Employers who are running into the brand name drug Ozempic on their employee benefits plans may be wondering how it fits into a group benefits program, says Dan Eisner, an employee benefits advisor and vice-president at ZLC Financial. While much of the discussion around this relatively new drug is about rapid weight loss, Ozempic was developed primarily for people with Type 2 Diabetes.
Employers who are running into the brand name drug Ozempic on their employee benefits plans may be wondering how it fits into a group benefits program, says Dan Eisner, an employee benefits advisor and vice-president at ZLC Financial. While much of the discussion around this relatively new drug is about rapid weight loss, Ozempic was developed primarily for people with Type 2 Diabetes. However, many individuals with diabetes on the drug also noticed weight loss. This has prompted some to take Ozempic for weight loss, even though they do not have diabetes. They are often paying out of their own pocket as most employee benefits plans in Canada do not cover this drug for anything other than diabetes. As well, the plans that are covering it when prescribed for diabetes are mostly developing pre-authorization criteria and processes to ensure that only diabetes is treated. Provincial drug plans also generally do not pay for coverage of this drug at this time, he says. Even for diabetics, Canadian insurers and provincial government plans require them to use the more cost-effective first-line therapy, Metformin, before ever being considered for Ozempic. Still, here are a few things that should be considered, he says. Some may be looking at this as a ‘lifestyle drug’ issue given that people might be using Ozempic as a shortcut for weight loss instead of first looking to diet and exercise. Part of these criticisms may be a result of obesity still not truly being recognized as a ‘disease’ in Canada. This means many would likely reconsider critiquing the use of drugs to help manage ‘diseases’ versus being used simply for “lifestyle” purposes. However, if Ozempic does, in fact, help achieve weight loss, would that not mean better health in general for employees, making it worth the cost. When overall long-term health is considered, in general, individuals with excess weight often have other health-related issues (co-morbidities such as hypertension, high cholesterol, diabetes, depression, etc.). The cost savings of those individuals coming off their existing medications in the long term would most certainly outweigh the cost of Ozempic.
