In episode 15 of The Healthcare Hangover, David Contorno and Emma Fox dive into the topic of GLP-1 weight loss drugs, exploring their effectiveness, financial implications, and the debate surrounding their accessibility for weight loss.
Tune in as they navigate and share their insights through this issue.
TIMESTAMPS
[00:00:30] Introduction to GLP-1 Weight Loss Drugs
[00:01:00] Weight Loss and Financial Perspective
[00:03:00] Personal Weight Loss Experiences
[00:05:00] Coverage and Accessibility
[00:06:30] Patient Assistance Programs (PAPs)
[00:09:00] Proposed 12-Month Program
[00:11:30] Additional Benefits of GLP-1 Drugs
[00:13:00] Employer's Perspective
[00:14:20] Pharmaceutical Industry Considerations
[00:16:30] Addiction Analogy
In this episode, David Contorno and Emma Fox focus on GLP-1 weight loss drugs, as they share their experiences with employers interested in covering these drugs under self-funded health plans. They explore the efficacy of these drugs, emphasizing that they are not a silver bullet and require complementary lifestyle changes for sustained results.
In addition, David and Emma share personal weight loss journeys and debate whether access to these drugs should be expanded to make weight loss more achievable for individuals struggling with obesity. They discuss the financial aspects, including the high costs and varying coverage percentages across health plans. They also address potential benefits beyond weight loss, such as reducing cravings for other addictive behaviors. Thus, expressing concerns about the affordability of these drugs and the pharmaceutical industry's motivations.
QUOTES
SOCIAL MEDIA LINKS
David Contorno
LinkedIn: https://www.linkedin.com/in/dcontorno/
Emma Fox
LinkedIn: https://www.linkedin.com/in/emmamariefox/
WEBSITE
E-Powered Benefits: https://www.epoweredbenefits.com/
Emma Fox: https://emmamariefox.com/
Welcome to the healthcare hangover. I'm one of your hosts, David contorno.
EF
Emma Fox
0:05
And I'm your other host, Emma Fox. This is a podcast about the headaches we've been encountering in the healthcare system that are leaving us feeling a little hungover. Let's dive in. Alright, I know this is an old topic, and I know we've we've broached it here and there on a variety of episodes, but I think we need to dedicate an entire episode to GLP. One weight loss
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David Contorno
0:26
drugs. Yeah, it's certainly a lot of conversation out there. Yeah, well.
EF
Emma Fox
0:33
It's come up more for us lately, I think because we have a couple of employers who really want to cover this drug for weight loss, specifically under their self funded health plan. And for anybody who knows us, most people know that we have very, very, very similar ideals and goals, and we're on the same mission, but we do disagree on some things sometimes. And I think you and I have had to compromise a little bit on this GLP one argument, right. Yeah.
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David Contorno
1:02
Yeah, I mean, I, the way I see it is it's very long term, it's not a silver bullet, you still need to do other things that if not done means you have to be on the medicine forever. And if you do have to be in the medicine forever, just from a strictly financial perspective, the employer funding that one to $3,000 a month medication now is probably doing more good financially for that employees next employer, because a lot of the things that come with being overweight or long term, hypertension, and cardiovascular disease. And they typically don't rear their heads until 40s 50s 60s. And this one client, in particular, their average age employees, like 30, something we just saw read this the other day. So, you know, I didn't say this, but you intelligently deduced it. But what if we compare it with something that makes it more successful and less likely to be needed for the whole time because it is proving to be highly effective. And not just, it doesn't just lower your desire to eat? It also slows down the emptying of your stomach, like physically. And so you're not only less hungry unless food but you stay hungry longer, unless food and it's almost, it's almost like the impact of stomach surgery without needing surgery.
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Emma Fox
2:14
Yeah, I think it's a very non invasive appetite suppressant that normally you would only get from surgery. And the one thing that's bothering me is people claiming that these drugs are new, which is I mean, some of them are new, don't get me wrong, but the formula has been around for a long time, we've been using these drugs to treat diabetes. And the other argument that I hear that really pisses me off is that we should allow it for diabetic people and not for overweight people. And I'll tell you why it really annoys me, because I would argue that many, many, many, many, many people who are diabetic are also overweight. And so by proxy, we were able to tackle two problems. And we have evidence, we have data that shows that this literally cures type two diabetes. If somebody loses enough weight and gets healthy enough, they will put their diabetes into remission. So, yes, it should be available for folks with diabetes, but I don't understand why it shouldn't be available for people who need to lose weight. And I'll tell you why. You and I both lost a bunch of weight, I lost 150 pounds, like six years ago, how much did you
DC
David Contorno
3:28
lose 22 To 15 to 15.
