Weight Loss Drugs in Workers’ Comp: A Justified Expense?

When I first entered the world of case management and cost containment dealing with workers compensation cases, a frequent request was for injured individuals with low back pain complaints to have a treadmill placed into their homes, precipitating weight loss and improvement with respect to the low back pain complaints. The running joke became what was the world’s most expensive clothes hanger, and the answer is that treadmill.

The Rise of GLP-1 Medications: A New Weight Loss Frontier

There is an ever-escalating use of a medication developed for diabetes known as glucagon -like peptide – 1, (GLP-1) more commonly known as Ozempic, Wegovy, Victoza and Trulicity. The development of these medications dates back more than 100 years. The current escalating use of this medication to address obesity has created shortages and opened an extensive market for compounded medications, and other implications.

As one who has participated in the battle of the bulge for my entire adult life, I can assure you that losing weight is a particularly difficult challenge. Any intervention to assist in this challenge is always endorsed. Recently, a file came across my desk asking for this medication to assist the injured individual in a weight loss program that “would most assuredly” benefit the recovery from the compensable injury sustained by the injured employee. However, the question becomes is this particularly extensive medication warranted to address a soft tissue myofascial strain in an obese individual?

As noted with any injured employee and the Worker’s Compensation system, the primary goal is to restore this individual to a functional level, facilitate a safe return to work, and be a positive benefit for that situation. The identified comorbidities of diabetes, obesity, and a challenge to that recovery. Part of the overall figure plan as to address these unrelated comorbidities and remove the identified barriers to recovery.

Unpacking the Cost and Clinical Evidence for GLP-1s

The use of these medications is beginning to emerge as clinically relevant and as such demonstrates the need for a careful competent insightful review within the realm of occupational health and functional restoration. What is not presented in my cursory literature review was any specific objective clinical information demonstrating that behavior patterns have been appropriately changed during recovery from the compensable injury, so that when the medication is discontinued, the weight does not return.

Thus, consideration of proposed use of these medications must be detailed, debated, and insightful. Moreover, the cost factors need to be part of this discussion. A recent article noted that a majority of the drug spend for a Blue Cross/Blue Shield system for the entire state was simply addressing this medication. The clinical records provided by the treating providers must address and scrutinize the need for this medication.

Obesity and Injury: A Pre-Existing Condition or a Complication?

As noted in every statute across the land, the workers compensation payer is to provide all care reasonably required to address the sequela of the compensable event. Is obesity a pre-existing condition or a function of the identified injury? The same can be asked about the noted diagnosis of diabetes, a particularly common unrelated comorbidity identified in injured employees.

Potential Benefits: How GLP-1s Might Aid Recovery

It is without a doubt that many musculoskeletal injuries, particularly those involving the knees, hips, and lower back are compromised by degenerative joint disease or soft tissue damage that was exacerbated by excessive body weight. Therefore, there is a rational argument that weight reduction induced by GLP-1 medications may reduce the forces noted across any specific joint and thus overcome the pain complaints. The sequelae of this argument would be that this medication protocol may improve the overall clinical profile and contribute to a more positive outcome with respect to orthopedic treatment.

An additional consideration is that the psychological burden of a prolonged work injury scenario, one that includes depression, anxiety, and eating disorders, should be addressed with the utilization of this medication protocol. The literature reflects that the utilization of this specific medication protocol is still being studied with respect to the psychological factors and the attached workers compensation injury.

The Missing Link: Why More Data is Needed Before Widespread Adoption

Clearly there are cogent arguments to be offered for the utilization of this protocol. However, the underlying fact remains that obesity was present prior to the injury, and there is no specific objective data presented that the current body habitus is in any way compromised by the compensable event. Consequently, prior to endorsing the utilization of this medication protocol there needs to be specific objective clinical data that definitively establishes the utility or efficacy of this approach when treating a compensable injury. In any event, a detailed utilization review process needs to be completed prior to incorporating this protocol. While some authors feel that with increasing studies and data these drugs may become an important tool in managing the complex and unrelated comorbidities attached to these claims. However, currently that data is not present.