One would expect that employees could sue you for not covering weight-loss drugs but that scenario is very unlikely in an ERISA plan. It is at least arguably a sound fiduciary decision not to cover them because, as Quizzify’s Weight Loss Drug Economics Calculator shows, coverage of weight loss drugs drives the total cost of the health benefit up by 4% to 8%. No other drug or procedure comes close.
And yet if you cover them, you might very well expose yourselves for that exact same reason – high costs. One might ask, isn’t that what insurance is all about? Obviously, people using insurance drive up the cost for everyone else, right? How would that create a cause of action? People who don't have babies can’t demand compensation because other people do have babies, right?
But here’s the key distinction. These drugs are approved only as adjunct therapies to diet and exercise. If your organization is not requiring diet education, such as the type Quizzify provides or exercise monitoring, such as what US Preventive Medicine or Advanta provide, you are encouraging a use case that the FDA has specifically not approved.
Fortunately our Weight Loss Drug Secret Sauce not only earns an immediate ROI, but also allows you to completely avoid this particular source of potential liability. Read on...
How does this create liability?
Let's let the country's leading wellness lawyer, Barbara Zabawa, expound on that topic. After noting that as mentioned above these drugs are adjunct therapy, Barbara writes:
It could be argued that group health plans that cover GLP-1 drugs and do not also provide lifestyle assistance are violating their fiduciary duty of prudence to plan beneficiaries. Breaching such fiduciary duties violates the Employee Retirement Income Security Act (ERISA) and could lead to lawsuits.
The reason is that fiduciaries (meaning half the readers of this post) need to "act with care" when administerting the health benefit. She continues:
Acting with care arguably includes offering benefits in accordance with FDA approval and manufacturer instructions. Offering a benefit that flouts manufacturer instructions and FDA approval is arguably reckless and not in the care or best interest of plan beneficiaries.
What should health plan sponsors do?
Barbara writes:
First and foremost, follow FDA approval guidelines and manufacturer instructions for GLP-1 medications, should you choose to cover them.
And that, of course, is where Quizzify comes in. Our diet/lifestyle curriculum is unique in the field in three ways:
We use educational quizzes. In addition to teaching and engaging employees, we can track their progress. They will become wise enough consumers to wean off the drugs.
The educational questions (excluding those that mention brand names) carry the Harvard Medical School (HMS) "shield" because our material is reviewed by HMS staff physicians.
We guarantee that (if you use us in conjunction with an exercise-monitoring vendor we approve of) you will not face ERISA liability.
So why take any chances at all? Quizzify's Weight Loss Drug "Secret Sauce" doesn't just reduce your legal exposure. It also reduces your cost immediately while increasing the effectiveness of the drugs.