WPBN: In recent years, the usage of drugs such as Wegovy, Ozempic, Mounjaro, and Zepbound to treat obesity and weight reduction has increased dramatically, with both patients and medical professionals reporting positive results with sustained use.
However, patients and their insurance companies are now responsible for paying the exorbitant sticker prices of these injectable medications, which range from $700 to $1,350 for a month’s supply at the top.
Some local commercial insurers, such as Independence Blue Cross (IBX), are limiting coverage, despite state and federal attempts to increase insurance coverage for these medications in public programs like Medicaid and Medicare.
GPL-1 agonists and comparable medications will be fully covered by IBX health insurance starting January 1st if they are prescribed for weight loss alone.
When these drugs are administered for persons with Food and Drug Administration-approved diseases including Type 2 diabetes and cardiovascular disease, IBX, the biggest insurer in southeast Pennsylvania, will still pay for them.
In the event that specific corporations or organizations opt to include weight reduction medications in their prescription plans, people who receive insurance via their employers may still be covered.
IBX stated in a notice sent to health plan participants on November 1 that the decision “was not made lightly” and that if these expensive medications are continuing to be covered, everyone else’s rates may go up.
“These exorbitant costs have made it extremely challenging to be able to continue to provide drug coverage to everyone who wants these drugs but does not have an FDA-approved medical or indication for these drugs,” according to the company.
Blue Cross Blue Shield of Michigan, North Carolina’s State Health Plan, RWJBarnabas Health in New Jersey, the Mayo Clinic, and Ascension are just a few of the major insurance companies and large businesses who have similarly limited or discontinued coverage.
Only a few states, including Pennsylvania, offer Medicaid coverage for these drugs for obesity in addition to Type 2 diabetes, but the cost is still significant. According to new statistics from Real Chemistry, the state spent over $298 million on these medications between November 2023 and this past October, or roughly $106 per enrollee.
According to Dr. Kunal Shah, clinical head of obesity medicine at the Rutgers Center for Metabolic Health and Weight Management, the list prices for these weight reduction drugs are a persistent issue that need attention.
However, if patients can utilize these drugs to better control or avoid obesity-related risks and problems, such as heart disease, diabetes, cancer, renal disease, osteoarthritis, asthma, and more, there may be long-term savings, he said.
According to Shah, some people want these drugs to get even thinner or to drop a certain amount of weight rather than because they are overweight or obese.
However, he noted that many more people whose weight is causing them health problems and lowering their quality of life will probably be impacted if access to these medications is generally reduced through insurance limits and cuts.
2024 Border Data Shows 271K Migrants Deported, Just 9% of Total Encounters
“I’ll have someone who has pre-diabetes, who has sleep apnea, who has COPD and they’re 300, 400 pounds. They’re on oxygen, they can barely get up out of their seat without getting short of breath,” Shah stated. “Losing 30, 40, 50, 60 ,70, even 100 pounds would be life changing. They may be able to get off oxygen, they may be able to exercise more. And then I have to tell them, listen, your insurance is not going to cover it.”
There are a few things consumers may do before their insurance coverage for these drugs expires in 2025, Shah added.
“That gives you some time in case you do need to pivot,” he advises patients who presently have a prescription for a GPL-1 or other weight reduction medication to ask their doctors for a three-month refill.
Shah advised those who might be thinking about taking weight loss drugs in the new year to have their health evaluated by doctors who specialize in obesity medicine because their insurance is more likely to cover prescription drugs if they find conditions like Type 2 diabetes or cardiovascular disease.
Will Disability Payments with 2025 Cost of Living Boost Arrive Before Christmas?
According to Shah, patients have alternative options for managing their weight and treating obesity, including several prescription pharmaceuticals that might or might not work as well as some of the GPL-1 therapies.
Independence Blue Cross and other insurance companies still pay for bariatric surgery for those who are at danger of becoming fat, as well as behavioral health and nutrition counseling and incentive programs for exercise and fitness.