EF
Emma Fox
3:32
And we had to do it the natural way, I guess the hard way. Diet, exercise consistency is really what it is diet, exercise consistency. But I gotta tell you, if this was available to me, and I couldn't afford it back then I don't know why we wouldn't make it easier when I see people say that overweight people shouldn't have access to GLP ones. My first question is why you just want to you want them to lose weight, but you want them to do it the hard way. So you'd rather see them suffer? You'd rather say to a fat person and potentially fail, right? You know, do you know what the rate of successful long term large weight loss is? It's like in the the teens, maybe even the less than teens percent. And people who can effectively lose massive amounts of weight, the percentage of people that can maintain that for their life's lifetime is just as low. And I got into an argument with someone the other day and I said, Do you want to also reverse availability to bariatric surgery? Well, no, no, of course not. Okay, so I don't get it. I don't get it. We're okay with bariatric surgery for very obese people to help them but we have now have this injection that is very much effective and a lot less costly than surgery. But we're saying no, I don't understand. Can you help me understand?
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David Contorno
4:59
Listen Right now, the statistic I read is that it's covered for diabetics and over 70% of plans, it's only covered for non diabetics and 76.9% of plans. You know, part of it is it being used as a weight loss is new, it's newer than it being used for diabetes. And so that's part of it. I know there's still a lot of studies going on also, a very good thing that's occurring is a lot of competition is coming out. So what I think is going to happen is the data is going to come out showing it hopefully, as effective as early results show, the costs are going to come down. And the barriers to getting it are going to be made easier and easier and easier. But let's remember, you and I both know, you don't need health insurance to get this drug. There are other ways of getting it without health insurance.
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Emma Fox
5:43
There are although I will let let's build the secrets. First of all, if you are someone who is interested in or is taking ozempic, and it is too costly for you for any reason, whether it's your health plan, deductibles, co pays, or maybe it's not covered for weight loss, and you're paying out of pocket ozempic has a patient assistance programme that is is very generous, and so can be a little bit hard to find. But you can potentially qualify for the manufacturers of a patient assistance programme for ozempic. And what that means is if you do qualify for it, you can get that drug shipped to your provider to your physician, they don't ship it to your home, I can't recall why they don't ship it to your home, but you can get potentially get that medication for free. Now, the other ones Manjaro will go V I don't believe they have ma PS or PA PS. But I believe both of them are now available for international sourcing. So through certain companies, one of them that we use a lot is RX manage, you can get those medications for about two thirds of the price. So you know it's not it's still expensive, don't get me wrong, but it is not as expensive as getting it just filled through your pharmacy here since the the coupon that they used to have. That was very generous. It's no longer out there. There are ways to get it. But to address the initial concerns that you brought up is that I have heard a lot of physicians say that this is a lifelong medication, if people come off the medication, they're going to regain the weight. Now, full disclosure, I am not a clinician in any sense of the word. But I did lose 150 pounds naturally, you lost 200 or 230 pounds whatever naturally. And do you think it's safe to say that we have kept that weight off? Because we developed habits? Do you think that's true?
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David Contorno
7:43
Yeah, I mean, I want to say in 2002, I had weight loss surgery, I lost all that weight, and then I gained it back again, post surgery, and then I had to lose it on my own. So yeah, I've had to lose it and keep it off. And I still struggle with it. I mean, I still have ups and downs and good days and bad days. And, you know, generally I'm keeping it okay, but I'm not doing a bowl I want to do.
EF
Emma Fox
8:04
But for me, it's the habits that I taught myself that built up over time that became routine that became lifestyle, that I still fall back on today when I'm having a rough day or a rough week. And I'll just be completely transparent, I developed an eating disorder when I started losing weight. So I went from 300 pounds down to 140, went into bodybuilding, got obsessed with body fat reduction, blew up my metabolism and developed a binge eating disorder. And so as happy as I am to be of normal weight, I have other things that I now have to deal with as a result of that. But I, in the last few years have managed to find this maintenance point this setpoint by leaning back onto those habits I learned and here's my theory. Again, not a clinician, but I think that if I can lose 150 pounds by by developing good habits, then couldn't we run a programme much the same parallel to these injectables just to get people started. And that's exactly what I did. That's what I built for our employers and I I'm interested to see we're doing a 12 month programme, where if you are prescribed these medications for weight loss, the plan will approve it for just 12 months, but only if you are also enrolled in a mandatory nutritional and Fitness and Lifestyle programme. We're actually using a company called Bio coach. And at the end of 12 months, the medication is no longer covered. And the hope is that you got your little Headstart, you got your little cheat sheet whatever you want to call it. But for 12 months you were held accountable to developing these good habits. And you should be able to keep the weight off that's my theory and Really?
