'Obesity is a hidden driver in benefits plans costs' warns vice president at Cowan Insurance
Despite the medications available, obesity has become a workplace issue with far-reaching consequences, leading to productivity issues, healthcare costs, employee well-being and ultimately, employers’ bottom line.
With 1 in 3 Canadians living with obesity, employers are being implored to ensure their benefits plans provide effective, evidence-based treatments.
“One of the most damaging misconceptions about obesity is that it's simply a matter of willpower. This couldn't be further from the truth,” said Ian Patton, director of advocacy and public engagement at Obesity Canada, in a recent webinar hosted by Connex Health.
“Obesity is not self-inflicted. It’s a complex chronic disease influenced by genetics, biology, and environment. Failing to treat obesity as a chronic disease doesn't just hurt individuals, it impacts all of us,” he said, emphasizing the lack of effective treatment and prevention strategies has created substantial economic challenges.
He pointed to a recent cost-of-inaction study by Obesity Canada estimating obesity-related costs at $27 billion annually. These costs include increased healthcare spending, higher disability claims, and lost productivity due to absenteeism and presenteeism.
Additionally, Lianne Clark, vice president of wellness and disability, innovation, and growth at Cowan Insurance Group, emphasized that obesity “is a hidden driver in benefits plans costs.”
"You don’t see obesity as a chronic disease really represented in the data of disability management,” she said. “Hardly ever would I see a claim with a diagnosis of obesity, even though it is a chronic condition. It's not asked for on disability claim forms.”
Pointing to cost concerns, she highlighted that some employers remain reluctant to cover obesity treatments.
"I've had clients put a cap of $500 a year. That might get someone one month of Wegovy when they need year-round treatment,” she said, noting that current costs are approximately $5000 or $6000 annually for coverage.
“Despite measures being put in place and the development of new treatments, obesity is expected to increase in the coming years,” highlighted Alison Adams, account executive at Beneva, underscoring that prevention can play a key role.
“While prevention is crucial at the source, it can also be ensured through effective treatments that limit complications and by implementing measures to minimize the impact on the costs associated with these diseases by promoting healthy lifestyle, investing in education and awareness and mobilizing resources to support those affected,” she said.
While new GLP-1 agonists like Ozempic and Wegovy have revolutionized obesity management by helping regulate appetite and food cravings, coverage continues to vary across insurance providers.
"In 2021, we made a very conscious decision to take a systematic approach to responsibly list these therapies as a standard across all our benefit plans. We coupled that with structured prior authorization criteria to ensure responsible access,” said Ned Pojskic, vice president of enterprise pharmacy and pharmacy benefits management at GreenShield.
The availability of generic versions of medications, expected to release as early as next March, could bring costs down and broaden access.
Pojskic anticipates that affordability could improve dramatically, highlighting medications like semaglutide and other weight-loss therapies might drop from $6000 to $1,000 a year.
“Semaglutide is more effective than previous iterations of obesity medications, but like anything, there is going to come a time where it plateaus,” noted Patton.
Adams noted that ceasing pharmacological treatments often results in patients gaining weight back, underscoring importance of a continuous and personalized approach to managing obesity.
“It's not one stop shop for everyone. Everything needs to be managed. There needs to be structure around that management of the drug and the person taking it,” she said.
“People are going to have to continue to manage their obesity with other supplemental things,” Patton added, pointing to diet, exercise, psychological interventions, pharmacotherapy and bariatric surgery.
Clark emphasized that a holistic benefits plan for obesity should include coverage for obesity medications without restrictive caps, access to registered dietitians and cognitive behavioral therapy, workplace wellness programs that go beyond basic weight-loss initiatives, awareness campaigns to combat weight bias and stigma and flexible workplace accommodations for employees with obesity.
Consequently, employers may not even realize the extent to which obesity-related conditions are driving up claims costs. A recent Statistics Canada report found nearly $12 billion in lost productivity due to obesity-related absenteeism and disability.
Workplace accommodations for employees with obesity, including ergonomic furniture and accessible spaces, can mitigate some of these costs, noted Patton, but without effective treatment, the economic impact for employer’s bottoms lines persists.
Prior authorization also remains a complicated issue for plan sponsors. Many insurers require patients to meet strict criteria, such as a BMI over 30 or a BMI over 27 with comorbidities, before covering obesity medications. Yet, BMI is often used as a measure for obesity. But should it be?
“BMI is not a great measurement of individual health. It's very useful [to compare] on a population level but for the individual sitting in front of a doctor, their BMI doesn't tell that doctor anything about their health,” noted Patton.
“One thing I hear push back on sometimes is BMI is not a good measure, because you get your weightlifters who have a BMI that's over, but they're not overweight. They're not the ones coming to the doctor asking for a medication for weight loss,” noted Clark.
