10 Strategies to Help Contain Costs of Non-Approved Weight Loss Drugs

10 Strategies to Help Contain Costs of Non-Approved Weight Loss Drugs

The rising cost of prescriptions on health plans already accounts for almost one quarter (22.2 cents of every dollar) of all the costs. Add in the growing use (and misuse) of type 2 diabetes and anxiety-related prescription drugs for non-approved weight loss and costs can escalate even further.

What steps can employers take to help balance the need to provide employees with prescription drug coverage with the fierce pressure to keep the cost of health insurance down?

Consider 10 I’s to control the excessive cost of non-approved weight loss drugs

Inform employees about the appropriate use of prescription medications. Clearly communicate that diabetes and anxiety medications are intended for specific medical conditions and are not suitable for weight loss. Leverage training platforms and communication resources you may already have in place to raise awareness about the potential risks associated with off-label use.

Improve prescription drug management, which includes monitoring prescription claims data to detect unusual patterns, excessive refills, or high doses. Collaborate with pharmacy benefit managers (PBM) to set up alerts and controls to spot possible misuse.

Insist on prior authorization for certain medications to force employees to obtain approval from their healthcare providers before a health plan covers specific drugs to deter misuse and support legitimate usage.

Investigate step therapy to encourage employees to try less expensive weight loss treatments first before pursuing higher-cost medications. For example, someone seeking a prescription for Wegovy might first try making lifestyle changes that include diet, exercise, hypnosis, or lower cost drugs approved for weight control.

Wegovy, an injectable Rx for adults with obesity
Monthly cost: about $1,350 without insurance or $16,188.24 per year.
Source: Kaiser Family Foundation, 2023

Invest in wellness programs that focus on weight management and mental health. Encourage employees to participate in fitness programs, nutritional counseling, and stress management to help reduce the need for off-label drug use.

Impose consequences of non-approved medication use in your health insurance plan policies. Ensure employees understand that misusing medication can lead to denial of coverage or increased out-of-pocket costs.

Include counseling and support services for weight management and mental health issues in employee assistance programs as an alternative to prescription medications.

Implement regular audits of your health insurance plan to identify if/where misuse of prescriptions may be occurring and assess the effectiveness of different strategies to reduce non-approved drug use.

Initiate a dialogue with healthcare providers to ensure they are prescribing medications appropriately and work with benefits advisors to open lines of communication with insurers to identify cases of non-approved use early on.

Inspect prescription data for patterns of misuse and, if found, educate employees as early as possible.

For more guidance about how to manage prescription drug costs for your health plans, connect with our employee benefits team.


Comments are closed.

Table of Contents

Recents Post
June Pulse
June 2024 The Pulse Newsletter
Golf cc hospitality state of the market
Hospitality, Golf, and Country Club Market Update
Heat Related webpage
Heat Illness and Workers' Safety Precautions

This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The content of this document is made available on an “as is” basis, without warranty of any kind. Baldwin Risk Partners, LLC (“BRP”), its affiliates, and subsidiaries do not guarantee that this information is, or can be relied on for, compliance with any law or regulation, assurance against preventable losses, or freedom from legal liability. This publication is not intended to be legal, underwriting, or any other type of professional advice. BRP does not guarantee any particular outcome and makes no commitment to update any information herein or remove any items that are no longer accurate or complete. Furthermore, BRP does not assume any liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Persons requiring advice should always consult an independent adviser.

Baldwin Risk Partners, LLC offers insurance services through one or more of its insurance licensed entities. Each of the entities may be known by one or more of the logos displayed; all insurance commerce is only conducted through BRP insurance licensed entities. This material is not an offer to sell insurance.

Get in contact with an advisor today to see how BKS can support you.