2024/05/23
Ozempic, a drug few knew about a year or two ago, has changed the world we live in. It’s become a household name, especially within the employee benefits industry. This surge in notoriety has brought both praise and criticism. While Ozempic and similar drugs have significantly benefited diabetics, their use for weight loss has sparked lots of discussion. It may be time to reconsider the stigma surrounding weight loss drugs and recognize their potential benefits.
Diabetes has now grown to be in the top therapeutic class of drugs in Canada, and the prevalence of Diabetes is expected to grow further given the relative age and poor health of Canadians. There is no doubt that Ozempic, and the broader class of drugs commonly known as GLP-1 drugs, has had a profoundly positive impact on the health of diabetics.
However, despite their success in treating diabetes, GLP-1 drugs like Ozempic have faced backlash for their “off-label” use in weight loss. Social media and celebrity endorsements have intensified this negativity, thereby overshadowing the drugs' benefits. All that said, the Canadian insurance industry has now built suitable protocols in employee benefits plans to ensure these drugs are only available to diabetics, which is also helping address supply chain concerns.
All the excitement around Ozempic did generate some positive discussion around obesity. There are drugs equivalent to Ozempic that will soon be available to Canadians, under the class of weight loss drugs (i.e., Wegovy is the equivalent to Ozempic). Recognizing obesity as a chronic disease opens the door to medical interventions that can help manage it effectively. This shift is crucial, considering over 60% of Canadians face health risks related to being overweight or obese.
There may also be greater acceptance for weight loss drugs given that there might be a positive Return on Investment by reducing plan costs for expenses like (1) drugs treating blood pressure, cholesterol, and mental health, for (2) medical devices like CPAP machines and knee braces, and for (3) paramedical services like physiotherapy and massage. Moreover, supporting weight loss aligns with Diversity, Equity, and Inclusion (DEI) initiatives, given that the majority of Canadians are either overweight or obese.
With Ozempic now effectively restricted to diabetics, and their effective equivalents becoming available for weight loss, where do we go from here? When trying to assess future employee benefits trends in Canada, it is often useful to look south of the border to the U.S., as they feel health care issues more acutely since plan sponsors are responsible for much larger primary health care costs. For example, here are a couple recent market trends within the U.S.:
- Several leading insurers in the U.S. have agreed to provide coverage for weight loss drugs to employees with certain heart conditions that meet certain body weight criteria to reduce heart attack risk.
- Costco members in the U.S. will be able to access these weight loss drugs if they are approved by a third-party provider that will help patients with appropriate diet, exercise and lifestyle modifications. Members would need to pay for the cost of the third-party provider and the cost of the medications.
Based on my recent experience, I believe employee benefits plan sponsors are generally supportive of adding weight loss drugs to their plans, but they are concerned about the potential costs and the lack of data to support offsetting decreases in current plan costs. Note that your employee benefits plan may already include some coverage for weight loss drugs but newer GLP-1 drugs like Wegovy may not be covered.
These new diabetic drugs, and now their weight loss equivalents have truly changed the landscape around obesity and could reshape the related healthcare system for millions of Canadians. Perhaps we need to assess this dilemma from a morally compelling perspective. We do not currently withhold medication for other chronic diseases like hypertension or cardiovascular conditions just because lifestyle changes alone could help in their treatment. So why shouldn’t obesity be treated similarly, with a combination of medical intervention and lifestyle adjustments? Why is it still appropriate to simply compel those with obesity to treat it with willpower and lifestyle adjustments around diet and exercise? Even when other chronic diseases can be improved with lifestyle changes, we do not cease providing medications. Obesity is a recognized and deadly chronic disease, and we may now have a way to treat it, so where do employee benefits plan sponsors go from here?
In a perfect world, we need assistance from the Canadian insurance industry to ensure these drugs are going to the right people and coverage will only continue if they generate positive results. Eligibility criteria, such as BMI levels and physician oversight, can ensure these drugs are used appropriately. In my opinion, if employees do not play their part in the weight loss program and/or the drugs prove to be ineffective, coverage should cease. This all makes sense intuitively but there are lots of remaining steps to resolve in order to make it happen.
It is time to stop shaming weight loss drugs and recognize their potential to improve health outcomes for those struggling with obesity. Obesity is a chronic and deadly disease, and medical intervention should be embraced just as it is for other chronic conditions. By shifting our perspective and policies, we can transform obesity treatment and enhance the healthcare system for millions of Canadians.
We would be pleased to discuss your specific situation with you to identify the best strategy for your employee benefits plans. Should you have any questions on the above, please do not hesitate to contact any member of our team.
ZLC Employee Benefits Solutions is one of the fastest growing advisors for employee benefits and group retirement programs in Vancouver and we are fortunate to have the best people, resources, and clients. We provide value by leveraging one of the most skilled benefits teams – collectively over 450 years of experience within our team of 21 employee benefits specialists. We have been working with businesses ranging from 3 to over 75,000 plan members for almost 40 years.