Are Glucagon-Like Peptide-1 (GLP-1) Covered Under Workers’ Compensation?

Glucagon-like peptide-1 (GLP-1) agonists are a class of medications primarily used to manage blood sugar levels in type 2 diabetes and, more recently, to treat obesity. GLP-1 agonists are often self-administered by the patient via an injection under the skin. These medications gained popularity, not only due to strong marketing campaigns, but also because of their effectiveness in controlling blood sugar levels and promoting weight loss. However, a common question arises with GLP-1 drugs: even if they are covered by health care plans, are these medications covered by workers’ compensation insurance? 

Type 2 Diabetes and Obesity within Workers’ Compensation 

Type 2 diabetes and obesity are concerns in the realm of workers’ compensation due to their impact on overall health and recovery. Both conditions can worsen the impact of work-related injuries and extend the healing process, resulting in increased medical expenses and longer durations of disability. 

Obesity is a major concern in the U.S., with nearly three out of four adults aged 20 and older classified as either overweight or obese— a condition closely linked to type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), 15.8% of U.S. adults had diabetes between August 2021 and August 2023. Additionally, the CDC’s 2021 National Health and Nutrition Examination Survey reported that 41.9% of adults experienced clinical obesity from 2017 to March 2020. 

Coverage Under Workers’ Compensation 

Workers’ compensation is designed to cover medical expenses and lost wages for employees who suffer work-related injuries or illnesses. The inclusion of specific medications under workers’ compensation can vary based on several factors, including the nature of the injury, the treatment plan prescribed by the healthcare provider, and state-specific workers’ compensation guidelines. 

When an injured worker is dealing with diabetes, obesity, or both, unmanaged comorbidities can lead to increased medical services, additional medications, longer claim durations, and higher costs. While there is still much to learn about the impact of GLP-1 drugs on the workers’ compensation industry, here is what we know so far: 

• A recent survey in the GLP-1 Drugs: 2024 Pulse Survey Report revealed that up to 40% of employers plan to cover GLP-1 drugs in 2024, a significant increase from the 25% who previously offered coverage. However, these medications can be quite costly, with prices reaching as high as $1,500 per month. 

• A review of Enlyte Pharmacy Solutions’ workers’ compensation prescriptions showed a 14.2% increase in the dispensing of GLP-1 drugs from 2021 to 2023, along with a 13.2% rise in spending on these medications during the same period. 

• Compensability is a crucial consideration due to the associated costs. While these drugs might aid in recovery and address comorbidities, they may not always be covered financially. 

• There are potentially significant benefits to including GLP-1 drugs in workers’ compensation, such as improved recovery, reduced comorbidities, and decreased injury risk. However, concerns remain regarding costs, varying efficacy, and supply issues. GLP-1 medications are expensive, with the most popular options ranging from $900 to $1,300 per month. 

As the conversation around GLP-1 medications continues to evolve, it is crucial for stakeholders to stay informed and adaptable. These drugs offer significant potential benefits in managing conditions impacting workers’ health, but they also raise important questions about cost and long-term efficacy. As more data emerges and the healthcare landscape shifts, payers and policymakers must carefully evaluate the role of GLP-1 medications in workers’ compensation. Until then, the debate remains open, with ongoing discussions shaping the future of workers’ compensation coverage and access.