As a workers’ compensation claims payer, you may be closely monitoring the rapid adoption of glucagon-like peptide-1 (GLP-1) receptor agonists. Originally developed for type 2 diabetes management, these medications have gained significant attention for their effectiveness in weight loss. Let’s explore the potential impact of GLP-1s on workers’ compensation claims.
Understanding GLP-1 Medications
GLP-1 receptor agonists, such as semaglutide (Ozempic, Wegovy), liraglutide (Victoza, Saxenda), and tirzepatide (Mounjaro, Zepbound), work by mimicking a hormone that regulates appetite and food intake. While their primary use is for diabetes management, the weight loss effects have led to increased off-label prescribing and the development of formulations specifically for obesity treatment. This trend has continued to evolve, with the FDA recently approving Zepbound (tirzepatide) for chronic weight management.
Zepbound, which is a new formulation of tirzepatide, was initially approved as Mounjaro for type 2 diabetes treatment. Unlike its predecessors, Zepbound is the first in this class to be marketed exclusively for weight loss, marking a significant shift in the application of GLP-1 medications.
While there is no direct link between GLP-1 agonists and work-related injuries or illnesses, the growing prevalence of these medications presents new challenges for claims professionals. As the health benefits of weight loss can significantly impact injury recovery, claims adjusters may increasingly face coverage decisions related to these drugs. The potential for improved outcomes in workers’ compensation cases, albeit indirect, raises important questions about the role of GLP-1 agonists in claims management and treatment plans.
Check the Label for Frequency Directions
It is always recommended that patients read the ingredients and directions for dosing on all over-the-counter (OTC) and prescription medications. Close attention should be paid to the suggested dosage and how often the medication should be taken. The amount and frequency should never be exceeded without consulting the patient’s healthcare provider.
Potential Benefits for Workers’ Compensation
Given the increasing popularity of these drugs, some employees may already be taking GLP-1 medications for weight loss through their group health plan or paying out-of-pocket. This widespread use could indirectly impact workers’ compensation outcomes. Here are some potential benefits that may arise when employees are taking these medications, regardless of the source:
- Improved Recovery: Excess weight can complicate recovery from workplace injuries. GLP-1s may help injured workers lose weight, potentially speeding up healing and return-to-work times.
- Reduced Comorbidities: Obesity is associated with numerous health issues that can complicate workers’ compensation claims. Weight loss through GLP-1s could reduce these comorbidities and remove associated medications necessary to treat these conditions.
- Decreased Injury Risk: As workers achieve healthier weights, the risk of certain workplace injuries, particularly those related to musculoskeletal strain, may decrease.
Challenges and Considerations
- Cost: GLP-1 medications are expensive, with the cost for many of the most popular medications ranging from $900 – $1,300 per month. This presents a significant cost consideration for workers’ compensation insurers and employers. However, as patents expire in the coming years, the introduction of generic alternatives is likely to drive down costs.
- Long-Term Use: Early indication is that these medications must be perpetually used to sustain weight loss benefits. The long-term effects of these medications are still being studied. There are concerns about the need for ongoing use to maintain weight loss.
- Supply Issues: The popularity of these drugs has led to shortages, potentially affecting availability.
- Varying Efficacy: Different GLP-1 agonists may have varying levels of effectiveness. For instance, tirzepatide (Mounjaro, Zepbound) has shown potentially greater weight loss effects compared to semaglutide in some studies. This variability may influence decisions about which specific medication to consider if coverage is deemed appropriate.
Future Developments in GLP-1 Medications
The landscape of GLP-1 agonists is rapidly evolving, with significant research and development underway. Our review of the clinical trial pipeline reveals 39 new GLP-1 drugs in development from 34 companies. Interestingly, only seven of these companies are among the top 20 pharmaceutical firms, suggesting a diverse and competitive field of innovation.
Industry leaders Novo Nordisk and Eli Lilly are both preparing to launch new injectables and oral formulations. These developments could potentially improve efficacy, reduce side effects, or offer more convenient administration methods. As the market becomes more competitive with new entrants and formulations, there’s potential for a decrease in costs. Some companies are also working on longer-acting GLP-1 formulations that could reduce the frequency of doses, potentially improving patient adherence. While GLP-1 medications are currently expensive, increased competition and the eventual introduction of generic versions could drive prices down.
Researchers are also exploring combinations of GLP-1 agonists with other medications to enhance their effects or broaden their applications. These developments could potentially address a wider range of health issues, making these drugs more versatile in treating various conditions.
Regulatory changes are also shaping the future of GLP-1 agonists. Under the new Centers for Medicare & Medicaid Services (CMS) guidance, Medicare Part D plans can cover obesity treatments that receive Food and Drug Administration (FDA) approval for an additional health benefit. This change opens the door for wider coverage of GLP-1 agonists that demonstrate benefits beyond weight loss, potentially increasing their accessibility and use.
For instance, earlier this year, the FDA approved Wegovy as a treatment to reduce the risk of heart attacks and strokes, marking a significant expansion of its approved uses. Other drug manufacturers are studying weight loss medicines as potential treatments for fatty liver disease, sleep apnea, chronic kidney disease, and more. These expanded applications could further justify the use of GLP-1 agonists in various medical contexts.
If the broader healthcare market begins to cover GLP-1 agonists more extensively, attempts at cost shifting to workers’ compensation may be limited in the future. This could potentially reduce the pressure on workers’ compensation systems to cover these medications, as injured workers may have access to them through other health insurance channels.
Conclusion
The emergence of GLP-1 medications presents both benefits and challenges in the broader workers’ compensation landscape, but there is not clear evidence that coverage should be authorized for workers’ compensation. Looking ahead, workers’ compensation payers may need to develop guidelines for claims professionals to help with coverage decisions.
As the market for GLP-1 agonists continues to evolve, with new formulations being developed and patents eventually expiring, the cost-benefit equation may shift. Claims payers should remain informed, continuously reassessing the impact of these medications on claim outcomes and overall costs.
Contact us if you have questions about GLP-1 Agonists.