Let's start with the newest bad news for employers covering these drugs: it is easier than ever to get these drugs. You can now order Eli Lilly's Zepbound through Amazon. So if your own doctor doesn't think you weigh enough, well, Eli Lilly will find you a doctor who does.
And here's the other bad news. For better or worse, Oprah has been American’s biggest weight loss influencer since the liquid diet fad in the late 1980s.
And now she’s all in for Ozempic, and presumably other GLP-1s. Of course, her regimen also includes significant exercise and, we would guess, the means and opportunity to eat healthy. Unfortunately, those nuances will likely be lost on your employees jumping on the GLP-1 bandwagon in hopes of a magic bullet.
Magic bullet or not, never before in the history of healthcare has anything – any drug, procedure, test, anything – combined this much effectiveness, popularity…and cost. Indeed, this single class of drugs – in what is forecast to be a "bumper year for them – will likely add 10 basis points to the overall US inflation rate in 2024. (You heard it here first, folks.)
Assuming you cover these drugs for weight loss, how you manage them will have a significant impact on not just your drug costs, not just your healthcare costs, but actually your entire compensation costs. In turn, private sector companies could feel a margin squeeze of about 1%. (See below.)
You might say: “Well, we covered them in 2023 and costs didn’t go up that much.” Perhaps, but that was when these drugs were in shortage.
And also pre-Oprah and pre-Amazon. Holding back the weight loss drug coverage tide just got that much harder.
The good news is that these 7 Steps can control the cost increase by discouraging some employees and educating others…while denying none.
And you'll see for yourself why serving as a companion to weight loss drug coverage is the ideal use case for Quizzify,
Step 1: Project the likely costs, using our Weight Loss Drug Economics Calculator (WLDEC)
[SPOILER ALERT: regardless of what some vendors may have told you, the financial benefits of these drugs due to better employee health nowhere near offset the costs.]
WLDEC models every significant input – from obesity rate to uptake to cheating (see below), to our default estimates of the benefits – to estimate your cost increase, with and without using Quizzify.
WLDEC is available gratis to any employer or most advisors by writing to Mark@Quizzify.com. Otherwise, you can use https://wldec.quizzify.com/, where you can enter your own assumptions, your own data, and your own credit card.
Step 2: Cover Zepbound, not Wegovy.
Our polling from December’s webinar showed that most benefits professionals have never even heard of Zepbound (“Sounds like an off-brand bus line,” said someone). Yet it is both more effective and currently much less expensive than Wegovy.
Of course, you’ve heard of Mounjaro. You may not be aware that the exact same dosage of the exact same drug, Zepbound, is also called Mounjaro (“Sounds like a phony Scrabble word,” said someone else).
Yes, these are identical drugs. The difference is in the label: Mounjaro is labeled for Type 2 diabetes while Zepbound is labeled for weight loss.
Here is the differential impact of Zepbound vs. Wegovy on gross and net (post-benefits and post-Quizzify) healthcare cost increase and profit margin squeeze. For now, just look at the gross healthcare spending increase for Wegovy ($16,200/year) vs. Zepbound ($12,720/year) under a standard set of assumptions for obesity and uptake and assuming no shortages.
Wegovy:
Zepbound:
The former wins on name recognition, the latter on everything else.
Step 3: Don’t Rely on Preauthorization by the "Big Three" PBMs
Preauthorization works best if the diagnosis, test, image etc. supporting it is objective and somewhat definitive. (Whether preauth works at all is a topic best reserved for a different time, a different topic, and a different blogger.). Like in my particular case, to get authorized for PT, I needed an actual MRI.
For weight-loss drug preauth, all you need is a BMI of 30. Unlike blood tests or scans, this easily cleared hurdle will be gamed. How do we know this?
To begin with, the average American adult BMI is 30. (The median is lower.) A few hearty meals prior to a weigh-in can clear that hurdle for a big chunk of the population.
But will people gain this weight? Yes. Those old outcomes-based wellness programs were a hotbed of cheating, as employees would gain weight in order to lose it again. (People also cheat in "steps" programs.) And that was for maybe $1000 tops. This is for a drug worth ten times that amount.
