Sadie Janes
Health Canada’s recent approval of <a href="https://healthylife7.com/lizzo-reveals-weight-loss-setback-after-dramatic-transformation/" title="Lizzo reveals weight loss setback after dramatic transformation”>weight loss drug Zepbound as a treatment for obstructive sleep apnea in obese adults could create financial risks for benefits plan sponsors, says Joseph Koo, assistant vice-president of health solutions and national pharmacist at Aon
While the medication is a genuine clinical advance for this specific group of plan members, the use of a continuous positive airway pressure machine remains the most cost-effective first-line treatment for most employees diagnosed with obstructive sleep apnea, he says. “Zepbound’s role to treat OSA should be targeted for patients who also need weight management or who can’t tolerate CPAP, but it isn’t a broad replacement for CPAP therapy that costs a fraction as much and works from day one.”
Read:Expanded use of GLP-1s a major driver of drug plan costs in 2026: report
Once a patient is approved for this particular treatment, it will be perpetual, he adds, noting while CPAP machines have a larger one-time fee for the device plus monthly equipment supplies, it ends up being less expensive than the long-term use of Zepbound
To minimize financial risk, employers should look at Zepbound’s expanded treatment indication through a lens of cost-effectiveness. “A narrow indication like sleep apnea shouldn’t become the entry point for broad, permanent [coverage of glucagon-like peptide-1 therapies] that a plan never intended.”
Clear criteria like a documented sleep study, the body mass index threshold and CPAP therapy being tried first where appropriate, plus prior authorization and periodic reassessment, are important because these are indefinite therapies that have perpetual financial implications on plans, says Koo
When it comes to expanded indications, one of the challenges that plan sponsors face is the current technology at the pharmacy benefit manager or carrier level doesn’t really control cost based on indication, he adds, noting every new indication is another door into the formulary for the same expensive drug
Read: 2025 Face to Face Drug Plan Management Forum: Navigating coverage challenges for GLP-1 drugs beyond weight management
