- The popularity of Ozempic, Wegovy, and other GLP-1 drugs has skyrocketed recently due to their ability to help people lose weight.
- However, some insurance companies and employers are halting coverage of these medications due to increasing costs.
- If you find your insurance provider halts coverage of a GLP-1 medication after you’ve begun taking it, health experts say there are alternative treatments available that are also effective.
For instance, the private healthcare system Ascension stopped coverage on July 1, 2023, stating that weight loss and anti-obesity drugs will no longer be covered in its pharmacy benefit to its nearly 140,000 employees.
- Alli (Orlistat)
Ascension noted that new weight loss medications that become available in the future will not be covered either. However, it pointed out that coverage for access to weight loss services provided through clinics or provider offices will not be affected by its change in coverage.
Similarly, the University of Texas declared that it will no longer cover GLP-1s under its UT Select and UT Care insurance coverage packages come September 1, 2023. The University blamed its change on the massive increase in cost, noting that in the month of May, coverage for these medications cost $5 million compared to about $1.5 million per month that it cost a year and a half ago.
“It used to be that the options for treatment were so limited that few people received real medical care for obesity. They were merely told to do their best to lose weight without any help,” he told Healthline.
New obesity drugs like GLP-1s came into the market at a high price, resulting in very few people using them, Kyle said.
“But these new drugs work so well that many more people want them and the costs at list prices are too high for health insurance plans to feel comfortable with the expanding use,” he said.
While pharmacy benefit managers are getting discounts of 50% or more from these inflated prices, he said not all of that savings filters down to the employer who pays for drug plans or to the patients who typically have to pay a copay of 20% on the list price.
“So it’s a big mess right now. But the trajectory points to better access and lower costs,” Kyle said.
“When you take into account how long patients are taking them and the number of patients eligible, the cost adds up,” she told Healthline.
“[It’s] unlikely that we’d ever see abrupt halts in coverage for expensive medicines for other chronic illnesses like we’ve seen for obesity, particularly in how the lack of coverage has been communicated to patients,” she said. “What we’re currently seeing is a clear example of how stigma contributes to the obesity epidemic on a systemic level.”
She founded her company with the goal of getting pharmaceutical companies, insurers, employers, and healthcare clinicians to work together to figure out a sustainable and accessible care model for patients.
Obesity is a chronic condition that requires ongoing attention, and for this purpose, “GLP-1s are quite a big help,” Kyle said.
“But, if a person’s goal is just to lose some weight right now, they may find the long term to be disappointing and that the money spent on a short course of GLP-1s for weight loss is wasted,” Kyle added. “These drugs don’t work unless you keep on taking them. Just like blood pressure or diabetes medicines.”
After declaring it would no longer cover GLP-1s, the University of Texas suggested its patients reach out to the manufacturers of the medicines to inquire if there are discounts available.
For conditions where most health insurance will cover drug treatment, drug companies typically offer patient assistance programs that help people gain access to care without huge out-of-pocket expenses, said Kyle.
“But for obesity, these programs are not yet generally available, perhaps in part because insurance coverage is so poor,” he said.
For instance, the cost of Ozempic without insurance can range from around $900 to over $1,000 per month, according to GoodRx.
While many pharmaceutical companies offer discount coupons that can be helpful in reducing the copay when the drug is a covered benefit on a patient’s plan, Fitch noted that they are not that helpful if the drug isn’t covered.
“While $200 off the price sounds great, when the drug costs over a thousand dollars it still doesn’t help patients without coverage,” she said.
To receive treatment for weight management, she said it is critical to work with physicians who understand the full landscape of anti-obesity medications.
“We have efficacious medications that have been on the market for a long time and are generally covered,” she said. “Having said that, I would strongly caution against using compounded drugs, as there is very little quality control for these products and no safety data.”
Working with providers who also offer guidance on other non-medicine-related methods for the treatment of obesity, such as help with nutrition and exercise, is also best for the long-term management of obesity.
Kyle stressed that a qualified obesity medicine clinician may be able to point you to medicines that are much less expensive than GLP-1s and that, for some people, can be effective.
Finding a provider who is willing to advocate for the coverage of medication that is appropriate for you can ensure you receive the best care possible.
“[Many] health insurers reflexively deny coverage in hopes that people will give up and they won’t have to pay. Don’t give up on accessing tools that you deserve,” said Fitch. “Also advocating with your employer to add coverage is important.”