More employers could cover weight loss pills like Wegovy next year Here’s what the cost means

Updated October 11, 2023, 03:29 pm EDT

Top line

A new survey shows more employers could cover popular diabetes and weight loss drugs like Ozempic and Wegovy by 2024, allowing workers to avoid out-of-pocket costs overpaying, a new survey finds, although the high cost of these drugs has caused other workplaces to stop covering them altogether or increase monthly premiums. -pay.

Major Events

About 43% of 500 employers participating in a new survey by health care advocacy service Accolade and research firm Savanta said they plan to cover GLP-receptor agonist drugs. 1 in 2024, almost double the amount paid in 2023 (25%).

Ozempic, Wegovy and Mounjaro are part of a class of drugs called GLP-1 receptor agonists that can control weight loss and type 2 diabetes by interacting with the hungry part of the brain to suppress appetite and reduce appetite. blood sugar and A1C.

Some 48% of employers said a lack of reliable information was the biggest obstacle preventing them from covering their employees’ medications, and 38% cited medication costs as a potential problem.

Almost all employers that already cover GLP-1 receptor agonists said they will continue to cover them in the future, with one-third reporting a strong financial impact from adding the drug and more than two-thirds reported an increase in enrollment after the drug was added.

Most HR professionals surveyed agree that covering these medications will help employees’ health in the long run and make employees feel like they have better insurance coverage.

However, the cost of these drugs without insurance can be prohibitive, with some costing over $1,000 for a 28-day supply.

Big number

77 billion USD. That’s how big Morgan Stanley estimates the weight loss drug market will grow by 2030.

Important quotes

For plans to provide coverage to 43% next year, we recommend a physician-led approach to guide who should be prescribed GLP-1 drugs and how to make them part of the plan comprehensive health management, James Wantuck, Accolades’ vice president of health, said in a statement part of the survey.

Key background

Popular weight loss and diabetes medications are often expensive without insurance. Eli Lillys Mounjaro (still seeking FDA approval for weight loss) is $1,023 per fill, Novo Nordisks Wegovy is $1,349.02 per pack, and Saxenda is also $1,349.02 per fill. Ozempic, although only approved for use in diabetes and used off-label for weight loss, costs $935.77 per package. Although pharmaceutical companies offer savings cards for most of these drugs, some people may still have to pay hundreds of dollars out of pocket. The Wegovys Savings Card only covers up to $225 per 28-day supply for 12 refills. The rapid popularity of these GLP-1 drugs has also contributed to their increased cost. Their popularity has caused many shortages as manufacturers cannot keep up with demand. Their high demand is due to their good weight loss results: Mounjaro helps patients lose about 22.5% of body fat, semaglutide (generic name for Wegovy and Ozempic) was found to reduce body fat by 15%. body and Saxenda help reduce 5%. drop.

Opposite

Some companies have discontinued GLP-1 receptor agonists and other anti-obesity drugs due to high costs. Ascension, a nonprofit health care system, discontinued coverage in July, forcing employees to pay out of pocket. The University of Texas System dropped coverage in September, citing a nearly tripling of drug costs in 18 months, from $1.5 million to $5 million a month. In its news release, the company said continued coverage is unsustainable given current rates of prescription drug spending. Other large employers like the University of Michigan have chosen to increase their monthly copays: The university spent nearly $9 million on Wegovy and Saxenda between July 2022 and June 2023 , so it increased the copay from $20 to $45 a month, Bloomberg Law reported. Angela Fitch, president of the Obesity Medicine Society, told Healthline that another barrier that is holding back companies from offering GLP-1 receptor agonists is the fact that people have to take them continuously over a period of time. long time. When you factor in the time a patient takes the drug and the number of eligible patients, the cost increases, she said.

Read more

Wegovy Shortage: Drug Maker Limits Distribution This Is Time for Supply to Improve (Forbes)

Things to know about Ozempic: Diabetes drug becomes a viral weight-loss drug (Elon Musk is proud to use it) Creating a shortage (Forbes)

Diabetes drug Mounjaro expected to be approved soon for weight loss: What to know and how it compares to similar drugs (Forbes)

Insurance providers are pausing coverage of Ozempic and other GLP-1 drugs (Healthline)

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Image Source : www.forbes.com

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