Should plan sponsors increase weight management drug coverage?

Weight management in the workplace is more important than ever, recent findings from TELUS Health’s 2025 Drug Trends report have found.

As Vicky Lee, pharmacist and pharmacy consulting for TELUS Health explains, the uptick follows a surge in use of diabetes drugs like Ozempic, which has crossed over into weight control due to its GLP-1 classification. She believes the trends reflect a broader evolution in how obesity is perceived, both clinically and culturally.

“It’s getting recognized more as a chronic condition,” she said, noting that some medical associations have begun classifying it as such. “It’s a change for private payers because it was traditionally classified as a lifestyle class of drugs and excluded from plans.”

That reclassification is leading to greater coverage and plan sponsors are increasingly expected to step up.

“We are seeing that increase where not only are plans adding coverage to the class in general but so are all the different types of drugs that are available to help manage weight,” she said.

According to the report's key findings, weight management emerged as the fastest growing drug category in 2024, climbing from 54th position in 2016 to 17th position in 2024. Claims for weight management surged by 90.6 per cent since 2023, driven in part by the launch of Wegovy.

Additionally, six out of 10 plan members made at least one claim in 2024, submitting an average of 12.1 claims each. The average eligible amount per claim increased by 2.4 per cent to $85.52, while the average annual eligible amount per claimant was $1,037.95, up 3.3 per cent from 2023, noted TELUS Health.

The report also found that diabetes drugs maintain their top position among claims, while new data demonstrates that the transition to biosimilar drugs is driving consistent cost savings across private plans in all regions of the country.

The downstream effects of covering weight management drugs aren’t just about employee health. They’re about long-term cost control.

The focus on weight management aligns with growing health concerns, particularly as obesity is recognized as a chronic disease by healthcare organizations in Canada and the US and “continues to be a significant risk factor for many chronic conditions, with recent Statistics Canada findings showing 30.2 per cent of people in Canada had obesity and 35.5 per cent were overweight in 2023,” said a statement in TELUS Health’s press release.

“Obesity has big impacts on other areas as well. There’s a lot of comorbidities. When you get obesity, you’re at increased risk of diabetes and heart conditions. If you’re able to get in front of that and manage obesity to an efficacious extent, you’re able to prevent further comorbidities down the line,” emphasized Lee, adding that has a direct impact on claims, cost per individual, and productivity loss across an organization.

Biosimilar adoption increases

Shifting to biosimilars is another strategy plan sponsors are using to mitigate drug costs. These alternatives to biologics are designed to be just as effective as their originator drugs but at significantly lower prices.

“On average, biosimilars represent close to 20 to 40 per cent savings from the originator,” Lee said. “That’s intrinsic cost management for the plan.”

She concedes, however, that adoption has been uneven across the country because “it takes time for the medical community to accept new options, especially because it's not really deemed interchangeable,” she said, pointing to the manufacturing differences between biosimilars and originators as a complicating factor.

However, she’s quick to emphasize that provincial mandates have moved the needle.

“With the provinces having those mandatory switch programs in place, that has really helped with the adoption,” she said.

While Ontario has typically lagged in that respect, Lee agrees the provincial landscape plays a role, notably in provinces where public payers dominate, like BC and Quebec, who have been quicker to adopt biosimilars.

However, weight management drugs currently aren’t biologics so biosimilar savings strategies don’t yet apply but Lee believes that generics could still offer future relief as she anticipates for Saxenda to offer generics in the market “as early as this year,” with Wegovy generics expected to follow at a later date.

Lee also flags emerging therapeutic areas that plan sponsors should keep on their radar. Gastrointestinal drugs, like Entyvio, have cracked TELUS Health’s top 10 therapeutic categories for the first time.

Ultimately, controlling costs without cutting off access remains a fine line. That’s why Lee points to programs like prior authorization, step therapy, generic pricing policies that could provide relief for plan sponsors.

Meanwhile, average claim submissions are up, now at 1,338 per certificate, but Lee cautions that this doesn’t necessarily signal broader access.

“It could be that drugs are getting more expensive,” she said. “A lot of [new drugs] are high-cost and that’s going to increase your average submitted eligible amounts per certificate.”

For Lee, the data from the report points to a future where sustainable benefit plans will depend on proactive strategy, not reactive cuts.

“It helps [plan sponsors] do a little bit of assessment on what the plan experience is, and then plan for the future,” she said.