over a healthy meal option. And there are plenty of other examples.
Bottom line: People who rely on GLP-1s for health protection may fall prey to the curse of licensed self-indulgence and end up another victim of unintended consequence.
At What Cost?
Then there’s the issue of employer cost/benefit. In essence, coverage of these drugs may cost $500 per plan member per year (ALL plan members, not just per obese adult). This assumes only half of those clinically eligible use these drugs.
So, let’s say the drugs do provide the intended net benefits long term. Will the employer who made the investment be the same one to reap the rewards of a healthier employee?
Of course, it seems callous to turn our back on people wrestling with obesity because of cost. Most of us wrestle with our weight, and corporate wellness programs have not been able to make a noticeable impact on this population health trend.
But instead of simply throwing another log on the fire, it may be time to rethink how your wellness program is structured and, potentially, redirect some funds to offset this new cost (Are those health questionnaires and biometric screenings really accomplishing anything?).
The new drugs are designed to support improved diet and increased exercise — not replace them. If your plan does opt to cover GLP-1s for weight loss, you might want to at least pair it with formal coaching and monitoring programs. [Note: The rebates are huge, so PBMs will be motivated to get these drugs out the door in rebate-driven arrangements, which is most PBM contracts.]
There are many more strategic considerations here. But at a minimum, we recommend plan sponsors proceed with caution.
There is nothing wrong with putting your foot on the brake and taking more time to learn how these drugs function more broadly in the real world. Because beyond the financial costs and unintended behavioral consequences we’ve discussed, we still don’t know if they will improve physical health in the long term and all the potential side effects.