Why is everyone talking about Ozempic?
Over a century ago, Frederick Grant Banting and Professor John James Rickard Macleod were awarded the Nobel Prize for discovering insulin, a revolutionary treatment for diabetes. Since then, the lives of thousands of people with diabetes have been saved by insulin treatments. Yet today, diabetes remains a common cause of illness and shortened life expectancy, resulting in constant pressure on our healthcare system. In recent years, another revolutionary treatment came to the scene in the form of a class of medications known as GLP-1 agonists. This class of drugs is used to treat type 2 diabetes and include medications such as Ozempic, Mounjaro Saxenda, Victoza and others.
Recently, there has been a lot of talk on social media about these same medications - i.e., Ozempic, Wegovy, Saxenda, and Mounjaro - used as prescription treatments for weight loss. In fact, Ozempic and Wegovy are currently so popular that due to increased demand, there is a global shortage, and manufacturers only expect to restock in small amounts by the end of 2023. This is a massive cause for concern for diabetic patients who rely on these life-saving medications to prevent a relapse of symptoms, many of which are unfortunately already experiencing.
GLP-1 agonist medications are expensive and are often classified as "lifestyle" drugs, so some may question whether plan sponsors should offer coverage for them. However, there may be more to consider than initially meets the eye.
Sponsors may initially hesitate to cover a seemingly trendy TikTok phenomenon, but doing so could ultimately result in saving millions of dollars in healthcare costs. With the evolution of drug benefits, payers should acknowledge the worth of investing in groundbreaking therapies such as Ozempic & Mounjaro. The crucial factor in achieving a mutually advantageous outcome for employers and employees is implementing the appropriate anti-obesity strategy in the benefits plan.
Here are some staggering stats
Over the past ten years, obesity has been acknowledged as a serious health crisis. More than one in four adults in Canada struggle with this complex and chronic medical condition. Obesity has significant economic consequences for individuals, families, employers, and society as a whole. The evidence strongly suggests that obesity is not merely a "lifestyle" issue. It is estimated that the direct and indirect costs of obesity in Canada amount to $9B annually. Unfortunately, plan sponsors often bear the costs associated with lost productivity, short- and long-term disability, and direct medical expenses resulting from obesity-related illnesses.
A huge number of costly medical conditions are attributable to obesity: cancer, kidney disease, liver disease, sleep apnea, diabetes, depression, and the list goes on. Consider just a few sobering examples.
- Individuals who are overweight or obese have a greater likelihood of needing knee replacement surgery, which is a major and costly procedure. This can result in short-term disability claims, rehabilitation, pain medication, physiotherapy and other related expenses. Research shows that losing weight can reduce the need for surgery and its associated costs by 31%.
- Obesity is also linked to a 32% higher risk of depression, which can result in significant treatment costs for private payers, estimated at around $6000 per member annually.
- Additionally, obesity is a major risk factor for metabolic syndrome, which can lead to serious health issues like heart disease, diabetes and premature death. Healthcare costs for people with metabolic syndrome are 1.6 times higher.
- Obesity puts greater stress on the heart to pump more blood around the body, leading to high blood pressure. This, in combination with a rise in bad cholesterol and reduction of good cholesterol, put individuals at higher risk for heart attack.
Despite more and more medical evidence showing how obesity affects your long-term health, only around 35% of plan members have coverage for obesity medications. This often arises from outdated beliefs that obesity is a matter of self-control and will rather than a chronic medical condition.
Eighty to ninety percent of the time, obesity and type-2 diabetes can occur together in an individual. In these cases, Ozempic can be very helpful as it can reduce both blood glucose levels and weight, allowing plan members to achieve benefits for both conditions. This synergistic approach saves money for both plan sponsors and members.
On average, if an individual is not covered by public health insurance, type 2 diabetes treatment costs could add up to about $5,500 per patient per year in Canada. As diabetes worsens, patients require more medications, medical devices such as insulin pumps or continuous glucose monitors, and more supplies for insulin injections— triggering further inflated costs. Other considerations are long-term expenses incurred by hospitalizations, disability caused by vision loss, limb loss, and much more.
My opinion
The utilization of anti-obesity medications by insurance companies presents an opportunity for significant cost savings for patients in the long run. However, it is imperative for plan sponsors and benefits advisors to ensure appropriate coverage implementation because plan members typically require additional support when taking these medications. Inadequate programs and resources may lead to unsatisfactory patient outcomes. Research shows that incorporating lifestyle changes and chronic disease management is crucial.
At Pocketpills, we understand the vital link between drug and non-drug therapies. Our upcoming diabetes management program will allow members to connect virtually with a team of healthcare professionals to proactively manage all aspects of their clinical weight loss and diabetes needs.
Medications such as Ozempic and Mounjaro hold great promise in addressing the obesity epidemic, offering a viable solution for better disease management and long-term cost savings. Insurers, TPAs, and benefits advisors should adopt appropriate screening processes to ensure that plan members participate in effective treatment plans and receive a holistic program overview to treat their symptoms. By providing adequate coverage and integrated programs, plan sponsors can improve member outcomes and potentially save millions in healthcare expenses.
Based on my analysis, it is projected that the Anti-Obesity market will reach a worth of $6 billion dollars in Canada by 2030.
