The utilization of GLP-1 drugs has skyrocketed over the last few years, with no signs of slowing in the near term. Yet questions remain regarding whether workers’ comp programs should cover GLP-1 drugs, in large part because obesity itself is often not considered a compensable condition.
This creates variability in how stakeholders approach these therapies and suggests that, even where coverage is not required, programs should begin establishing clearer parameters for evaluation and management. In doing so, there are both benefits and concerns to consider.
Let’s look at the pros and cons of covering GLP-1s in workers’ comp:
The Pros: Beneficial Use Cases in Workers’ Comp
Though GLP-1s should be evaluated on a case-by-case basis, examples of potential beneficial use in workers’ comp include:
- Helping injured workers reach an effective weight to qualify for surgery or other treatment milestones
- To assist injured workers who have gained significant weight due to mobility limitations that resulted from injury
- If obesity has severely exacerbated the impacts of an injury to the spine and/or musculoskeletal system, where weight loss could reduce stress to the injury
- In first responder populations where heart conditions are considered compensable and a GLP-1 is considered beneficial, especially in the presence of comorbid obesity and/or diabetes
- In cases of catastrophic claims, particularly in the presence of comorbidities like obesity, diabetes, and heart conditions
- If the effects of comorbid obesity – such as high blood pressure and other factors – severely limit drug therapy
The Cons: Concerns in Workers’ Comp
While there are many benefits to GLP-1s, they also come with concerns related to cost, safety, and proper administration. These include:
High Costs and Prolonged Duration of Use
Given the high monthly cost of GLP-1s (anywhere from $500 to more than $2,000), programs considering coverage may benefit from defining timeframes and treatment goals tied to use. Without defined endpoints, GLP-1 therapy may extend beyond the period of injury-related need. And for the treatment of diabetes or cardiovascular conditions, treatment may be considered chronic or lifetime therapy.
Side Effects and Adverse Events
GLP-1 medications commonly include gastrointestinal side effects, such as nausea, constipation, and diarrhea, but they also come with the potential for adverse events such as dizziness, hypoglycemia, acute pancreatitis, acute gallbladder disease, and thyroid C-cell tumors in certain patient populations. The FDA also continues to investigate reports of suicidal thoughts or actions in patients treated with GLP-1s. However, the number of reports is small, and the evidence of risk is not yet clear. Ongoing monitoring remains essential, particularly as long-term safety and outcomes continue to be evaluated.
Effective Administration
Different GLP-1 medications come with different administration considerations. For instance, oral Wegovy® must be taken once daily in the morning on an empty stomach with only water and no other liquids; patients must wait 30 minutes before eating or taking other oral medications. And while oral tablets are now available, GLP-1 drugs are still primarily available in injectable formulations, and effective use requires proper administration.
Loss of Lean Body Mass and Reinjury Risk
Rapid weight loss – whether involving GLP-1s or not – can result in a loss of lean body mass, including muscle, water, bone tissue, and other tissues. Degradation of lean body mass could increase the chances of reinjury, especially in older adults, those with degenerative conditions, and those with low baseline muscle mass. Considering that GLP-1s reduce hunger to lower caloric intake, these risks are compounded if patients are not getting enough nutrients.
One Ingredient in a Comprehensive Approach
It’s important to remember that GLP-1 medications are not a finite solution, but simply one part of a comprehensive treatment approach. They work best when combined with diet, exercise, and lifestyle changes. A defined treatment plan should be clearly established before the start of treatment, and ongoing evaluation should occur for effectiveness, clinical appropriateness, and potential side effects.
Want to Learn More?
To learn more about GLP-1 drugs and workers’ comp, including strategies for managing these medications, read our RxInformer magazine article, Tipping the Scales? GLP-1 Considerations for Workers’ Comp.
