August 5, 2025
Objective: Explore the growing role of GLP-1 drugs in workers’ compensation and the broader implications for healthcare, legal and risk management professionals.
This article is based on a recent presentation made at the California Coalition on Workers’ Compensation (CCWC) Conference, which took place in Anaheim, CA June 11–13, 2025.
The rise of GLP-1 medications such as Ozempic, Wegovy and Zepbound has sparked both excitement and controversy in the health care and insurance industries. Originally developed to treat type 2 diabetes, these drugs have gained widespread attention for their effectiveness in promoting weight loss. As their use expands into the workers’ compensation system, stakeholders are facing complex questions. Are these medications a breakthrough in managing comorbidities, or are they a costly and legally complicated detour?
Understanding GLP-1 medications
GLP-1 (glucagon-like peptide-1) receptor agonists work by mimicking a hormone that regulates appetite and insulin. They slow digestion, reduce hunger and help patients feel full longer. While their clinical benefits are well documented, their integration into workers’ compensation claims introduces new challenges.
Dr. Robert Hall, Medical Director at Optum, explains that obesity is a significant comorbidity that can delay recovery from workplace injuries. Historically, treatments like bariatric surgery and gym memberships have been considered in certain claims. Now, GLP-1 medications are being viewed as a potentially more accessible and less invasive option.
Legal and claims handling implications
The inclusion of weight loss medications in workers’ compensation claims raises several legal and administrative questions. Brenna Hampton, Esq., CEO and Government Relations Chair for CCWC, notes that the California workers’ compensation system has a history of addressing obesity as a compensable consequence. However, the use of GLP-1 drugs introduces new complexities.
Claims professionals must consider the duration and cost of treatment, compliance with treatment plans under Labor Code 4056, management of side effects, Medicare Set-Aside (MSA) implications, and the distinctions between compound and prescription medications.
There is also concern about fraud and cost shifting. As these medications become more popular and expensive, there is a risk that some costs may be improperly shifted to workers’ compensation programs. This is especially relevant when medications are prescribed for uses not explicitly approved by the FDA, a practice known as off-label use, which is common but still subject to scrutiny.
Regulatory and cost considerations
GLP-1 medications are costly, and long-term use is often necessary to maintain results. This raises questions about sustainability and approval within the workers’ compensation formulary. While the FDA has approved these drugs for specific uses, their application in workers’ comp cases often falls outside those parameters.
According to the 2024 Independent Medical Review (IMR) Annual Report, weight loss programs were among the most frequently overturned treatment requests. Only 13 percent were approved, which suggests a high level of skepticism among reviewers and highlights the need for clear medical justification.
The role of ancillary programs
To manage the use of weight loss medications effectively, organizations must leverage ancillary services such as pharmacy benefit managers (PBMs), utilization review organizations (UROs), nurse case managers and risk management teams.
Dr. Teresa Bartlett, Senior Medical Officer at Sedgwick, emphasizes the importance of a coordinated approach. She explains that it is not just about the medication. It is also about the ecosystem around it, including how outcomes are monitored, supported and evaluated.
Exploring alternatives
While GLP-1 medications are gaining traction, they are not the only option. There are several complementary treatments, including exercise and physical therapy programs, nutrition and behavioral therapy, bio-psycho-social models of care, bariatric procedures and wearable health technology.
These alternatives may be more appropriate for some patients and can be integrated into a holistic recovery plan. The key is to tailor treatment to the individual while balancing medical necessity, cost and long-term outcomes.
A cautious but open-minded approach
The use of weight loss medications in workers’ compensation is still evolving. While the potential benefits are significant — like faster recovery, reduced comorbidities and improved quality of life — the risks are also considerable. Legal, financial and ethical considerations must be carefully weighed.
As the health care landscape continues to shift, collaboration between medical professionals, legal experts and claims managers will be essential. By staying informed and proactive, stakeholders can navigate this new frontier with both caution and compassion.
