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June 1, 2023
Obesity challenges employer benefit plans
In Canada, the clinical practice guidelines for obesity describe it as a prevalent, complex, progressive, and relapsing chronic disease characterized by abnormal or excessive body fat that impairs health.
Worldwide, organizations have issued very similar statements recognizing obesity as a chronic disease and a health issue, says Rami Halabi, medical science liaison, obesity, at Novo Nordisk Canada. In the ‘Obesity: The Science, Impacts and Strategies’ webinar hosted by the CPBI Alberta, Saskatchewan, and Manitoba regions, he called this “an essential step in advocating for appropriate health care management and treatment of people living with obesity.”
Currently, body mass index (BMI) is used to classify somebody as obese. If their BMI is greater than 30 kilograms per metre squared, “then we say you are living with obesity.”
The rate of obesity has tripled in the last 30 years in this country and around 27% of adults in Canada are currently living with obesity.
“Obesity is not the result of eating more and not moving enough. It's actually the interplay of many different things, many of which are actually out of our control. What's important to take into consideration is our brain biology can control our eating behaviour and our appetite, but genetics can actually dictate whether we're going to be predisposed to developing obesity,” he said. The condition can also be driven by psychological or social impacts like stress and even economic inequalities. Even some of the medications taken for other health conditions may, in fact, promote weight gain and thus promote obesity. “Overall, obesity is not simply due to an individual's choice or lack of willpower, but it is this complex interplay of all of these components together,” said Halabi.
Unfortunately, those who live with obesity are also likely living with a number of other complications that target every layer of your body. They are probably also suffering from another metabolic condition, such as type two diabetes or fatty liver. Even some cancers are associated with obesity. “And then if we look more into the mental state, we know that obesity is associated with depression and anxiety. In fact, obesity is actually associated with over 229 complications and it affects every single organ system in the body,” he said.
What is known is that weight loss can lead to overall health improvements. A weight loss of 5% can improve hypertension and losses of 15-plus per cent of total body weight result in improvements in type two diabetes and even cardiovascular death.
Canadian healthcare professionals are actually equipped with clinical practice guidelines on the management of obesity. These guidelines have been so well received that both Ireland and Chile have adopted them as their own national guidelines. And a week ago, the Obesity Society in the US formally endorsed them.
These guidelines call for the root cause of obesity in the patient to be addressed. Ultimately this is going to dictate what intervention should be used moving forward.
There is a very comprehensive approach to obesity management in these guidelines, he said, from medical nutrition to physical activity.
But the actual pillar of obesity management is behavioural interventions in which a patient is meeting with a therapist or a counselor or is engaging in cognitive behavioural therapy, because, depending on the root cause, that's the necessary approach.
There are also pharmacotherapy interventions, which can achieve upwards of 15% weight loss. There are four currently approved medications in Canada.
Lastly, there is surgical intervention. Bariatric surgery can achieve upwards of 30% weight loss.
“Now, it's really important to know these are not independent of one another. They can all be used in conjunction as, again, it's dependent on the patient's needs and the root cause of obesity,” he said.
In the case of pharmacotherapy, healthcare providers are actually advised to intervene to bring up the conversation of pharmacotherapy when lifestyle interventions alone have been ineffective, insufficient, or not sustainable.
The evolution of obesity management can be traced back 30 years, said Dan Ekstrand, associate director, patient access, western Canada, at Novo Nordisk. “We too had a very solid understanding around the impacts of obesity on employees and, ultimately, employers’ bottom lines. They understood that there was interplay relationship with other chronic conditions.” Since then, there has been very little progress simply because they didn't have effective tools at the time.
There were also challenges. “One, typically, was we didn't have the wraparound support outlined in the clinical practice guidelines which are providing holistic supports today,” he said.
Today, treatment of obesity is built around three core objectives. “The first is to create an understanding around the implications of obesity within the workplace. Second is the strategies for those organizations that want to take that leap and create a full support system. Finally, we want to provide some evidence based, agnostic tools that can help educate those employees,” he said.
In Canada, group benefits plans are going to feel the effects of the rise of global obesity, said Blake Robillard, account executive at Desjardins Financial Security, because it impacts physical health and mental wellbeing and, as a result, the productivity of employees.
He cited statistics which show for group benefit plans, people with a BMI of 30 or more ‒ so considered to be obese ‒ have a 30% greater risk of developing an anxiety disorder. That risk is 50% with a BMI of 35 or higher. With a BMI of 30, there is a 10% greater risk of developing a depressive disorder and the risk increases to 40% at a BMI of 35. “The costs of mental health, depression, and anxiety alone have a significant impact on the Canadian economy of about $50 billion,” he said.
Almost half of employees with chronic conditions, including obesity and those related to obesity, report that they have missed work or found it harder to do their jobs.
There's many different facets of the financial impacts to group plans such as increasing drug costs or premiums. However, “we do know that reducing obesity can reduce the use of some of these drugs,” said Robillard.
June 7, 2023
Greatest opportunity for drug savings hard to determine
Bianca Brooks, senior pharmaceutical benefits strategist at Sun Life, has no single answer to identify the greatest area of opportunity for plan sponsors to create value for plan members while still remaining cost conscious with their drug benefit plans.
She told the ‘Panel on Private Drug Benefits: Ensuring Value for Plan Sponsors’ at CPBI Forum 2023 that when she puts herself in the shoes of plan sponsors, first and foremost, she wonders “what I might be able to do, or change, from a plan design perspective that would help to support and ensure the financial viability of the plan in the long term. “We could talk about lots of different cost containment solutions and different formulary options, different drug review processes, and prior authorization. These are all tools that you have at your disposal from a plan design perspective.”
The other big piece is “what can I do as a plan sponsor to make sure that my members actually understand the design and the benefits that are available to them. So it's more around education, communication, and making sure members understand the investment that you've made in your benefits program, what they have access to, and how they use it. That's an area where there's lots of opportunity,” she said.
On the cost side, a strong biosimilar policy can help create value for a plan, said Frédéric Leblanc, strategic advisor, drug program management, at iA Group.
This starts in the drug lifecycle when patents expire. “Are we making sure that we take advantage of the savings that are there. In today's world, the big medications that can cure a lot of ailments are oftentimes biologics, he said. Biosimilars offer a less expensive alternative to biologics. They will be coming to market so “it's important to have a long-term vision.”
Controlling costs through drug strategies is more important with today's workforce shortages and the importance of benefits to attract and retain employees. Employers have to look at what is included and excluded in their plans and be prepared to provide some “not-so-expensive benefits that can add to the health of the members and the value of the plan,” he said.
Farago addressed the issue of new products coming to market. This drives competition, he said. When there are only one or two biosimilars, there’s not much competition. “What we're seeing now is as more and more of these products are coming out which forces more competition which means lower prices. So you either are saving money because the biosimilar is less expensive or, if you're a carrier that has a product listing agreement, you're just saving money.”
