American businesses, which are experiencing increasing expenses due to covering the costs of Novo Nordisk’s Wegovy and other obesity medications, are enlisting the services of virtual healthcare providers such as Teladoc to establish weight-loss management programs, according to a group of twelve consultants, pharmacy benefit managers, analysts, and providers interviewed by Reuters.
These programs might need dietary and physical activity before allowing access to the prescriptions. In many instances, they will be the only covered choice for employees seeking pharmaceuticals such as Wegovy and Eli Lilly’s competing treatment Zepbound, both of which have monthly list prices over $1,000.
According to one of the benefits experts, firms might reduce expenses by restricting employees to smaller networks of more affordable providers or by requiring lifestyle changes before approving medications.
Another advisor praised the advantages of such programs, stating that dietary and physical activity plans could result in lasting enhancements in patient well-being.
Initially, numerous employers had doubts over the expenses associated with these medications. However, that perspective has now changed. Employers and health plans are becoming more inclined to provide coverage for them, with the appropriate policies in place,” stated Ananth Balasubramanian, an executive of Teladoc, during an interview.
Over a quarter of the 152 firms questioned by the Business Group on Health stated that they plan to utilize virtual physicians to manage obesity medicine prescriptions in the coming year.
Boeing, Hilton, and Fortune Brands are some of the firms that have entered into or expanded agreements with virtual healthcare providers, as reported by persons familiar with the situation.
Analyst Jailendra Singh from Truist predicted that the market for managing virtual obesity medicine may potentially reach $700 million by 2024 and could develop even further to approximately $9 billion in the long run. This estimation is based on the assumption that providers would charge around $30 per member per month and $50 for medical appointments.
According to a Reuters story in June, the use of obesity medications caused U.S. businesses to reconsider their insurance coverage. However, most employers either requested special permission or ceased covering diabetes medications that are used off-label for weight loss.
Aon, a consultant for healthcare benefits, presented suggestions in August to regulate the usage of GLP-1 medications. These suggestions include implementing “step therapy” and creating narrow networks or “centers of excellence.” Aon provided a 10-page document to their corporate clients outlining these proposals.
It is recommended that patients make lifestyle changes for a period of one to three months through programs offered by telehealth companies or pharmacy benefit managers (PBMs) before being prescribed medication. These programs aim to help patients adopt long-term strategies for healthier nutrition and exercise, providing them with coaching and other forms of support.
Wegovy and Zepbound are part of a group of medications known as GLP-1s, which were created for the treatment of type 2 diabetes. These medications help to decrease the desire to eat and slow down the rate at which the stomach empties. In clinical trials, they have been proven to decrease weight by approximately 15% and 20%, respectively.
The President of the American Medical Association, Jesse Ehrenfeld, stated that choosing telehealth providers that do not offer in-person care inappropriately diverts patients from their present doctors, which poses a risk to the continuity of their medical treatment.
He stated that telehealth should be an addition to, rather than a substitute for, in-person provider networks.
HEALTHY EATING AND PHYSICAL ACTIVITY
According to three virtual healthcare providers, the major service companies are looking for step treatment. This involves first completing a diet and exercise program and may also involve limiting the duration of the medicine’s use.
Blue Cross Blue Shield of Michigan, a health insurance company with over 5 million members, said that starting next year, it will provide employer clients with the choice to enroll in Teladoc’s weight management program. This program requires patients to undergo six months of diet and exercise before they may receive Wegovy or Zepbound.
They need to maintain the diet and exercise regimen to continue receiving the prescription for the medication.
Companies are also establishing “centers of excellence” for weight loss that would restrict the individuals authorized to prescribe the drugs.
Specialized initiatives designed to equalize service quality and reduce costs for expensive treatments such as knee replacements are already prevalent in areas like cardiology and bariatric surgery, but they are seldom implemented virtually.
Richard Frank, a senior employee at virtual provider Vida Health, stated that his organization intends to oversee a weight-loss center of expertise for at least one of its clients in the coming year. He mentioned that Vida will enhance the quality of life for patients by encouraging them to prioritize aspects beyond weight loss.
The step-therapy approach was not designed to create obstacles, but rather to ensure that patients receive appropriate care when it is needed, according to him.
Capital RX, a pharmacy benefit manager with over 200 clients covering around 2.4 million individuals, stated that over 20% of its clients expressed interest in centers of excellence for obesity.
BMO analyst Evan Seigerman stated that the market for GLP-1 obesity medications will be influenced by supply next year, and it is doubtful that obstacles such as these will affect the sales of Novo or Lilly.
Both Wegovy and Zepbound U.S. approvals stated that they should be used in conjunction with dietary and activity modifications.
According to benefits expert Jeff Levin Scherz at Willis Towers Watson, businesses can use weight reduction programs to distribute the expense of a prescription or even avoid paying for it completely. According to him, they might postpone the qualification, and when people become eligible, they could potentially no longer be enrolled in the plan.