For years now, employers have tried to get workers to exercise, eat better, and lose weight. Healthier employees, the thinking goes, are more productive and have lower medical costs. Now insurance company Aetna is opening the door for companies to offer workers new weight-loss drugs, along with other support for healthier habits.
Under a pilot program announced Jan. 14, company health plans can alert workers who might be candidates for two obesity drugs that hit the market last year, the first ones approved by U.S. regulators in more than a decade. If employees are interested, and their doctors agree, workers start taking the medication and use Aetna’s lifestyle coaching apps to help them manage their diet and exercise.
It’s a more direct intervention than wellness programs that often involve health screenings and coaching but not recommendations for specific prescriptions. “We want to give [employers] more tools for treating the root cause of the problem,” says Ed Pezalla, Aetna’s national medical director for pharmacy policy and strategy. Workers will get the new medications at preferred rates, with co-pays generally between $30 and $50, depending on the plan.
The pilot program is available only to Aetna clients who are self-insured—that is, the employer assumes the risk for employee medical costs and uses Aetna to administer its health plan. It began when the companies behind the new weight-loss meds, Eisai and Vivus, approached Aetna about a collaboration, Pezalla says. Many of Aetna’s self-insured health plans don’t cover the drugs. The idea is to combine medication with support for workers trying to lose weight, Pezalla says. “Most of the plan sponsors who will take us up on this are already doing things in the wellness area.”
The goal: For people who use the medications, it’s to lose weight and potentially lower employers’ costs by reducing the need for treatment of obesity and related conditions, such as diabetes or high blood pressure.
The new medications, which go by the brand names Belviq and Qsymia, were approved by the Food and Drug Administration in mid-2012. They’re intended for adults with a body-mass index of 30 or higher who are considered obese or for those with BMIs of 27 who have another condition, such as diabetes, high cholesterol, or high blood pressure.
While the American Medical Association last year labeled obesity as a disease, drug treatments for weight remain controversial since diet drugs in the 1990s were pulled from the market. The FDA initially rejected both compounds before reversing course in 2012. European drug regulators declined to approve the medications. Consumer Reports advises against taking the weight-loss drugs, saying the potential risks and side affects don’t justify the modest weight loss the drugs may help patients achieve. Sales of the new drugs have been slow.
Al Lewis, a consultant to employers on wellness programs and a co-author of Cracking Health Costs, says employers have no business “playing doctor,” and the idea of suggesting drug treatments crosses a line: “It’s one thing for them to cover it, but it’s another thing for them to advocate it.” A vocal critic of wellness programs, Lewis says Aetna offering the program only to self-insured clients should be a warning. “If I’m an employer, and my insurer that has millions of covered lives doesn’t find this program to have enough merit to offer when it’s paying the tab, why should I pay the tab?” he says.
Aetna hasn’t ruled out offering the same program to its fully insured health plans, in which Aetna would be paying the cost of the drugs and reaping any savings from lower obesity-related costs, Pezalla says. The company is currently talking to employers interested in the program, though none has signed on yet. Aetna’s modeling “suggests that the drugs will have enough of a return to get very close to covering those costs,” Pezalla says, and the pilot program with employers will provide evidence to test that hypothesis.
He says the medication is meant to be used in combination with support for healthier habits that employers are in a position to provide. “It’s not a magic pill,” Pezalla says. In the drugs’ clinical trials, “all patients also received counseling on nutrition and exercise. The drugs really should be used in combination with that.”