GLP-1s: What They Are, What They Do, and Where They Fit in Workers’ Comp
Summary
GLP-1s like Ozempic and Wegovy are transforming from diabetes drugs to multi-use metabolic tools—but their surge in workers’ comp demands scrutiny. While they show promise for obesity and cardiovascular risk reduction, the evidence doesn't support their use for heart failure or chronic pain. With costs climbing and off-label momentum growing, payers need a clear clinical line: use when appropriate, reject where evidence is thin, and always compare against proven alternatives like SGLT-2s. If approved, develop a policy to standardize evaluation and conditions for determining success or failure.
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GLP-1 receptor agonists—like Ozempic, Wegovy, and Mounjaro—were once niche therapies for Type 2 diabetes. Now they’re commanding attention (and cost) across obesity management, surgical optimization, and even cardiovascular disease. But how do they work—and when do they make sense in comp?
Mechanism & Approved Uses
GLP-1s mimic natural gut hormones that regulate blood sugar and appetite. By enhancing insulin, suppressing glucagon, delaying gastric emptying, and promoting satiety, they reduce both A1c and waistlines.
Approved for Type II Diabetes (T2DM): Ozempic, Trulicity, Victoza, Mounjaro
Approved for Weight Loss: Wegovy, Saxenda, Zepbound
Eligibility for weight loss: BMI ≥30, or ≥27 with comorbidities (e.g., hypertension).
Where They Show Promise in Comp
Obesity + Mobility Impairment: Weight loss can improve function, endurance, and rehab timelines.
Pre-Surgical Optimization: Reduces perioperative risks, especially in obese claimants.
T2DM + CV Risk: SELECT trial shows 20% reduction in major CV events with semaglutide in non-diabetics with obesity.
Where the Evidence Falls Short ⚠️
Despite media buzz, GLP-1s are not heart failure drugs.
Major GLP-1 trials like FIGHT, LIVE, ELIXA, and SUSTAIN HF failed to show benefit for heart failure outcomes.
In contrast, SGLT-2 inhibitors like Jardiance and Farxiga are guideline-backed for heart failure and should be first-line for CV risk.
Clinical Takeaway: If the diagnosis is metabolic syndrome with functional goals, GLP-1s may be appropriate. If the concern is heart failure, go SGLT-2.
Emerging Use Cases (Trend Alert)🚩
Pre-op patients with obesity
Addiction and Alzheimer’s (early-stage trials)
PCOS and non-diabetic metabolic conditions
But popularity is outpacing peer-reviewed evidence—and cost pressures are mounting.
✅ Prodigy’s Approach
We flag every GLP-1 fill for indication, cost, and evidence. Clinical review ensures:
Approved use? ✅
Best agent? ✅
What is the policy for evaluating success or failure? ✅
Bottom Line: GLP-1s are a breakthrough—but not a blank check. With costs high and use cases expanding, our job is to apply the science, not chase the hype.
By PharmDs @Prodigy
E-mail: pharmd@prodigyrx.com