Introduction
The workers compensation industry has mostly rejected covering increasingly popular weight-loss injections. However, doctors treating injured workers continue to prescribe these drugs.
Prescription Trends
Sedgwick Claims Management Services Inc. reported a 46% increase in prescriptions for drugs such as Ozempic, WeGovy, Mounjaro, and Zepbound. However, very few are approved by workers compensation payers.
Growing Interest
Ryan Hamm, a clinical pharmacist at CorVel Corp, notes, “There’s a growing trend of doctors prescribing them in cases where improving overall health, like weight loss or better diabetes management, could help with injury recovery, especially before surgeries.”
Challenges and Concerns
Obesity, a common comorbidity among injured workers, can impede recovery. However, experts warn that the potential side effects of weight-loss medications, such as cancer and stomach paralysis, outweigh the benefits for the compensation system.
Silvia Sacalis, vice president of clinical services for Healthesystems LLC, states that long-term effects, required monitoring, lifestyle changes, and high costs contribute to the rejection of most prescriptions by comp payers.
Legal and Coverage Considerations
Johnny Taylor from GBCare estimates that these drugs represent less than 0.5% of pharmacy costs. Many cases are not reasonable from a compensability standpoint.
Acceptance of prescriptions is often case-by-case. Teresa Bartlett from Sedgwick states, “We have a specific plan with our pharmacy benefit management companies, and clinicians review each prescription.”
Conclusion
The workers compensation legal system lacks specific guidelines supporting the use of these drugs for weight loss. However, Nikki Wilson from Enlyte LLC notes, “In certain cases, weight-loss treatments might be considered for coverage if obesity contributes to a work-related injury or if necessary for treatment and recovery.”