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David Contorno
10:00
Yeah, I think it's a great theory. And I'm looking forward to seeing how it works. We're tracking it very closely. It doesn't get paid for if you're not diabetic, if you don't engage in the programme. And the idea is, if you do engage in the programme for 12 months, you might not need it after 12 months, We'll reevaluate clinically. But that's the hope. So we'll see if we can set up a programme where the GLP is there for 12 months only. And people still stay healthy and don't really become a diabetic or gain diabetes, some sort of diabetes diagnosis. That's a programme that should be pretty well received by employers across the country.
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Emma Fox
10:34
Well, in Listen, I know there's been some studies out al Lewis did some studies that are, I don't want to say they're anti GLP. One, sorry, owl. But they do make a case for these drugs not being financial. I don't know how to put it like a good financial decision for self funded employers. Is that kind of the point? Yeah, that
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David Contorno
10:55
for the actual people, it helps and what it saves, it costs a lot more to get there than it does to save it.
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Emma Fox
11:01
Yeah, and I know, listen, he is one of the experts when it comes to reviewing data. I mean, the guy found it validation Institute for goodness sake. But I just I feel like there's something in me that disagrees. As, as is good, Emma fashion. But I mean, okay, let's come at this from another angle, we now are seeing studies come out that these medications, they don't just reduce the food noise, which is a legitimate thing. But they're also reducing the cravings people have for other addictions in their lives. There was a study that came out and said that people are less likely to over drink, if they've had drinking problems before. People are coming off of drug addictions, using these medications. And binge eating disorder. It's fantastic for binge eating disorder, and again, allows people just some free space mentally, to start developing those habits without the crushing noise of of that food noise, which is a very real thing. You know what that is? And I don't want that is because we're former fat people, right. But I think there's a lot more benefit to these drugs. And to your point, if we're curing diabetes, and if we are curing all the other comorbidities that come with obesity, Surely there is a financial value for that somewhere along the line?
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David Contorno
12:25
Yep, that's just harder to quantify. Because how can you say least prevent somebody from having a heart attack or an amputation, you know, you really can't measure that it's just not black and white, you don't know that they would have had it to begin with, you just know that had they continued on the path, the likelihood of them having it was greater. So it, but here's the difference, the one employer that's doing this, I don't think they're doing it for an ROI. They're doing it because he feels it's the right thing to do. Now, he wants to do it in as fiscally responsible manner as possible. He wants to do it in as clinically responsible manner as possible. But he's not doing it because he wants to avoid a heart attack financially for someone down the road. He wants to avoid a heart attack for that person's family down the road. Yeah.
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Emma Fox
13:03
And I really applaud him for doing that. He is one of the biggest innovators in our employer space, I think that we've seen in years and years and a fantastic guy. And in fact, fun story. He came into this organisation just a few years ago, and inherited this health plan. And he went out of his way to buy the books that you've been in, and to really learn about what we're doing. And so often, we see new folks coming in to employers, and they just they're like, Oh, I'm gonna bring in my old broker because that too, I'm comfy with. And he didn't do that he went out of his way to figure out who you were, and learn about these plans. And he's so committed to them. I'm really proud of him. I won't say his name. But yeah, they've been such a joy to work with in that regard. And I'm excited to roll out the programme. I think, you know, there's there's two options when it comes to this drug, either. It has been made completely unaffordable by the special interests, because keeping you obese and diabetic is very beneficial for the healthcare system. Or they've made it so expensive, and you can afford it, which just increases the wealth of the companies that are dishing it out to you, that
DC
David Contorno
14:16
you that they knew how to price it such that the new revenue made by the drug is equal to or greater than whatever downstream reduction in revenue would be created. I'm telling you, someone put someone was asked to calculations if this works the way we say, How much is it going to reduce spend in 1020 30 and 40 years? And how much do we have to charge for that drug now to compensate for that reduction in spend? I don't doubt that at all.
