Never before in the history of healthcare has anything – any drug, procedure, test, anything – combined asmuch effectiveness, popularity and cost as GLP-1s.
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%, as described below.
The good news is that these 6 Steps can seriously dent this cost increase by discouraging some employees and educating others…while denying none.
That is exactly what our Weight Loss Drug Companion Quiz does! It 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 and with and without other cost controls.
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: 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 physical therapy, 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 to their own preauthorization. You should have much better luck with the 'next-gen" or "pass-through" PBMs, who are more customer-focused and don't make more money if your employees use more drugs.
Likewise, if you are managing your weight loss programs through your wellness vendor, we strongly recommend US Preventive Medicine. They incorporate Quizzify's curriculum into their own.
Step 3: 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 25-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.
For example, someone seeking cosmetic improvement would likely pass on weight loss drugs after reading just this one question.
Many PBMs won't add this to their preauthorization, even though that is a fiduciary requirement, since these drugs are adjunct to diet-and-exercise. However, you can require this quiz as part of your wellness program to get a lower copay or earn the wellness incentive at all. You can "cover" the drugs but make the copay/coinsurance so high that everyone who wants the drug would take the quiz.
If your wellness vendor won't cooperate, we would recommend US Preventive Medicine. They are experts at integrating education and incentives and coaching for GLP-1s.
Step 4: Capture the ginormous savings from this one quiz...with zero risk
It seems pretty obvious that spending a little money on a quiz to save a lot of money on a drug is a good deal. But let's make it an even better deal by charging you only for people we dissuade:
Anyone who wants weight-loss drugs must take this quiz first. (You can do that internally as a wellness program requirement. This is not prohibited by your PBM contract.)
If they still get the drug, you pay Quizzify nothing...and they get access to the full curriculum below gratis.
Step 5: 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 for a while. 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 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 6 …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 who want you to pay for them to take the weight off should be willing to learn how to keep the weight off.
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...
