Many more employers could cover weight-loss drugs like Wegovy next year. Here’s what that means in terms of costs

Top line

More employers could cover popular weight loss and diabetes drugs like Ozempic and Wegovy in 2024, allowing workers to avoid high costs, according to a new survey, even as high drug costs have pushed more other workplaces to stop coverage altogether or increase monthly costs. -paid.

Photo of Wegovy Prescription Injectable Pens for Weight.

UCG Group/Universal Images via Getty Images

Highlights

About 43% of 500 employers who participated in a new survey by health care advocacy service Accolade and research firm Savanta said they plan to cover GLP-1 receptor agonist drugs in 2024, nearly double the number that covers them in 2023 (25%).

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

About 48% of employers said a lack of reliable information was the biggest barrier to covering their staff’s medications, and 38% cited medication costs as a potential problem.

Nearly all employers that already cover GLP-1 receptor agonists said they would continue to cover them in the future, with one-third reporting a strong financial impact from their addition and more than two-thirds reporting an increase in enrollment after adding medications.

Most HR professionals surveyed agree that coverage for these medications will improve employees’ long-term health and make them feel like they have better insurance.

However, the cost of these medications without insurance coverage can be high, with some costing more than $1,000 for a 28-day supply.

Large number

$77 billion. That’s the size Morgan Stanley estimates the weight-loss drug market is expected to reach by 2030.

Crucial quote

For the 43% who plan to offer coverage next year, we recommend a physician-led approach that guides who should be prescribed GLP-1 medications and how to integrate them into a holistic health management plan, James Wantuck, Accolades’ associate chief medical officer, said in a statement as part of the investigation.

Key context

Popular medications for weight loss and diabetes are expensive without insurance coverage. Eli Lillys Mounjaro (still seeking FDA approval for weight loss) costs $1,023 per fill, Novo Nordisks Wegovy costs $1,349.02 per pack, and Saxenda also costs $1,349.02 per fill. Ozempic, although approved only for use in diabetes and used off-label for weight loss, costs $935.77 per packet. Although drug 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 fills. The fact that these GLP-1 drugs quickly gained popularity also played a role in their costs. Their popularity has led to multiple shortages as manufacturers fail to keep up with demand. Their high demand is due to their good results in weight loss: Mounjaro helps patients lose around 22.5% of body fat, semaglutide (generic name of Wegovy and Ozempic) leads to a 15% reduction in body fat. body fat and Saxenda causes a 5% reduction in body fat. drop.

Contra

Some companies have stopped covering GLP-1 receptor agonists and other anti-obesity drugs because of their high cost. Ascension, a nonprofit health system, ended its coverage in July, forcing employees to pay out of pocket. The University of Texas System ended coverage in September, citing drug costs that nearly tripled in 18 months, from $1.5 million to $5 million per month. In its newsletter, the company said continuing coverage was unsustainable due to the current pace of prescription drug spending. Other large employers like the University of Michigan have chosen to increase their monthly co-pay: the university spent nearly $9 million on Wegovy and Saxenda between July 2022 and June 2023, raising the co-pay -shares from $20 to $45 per month, reports Bloomberg Law. Angela Fitch, president of the Obesity Medicine Association, told Healthline that another obstacle preventing companies from covering GLP-1 receptor agonists is the fact that people must take them continuously for a long time. When you factor in how long patients take them and how many patients are eligible, the cost adds up, she said.