For workers in employer-sponsored health plans, coverage of Wegovy and other GLP-1 medications for weight loss is lagging far behind coverage of that class of drugs for diabetes, a new survey shows.
While more than three-quarters of employer-sponsored plans are covering these drugs for diabetes, only about one in four are covering the medications for weight loss, according to the survey conducted in late October by the International Foundation of Employee Benefit Plans, a nonprofit research and education organization. And only 13% of the more than 200 employer plans surveyed said they were considering covering GLP-1 drugs for weight loss.
Those findings take on fresh significance in light of mounting evidence of GLP-1 drugs’ potential benefits in patients who do not have diabetes. Novo Nordisk
NVO,
on Saturday released new clinical trial data showing that Wegovy significantly cut the risk of major cardiovascular problems in people who do not have a history of diabetes but who previously had a heart attack, stroke, or peripheral-artery disease. The American Medical Association on Tuesday said it would urge health insurers to cover weight-loss drugs approved by the U.S. Food and Drug Administration, including GLP-1 medications. “The AMA regards obesity as a disease that poses a major health concern in the United States,” the group said in a statement.
In the employee-benefit foundation’s survey, employers cited obesity’s link with chronic diseases and associated costs as the top factor influencing decisions on GLP-1 coverage.
But the survey found that only 27% of employer plans cover GLP-1 drugs for weight loss, a figure that’s up only slightly from the 22% who said they offer such coverage in a survey conducted by the employee-benefit foundation in the late spring and summer of 2022. The surveyed employer plans ranged in size from fewer than 50 to more than 10,000 active participants.
Employer-sponsored plans are the most common form of health insurance, covering nearly half of all people in the U.S., according to KFF, a health-policy research nonprofit.
Many employers are holding back on weight-loss drug coverage because of concerns about the cost of GLP-1 medications and uncertainty about how long people might need to stay on them, said Julie Stich, the employee-benefit foundation’s vice president of content. More than half of employers surveyed said long-term costs factored into their GLP-1 coverage decisions for obesity.
The FDA’s approval last week of a new Eil Lilly & Co.
LLY,
obesity drug, Zepbound, could affect employers’ decision-making, Stich said. Lilly said the list price for Zepbound will be roughly 20% lower than Wegovy’s. Employers “will sit up and take note of this lower list price,” because costs are such a big factor in their decision-making, Stich said.
Some employers may be waiting for recommendations from consultants or pharmacy benefit managers before deciding to cover these drugs for weight loss, Stich said.
Many employers may also be taking a wait-and-see approach, Stich said, hoping that even lower-cost options will come along. Lilly, Pfizer Inc.
PFE,
and other drugmakers are working on oral versions of GLP-1 drugs, which may be cheaper and more accessible than the injectables available today.
Among employer plans that do cover GLP-1 drugs for weight loss, nearly 80% are controlling costs through some form of utilization management, such as requiring prior authorization or limiting coverage to people above a certain body mass index, the survey found.
For employers that cover the drugs for weight loss, those claims account for roughly 7% of total 2023 claims, on average, according to the survey.
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