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Emma Fox
14:41
Yeah, I don't either. I mean, that's really what's happening, right? If you could afford this drug, you're paying 850 to 1200 bucks a month, if you can afford Manjaro, for example. And so that's lining the pockets of the drug manufacturers. And if you can't afford it, or it's not covered, you stays Second, that's lining the pockets of the health systems in the insurance like,
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David Contorno
15:03
you know, you know, part of what's driving the demand is that because so few plans cover it for weight loss purposes. And because it's so expensive, it's largely being used in the celebrity circles. And you hear Sharon Osbourne and Kim Kardashian all of them have taken into or are taking it, which makes it seem even more desirous by the general public, which creates even more of a demand for it. I
EF
Emma Fox
15:23
was really disappointed to see that Eli Lilly came out with another drug, it's actually I'm pretty sure it's exactly the same as Manjaro. It's just called Zip bound. And I looked up, I was all excited, I was thinking, Oh, they came up with another option that's going to be more different, more affordable. It's not it's exactly the same price as Manjaro. And I'm just like, what was the point in that we already have Manjaro? What? I don't get it, I don't understand. But there are options. So what I would say is, if you're an anti GLP, one person, I'd really, I'd really encourage you to look at it from a more human perspective as somebody who was very very overweight my whole life. Yes, I finally did it naturally. But I'm, I'm the exception. I am not the rule. And so are you I would argue there are people I know personally that have struggled to lose weight for years and years and years. And sometimes you can do all the right things. I don't see I don't see food addiction any differently than I see any other addiction. And I don't know, you know, there's there's a drug out for alcoholism. Now trek zone is called right. It's supposed to reduce your desire to drink or maybe it's reduces your I don't know what it does, it does something.
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David Contorno
16:42
This is the impact that allows anyone it reduces your desire to drink, I
EF
Emma Fox
16:45
believe. Yeah. And I don't hear anyone saying we shouldn't give that to alcoholics. Do you? Have you ever heard anyone say, let's not give naltrexone to alcoholics? Let's make them do it themselves?
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David Contorno
16:56
Well, there I mean, there was a time by the way where alcoholics were put into psychiatric hospitals, because it was felt to be a psychiatric problem or a willpower problem. And I think weight loss is behind the times. But I think it's in a similar boat.
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Emma Fox
17:09
I think and I know this will resonate with you. But if you've ever had an addiction, or known somebody that has an active addiction, I think you understand that it is not a choice. And people who tell me that you can just you just lose weight, you can just stop do it. Like I want to smack them upside the head.
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David Contorno
17:27
Yeah, I think everybody is addicted to something, I have the luxury of being addicted to multiple things, everything. When one addiction gets out of hand, I temper it down, and then some other addiction bubbles up somewhere, usually before I notice it. So it's very frustrating. It's like I'm addicted to being addicted. I'm not really addicted to any one particular thing. It's buying things. It's close. It's electronics. It's you know, what
EF
Emma Fox
17:49
I think is your cutest addiction. It's sitting people can't see the video, we just released the audio, but it's sitting right over your shoulder. So funny aside, David is obsessed with garbage trucks.
DC
David Contorno
18:01
The Garbage Truck per se, it's the the ones that have the arm on the side where the guy doesn't need to get out and it just lifts it up and dumps it and puts it right back. So
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Emma Fox
18:12
we get our trash collected every Tuesday. And as soon as he hears the garbage truck, his office on the backside of the house Susan farthest away from from the action, but he'll run by my office and go outside and he's seen it every week. never gets tired of it. And it was his birthday. Gosh, it was a couple of weeks ago now. And me and the kids bought David all this cool stuff, you know all these gadgets for his birthday. And one of our very, very, very close friends. We went out to dinner for his birthday. And they gave him literally a children's garbage truck toy. And we were at this nice nice restaurant he's playing with right now. We're at this nice restaurant trying tried to press the buttons because and he just got it out on the table like moved all the plates and the silverware out and he's like, Oh my gosh,
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David Contorno
19:06
deal opening it up. It was not easy to open those stupid things.
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Emma Fox
19:10
And I'm like, Oh, if I hadn't known like a $25 children's toy would have been sufficient. I could have saved myself. A lot of money and a lot of shopping but yeah.
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David Contorno
19:18
liked everything I
EF
Emma Fox
19:20
got. Yeah. Yeah, I don't know. My My take is I think GLP ones are fantastic. So far. We're still waiting to see the evidence that every physician that I've talked to, has been for GLP ones I haven't run into one yet. That's not but yeah, I'm I'm interested to see how this this programme works. And if you're an employer out there listening and you're wondering how you can make this work, especially if you're self funded. I got I got a solution for you and we can we can make it work. Sounds good.
EF
Emma Fox
19:55
Thanks so much for tuning in. Be sure to subscribe and leave a review and remember there's more Always a hangover with health care
DC
David Contorno
20:01
until next time