If you plan to use injectable weight loss drugs like Vigovi or Zipbound, you also need to consider their cost.
These drugs, which belong to a class of drugs called glucagon-like peptide (GLP-1) receptor agonists, have list prices of more than $1,000 per month. According to a fall 2023 survey by the International Foundation of Employee Benefit Plans, although most employees have health insurance coverage through their employer or through the Affordable Care Act (ACA), only 30% currently have coverage for drugs. Fewer employers cover GLP-1s prescribed for weight loss. When similar drugs, such as Ozampic and Monjaro, are prescribed for diabetes, the likelihood of coverage increases to 76%.
ACA health insurance plans are not required to cover obesity medications.
Rick Kelly, national practice leader at professional services firm Marsh McLennan, told Verywell that in the past many companies covered anti-obesity drugs and diabetes drugs, but the popularity of GLP-1s has made them wary.
“A few years ago that number was much higher. It’s estimated that 70% to 75% [of employers] back then did so before realizing the financial risk of covering these drugs,” Kelly said.
Does Medair cover Vegovi?
Coverage by employers can be complicated
In the future, companies offering insurance coverage for GLP-1s may require employees to complete several steps. “The question is what processes, what preliminary approvals, and what utilization management programs will be implemented,” Kelly said.
For example, instead of charging just one, a workplace insurance plan could introduce its own conditions for BMI limits, ordering patients to try other medications, diet or exercise plans first. , and/or may require a letter from a physician certifying that the patient is eligible for drug coverage in accordance with the Company’s criteria.
It is possible to appeal an insurance company’s decision to deny coverage. But Kelly said that in 2024, you’re unlikely to have much success with that. Appeals give insurance companies and employers an opportunity to learn about therapists they may not be aware of.
“There are very few employers in the country right now who don’t know about these drugs. If they’re not covering the drug, employees will have already talked to them about it,” Kelly said.
Will insurance coverage for anti-obesity drugs improve?
There are some promising prospects for coverage of GLP-1s, but this may not happen through 2024. For example, while Medicare doesn’t cover obesity drugs at all—by law, they’re not allowed to—pending legislation called the Treat and Reduce Obesity Act could change that. Juliette Kubanski, deputy director of the Program on Media Policy at KFF, a health research firm, told Verywell that it will likely take several years to be implemented.
Even more immediately, new uses for obesity drugs may spur coverage for these indications. For example, the Food and Drug Administration (FDA) recently added a new recommendation for Vigovi to prevent heart disease in obese or overweight people who already have heart disease. There is a disease. Insurance companies, including Medicare, are now covering this use.
In addition to obesity, clinical trials of GLP-1 drugs are underway for use in several other disorders, including kidney disease and sleep apnea. FDA approval of these uses may encourage insurance companies to cover these drugs for these indications. Andrea Doukas, vice president for health policy at the Center for American Progress in Washington, D.C., told Verywell, “Going forward, it’s going to be harder not to cover these drugs as we see their indications broaden. happening.” “But prices may also decline as new obesity drugs come to market, and one or more of them will be subject to Medicare price negotiations, which, if successful, will be offered to other payers. will put downward pressure on drug prices.”
