Preparing for GLP-1 generics means rethinking the whole weight management playbook, argues NFP’s Jeannette Makad
Each month at BPM, we offer a slate of articles and content pieces that go deep on a particular topic. This January, we’re exploring GLP-1 and weight management coverage in benefits plans.
Interest in weight management drug coverage is growing among plan sponsors. Yet, as Jeannette Makad notes, adoption still isn't where it needs to be.
“We're still having a lot of conversations about the benefits of adding the weight management class in and of itself. A lot of plans do not have that category added, as of yet. We've seen a lot of uptake but not where we need it. Still, there is a lot of interest around it so I'm very pleased about that,” said Makad, senior consultant of group benefits at NFP, adding that cost has been the only barrier for implementation so far.
Makad acknowledges that the savings case also isn’t there yet. She stressed that any return on investment from fewer cardiovascular and diabetes claims will take years to show up, and Canada’s fragmented public–private drug landscape makes national ROI data "very difficult" to measure, she said. While she expects broader uptake of weight‑management coverage over time, solid ROI evidence on reduced comorbidities such as diabetes and cardiovascular disease would be a major catalyst for that shift.
Until then, some sponsors are managing costs the simplest way possible - by not adding the weight management class at all, she noted.
Yet, as Makad underscored, weight management treatment is supposed to sit alongside changes in nutrition and physical activity, as part of a broader management strategy rather than a standalone fix.
“Any drug is not a one and done. It's not a magic solution, or potion or pill or anything like that," she said, pointing to organizations like Obesity Matters Canada who advocate for comprehensive approaches that combine pharmacotherapy with other interventions.
"It can include surgery if that's the right choice for that patient. It absolutely includes nutrition programs and absolutely includes movement programs," Makad added, underscoring that plan sponsors can add dietitian coverage to paramedical benefits or build movement programs into wellness offerings.
“I’m trying to steer a little bit away from the old mindset that all you need to lose weight is eat less, move more. That is no longer the mindset that we're trying to sort of put out there, but it is definitely multifaceted," she said, adding the piece gaining more attention now, in her view, is psychological support, particularly cognitive behavioral therapy and expanded mental health coverage that can address not just depression or anxiety as comorbidities, but also disordered eating patterns like binge eating.
She sees these additions as part of a broader strategy that complements, rather than replaces, drug coverage.
Consequently, Makad highlighted significant momentum in mental health coverage, as more plan sponsors are increasing access to mental health practitioners. According to CLHIA data, mental health claims rose 120 per cent between 2019 and 2023.
“Any other increase of that magnitude would be cause for concern. But in this industry, it was almost cause for celebration," she said, pointing to years of effort to reduce stigma around seeking help.
Makad sees early signs of payoff. Antidepressants and anti‑anxiety medications are slipping out of the top five drug categories on some plans - anecdotal, she stresses but directionally encouraging. Meanwhile, mental health is disrupting what she calls "the trifecta of paramedical. It was always massage, physio, chiro were always top three in some order. We're seeing mental health claims bust through that and come in at one, two or three," she said.
Until a savings case or ROI presents itself, she’s pushing sponsors to prepare for generics - expected as early as February or March - by building in mandatory generic substitution, while warning that Health Canada approval doesn’t mean an instant flip to coverage or pharmacy availability.
"Once Health Canada accepts a drug, or generic, it takes a minute for it to get out to the pharmacies," she said, adding that carriers will then fold it into plans and communicate with existing claimants.
Makad also pointed to an important distinction that she believes gets lost in the GLP‑1 debate. While today’s GLP‑1 medications are classified as biological drugs, similar to insulin, the upcoming generics will be synthetic versions of GLP‑1s. This distinction matters for plan sponsors and pharmacy benefit management, she said, because these new products are synthetic rather than biologic and they can be substituted at the pharmacy level and treated as traditional generics. They will not fall under the biosimilar framework, which requires prescriber involvement before a switch can occur.
"When we have a generic, that can be swapped out immediately at the pharmacy level, so the pharmacist can make that swap for the lower cost alternative at the pharmacy level," she said.
That’s why she sees generics becoming more important. If people need to stay on these drugs for the long haul, lower‑cost versions matter, she said.
But some cost‑control tools are already built into the system. Notably, drugs like Wegovy and, eventually, Zepbound are subject to prior authorization, with clinical criteria that help ensure only appropriate patients gain access, which naturally reins in spending.
She emphasized that earlier access to therapy helps people build coping skills before problems escalate, which could eventually reduce disability claims - a category where mental health remains the leading driver.
Makad sees implications for workplace productivity and disability costs, noting that mental health and weight management converge in ways that affect work performance.
“If we can lean into the anecdotal ROI of the decrease in drugs for mental health categories, the hope is one day we will see a reduction in disability claims as well,” noted Makad.