WLDEC shows that cheating has an outsized effect on cost. Each point of cheating (in this case, 3% vs. 4%) moves a full percentage point in your gross healthcare spend increase:
There is also the issue of perverse incentives. No large PBM is interested in taking a profit cut in order to satisfy customer needs by adding the Quizzify step. You should have better luck with the 'next-gen" PBMs, who are more customer-focused. In particular, DisclosedRx is now partnering with Quizzify. We will be formally announcing this soon.
Likewise, you are managing your weight loss programs through your wellness vendor, we strongly recommend US Preventive Medicine, as they incorporate Quizzify's curriculum into their own.
Step 4: Use Quizzify’s Curb Their Enthusiasm quiz to reduce uptake
These drugs are effective…but they come with their own set of risks, particularly if not accompanied by the exercise and nutrition changes on which the effectiveness data is based. The 22-question Curb quiz covers all the risks, side effects, and other downsides. Both the content and even the length of the quiz are enough to discourage people who aren’t serious about weight loss…all without denying anybody anything, while educating everyone who passes. Example:
Step 5: Calculate Curb’s ginormous savings
Take a looksee here. We took out coaching, and we reduced the impact of the Curb Their Enthusiasm quiz by half (from a dropout rate of 40% down to 20%) because it appears that 20% would drop out anyway within a month. That makes the net Curb tire-kicker dropout rate 20%. Plus the people who do complete the full quiz will be better educated and hence more likely to succeed.
Note to the right that these drugs are expensive and popular enough to seriously impact your own profit margin, but that requiring completion of the Curb quiz – even without setting a passing score to further tamp down usage – salvages a large chunk of it.
Note that this is after paying for Quizzify's full curriculum @$100 or less per participant...or a far lower price should you also enroll your entire population in our complete health literacy program
The ROI is self-evident, though we're more than happy to check that box. You pay Quizzify $100 or less per participant against a drug cost of >24x that figure. (Zepbound doesn't save quite as much because it is less expensive to begin with.)
Step 6: Support those who are committed enough to complete the Curb quiz with Quizzify’s Weight Loss Drug Companion Quiz Set
Anyone who passes the Curb quiz then needs some support to continue and ultimately complete their journey. The Companion Quiz Set starts with the Digestive Side Effects quiz, to guide people over the initial hump of constipation, nausea and heartburn.
Don’t expect too much help from coaches. With the clear exception of US Preventive Medicine (USPM), where Quizzify’s quizzes form an integral part of the curriculum, coaches aren’t trained to know, for example, the safest vs. most hazardous ways to treat heartburn or constipation.
Speaking of constipation, coaches and doctors are apparently advising so many laxatives that there was a shortage in the fall. This was rather surprising because if there is one thing American companies excel at, it's producing tons of stuff we consume too much of.
Or, if you do are committed to a coaching organization already (meaning you can’t use USPM), insist that they work with us. We can provide them and your employees with consistent and correct information, in our, um, easily digestible format.
Step 7 …And then through the remainder of their year...
Like many employers, you may limit your coverage to 12 months, and employees will then have to “launch” back into the undrugged world. To do that, they’ll have to learn not only about nutrition generally but also about how specifically to shop – what actual brands are good and bad.
Once again (and once again with the exception of USPM), it is unlikely that coaches will know or teach this level of nutritional literacy without Quizzify’s support either for them, or directly for your employees. Our webinar revealed that even most professionals missed the answer to this question…
…and this question. We offer the option to name names in our questions, because that's how people shop.
As with the Curb quiz, you are well within your rights to require employees to take these monthly Weight Loss Drug Companion quizzes. Employees can’t really object to becoming nutrition-literate to demonstrate their commitment to long-term weight loss that you are paying for.
This would probably be an excellent time to learn more about the Weight Loss Drug Companion Quiz Set, not to mention the Calculator. You can contact us now.
Oh, yeah, and if you ask nicely, we might give you the answers...
