Weight loss drug trends for employers to know in 2024

As we turn the page toward 2024, employers and employees are thinking about their health plans and needs. Over recent years, we’ve seen new pharmacy and drug trends taking over the industry. As pharmacy director for Holmes Murphy, I’m closely following new pharmacy developments and what employers should be aware of heading into next year, including the increasing popularity of weight loss medications. How well do these medications work and should employers offer plans that cover these drugs?

Let’s preface by understanding the origination of when these weight loss medications came around. In 2005, a class of medications hit the market for treatment of type 2 diabetes (T2 diabetes), called glucagon-like peptide 1 (GLP-1) receptor agonists. These drugs mimic the action of a hormone called GLP-1, which works by reducing appetite, slowing the release of food from the stomach, and increasing feelings of fullness after eating. Ozempic (semaglutide) hit the marketplace in 2017 for treatment of T2 diabetes, while Wegovy (semaglutide) was approved in 2021 for chronic weight management. Zepbound (terzepitide) received approval as an anti-obesity medication (AOM) on Nov. 8.

Studies found that people who were using semaglutide and making lifestyle changes lost about 33.7 pounds (15.3 kilograms) versus 5.7 pounds (2.6 kilograms) among those who didn't use the drug. Most weight loss drugs are intended to be used along with diet and exercise. They’re intended for use in adults with a body mass index greater than 30 or a BMI of 27 or higher when a patient presents one or more obesity related comorbidities, which is the Center for Disease Control’s obesity standard. People who take these medications without behavior modification will use them for the long haul as stopping will make their appetite return.

Most people can tolerate GLP-1s well. The most common side effects (nausea, vomiting and diarrhea) are usually mild and occur in the first few weeks of treatment, and then reduce over time. Some severe reactions such as gut paralysis have been noted along with correlation investigations in Europe for upticks in suicidal thoughts.

Employers must be aware of and understand the trends that may come about soon. Coverage of weight loss medications are likely to expand once market competition increases and adherence challenges are addressed. It’s anticipated that oral treatments and lower out-of-pocket costs should increase adherence. Plan sponsors that cover anti-obesity medications must be aware of success bias, as patients lower their BMIs through using medications of which prior authorization criteria is not weight-based for continued treatment.

It's also important to know the cost range for these popular medications. The list price for Zepbound is $1,059, which is about 20% lower than the current list price of Wegovy. Uninsured patients may be able to obtain a 50% discount on list prices. Recent Morgan Stanley research predicts that competition in this class will reduce monthly drug costs from $1,300 per month to $450 by 2025 and $350 by 2026.

Employers should consider several options regarding employee health plans and weight loss medications. Some considerations include moving from a traditional pharmacy benefits manager to an acquisition cost-plus PBM, determining prior authorization and utilization management criteria that serve your needs, and using coverage as an employee retention and talent attraction tool.\

I believe this form of pharmaceutical support should be offered in combination with lifestyle and behavior support. The medication alone will not be a long-term cure; it must be coupled with behavioral change. For employers, behavior support can be provided through a proven weight-management vendor, connection with a registered dietitian, or research.

There are various reasons for employers to offer weight-loss medications. Understanding the details, trends, and considerations will be great factors for the decision.

Nathan Cassin serves as pharmacy director at Holmes Murphy & Associates. Contact him at [email protected].

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