Experts weigh in on whether weight-loss drugs can work in comp

ORLANDO, Fla. — Interest has increased exponentially in prescribing popular weight-loss medications for injured workers who may need to lose weight for surgery or who have work-related hypertension or a heart condition, panelists said Wednesday.

But the industry is cautious, as the long-term outlook for people who take GLP-1 drugs such as Ozempic, Mounjaro and Zepbound remains a question, as does whether the need for the drugs is related to the work injury, the panelists said at the Workers’ Compensation Educational Conference. Side effects also are a concern.

The drugs cost as much as $1,500 a month, and research is scarce over how long they must be taken, making overall costs unpredictable, said Dr. Gerry Stanley, Kansas City, Missouri-based chief medical officer at Evernorth, an Express Scripts company. “There is zero medical literature on getting people off this drug,” he said. Yet the drugs are finding a place in comp, as an overweight person may need to lose weight for surgery or risk prolonging their claim and hindering return to work, according to Danielle Quinn, Towson, Maryland-based pharmacy program director at Chesapeake Employers’ Insurance.

In one instance, in which a judge ordered Chesapeake to cover a drug for a man who needed back surgery after a workplace injury, his weight loss eliminated the need for an operation, Ms. Quinn said. However, questions remained over maintenance dosing, how long the drug would be needed, and whether the claim warrants a Medicare set-aside, which can “balloon” costs, she said.

The industry is still asking questions about the drugs because of “safety and efficacy issues,” said Dr. Adam Seidner, Hartford, Connecticut-based chief medical officer at The Hartford.

Connecting the need for the drug to the work injury also remains a concern, he said. If obesity is a pre-existing condition that was made worse by the injury, apportionment can help an insurer cover only part of the cost, Dr. Seidner said. However, coordinating costs with group health insurers and other employer plans remains an issue, he said.

Still, weight loss also can help with pain management, leaving the industry to consider whether the drugs would help a claimant, Dr. Seidner said.

“It’s too early to know, but we are looking at all the potential uses,” he said. “We are waiting to see.”