Mayo Clinic employee health insurance will cap coverage of weight-loss drugs

ROCHESTER Mayo Clinic employees insured by the Mayo Medical Plan will see a new lifetime limit on weight-loss drug coverage starting in 2024.

In a letter provided to the Post Bulletin, those prescribed FDA-approved weight loss medications, including Wegovy, Saxenda, Contrave and others, will have the cost of those drugs covered up to $20,000 effective January 1, 2024. The letter was sent by Alluma, the health insurance plan’s pharmaceutical benefits manager.

In a statement, the Mayo Clinic said it would continue to provide coverage for these weight-loss drugs through the Employee Medical Plan “with a new provision that reflects a maximum lifetime benefit of $20,000 for prescriptions filled after January 1, 2024.

“Mayo Clinic continually and carefully evaluates our prescription coverage and makes adjustments each year to balance affordability and coverage, in the best interest of our plan members,” the statement continued. “Plan participants are encouraged to speak with their healthcare provider(s), who are able to help them determine safe and effective treatment options and plans.”

Currently, there is no lifetime maximum benefit set for these drugs under the Mayo Clinic Employee Health Insurance Plan, offered by Medica. Until the end of the year, according to the letter, prescriptions for weight-loss drugs will be subject to “the plan’s standard copayment or unlimited coinsurance.”

Currently, the Mayo Medical Plan is an exception among employer-provided health insurance plans. According to the International Foundation of Employee Benefit Plans, only 22 percent of U.S. employers cover prescription weight-loss drugs.

The Mayo Clinic says this new lifetime maximum benefit does not apply to “approved GLP-1 prescriptions for diabetes.” Semaglutide, the active ingredient in Wegovy, is a glucagon-like peptide 1 agonist and is approved by the FDA for the treatment of type 2 diabetes under the brand name Ozempic. Both Wegovy and Ozempic are given as weekly injections.

“The Mayo Medical Plan provides coverage for Ozempic for adults with type 2 diabetes and this coverage is not subject to the $20,000 lifetime maximum,” the Mayo Clinic said in a statement.

Most weight-loss drugs work by “suppressing appetite and promoting satiety through central effects on the brain,” said Dr. David Lau, a bariatrician and professor emeritus in the departments of medicine and biochemistry and molecular biology at the University of Chicago. University of Calgary. Cumming School of Medicine in Alberta, Canada.

“This applies to GLP-1 receptor agonists like semaglutide… liraglutide 3 mg (Saxenda), tirzepatide (Mounjaro)… Contrave, Qsymia, Lomaira and Imciivree,” Lau said. “GLP-1 ARs also delay stomach emptying and improve blood sugar control.”

Lau said semaglutide is “a game-changing weight loss drug because it is the only drug that can cause body weight loss of more than 10 percent.”

The list price for a one-month supply of Wegovy shots is $1,349, according to the Peterson-KFF Health System Tracker. That’s a steep price compared to the cost of the drug in Germany and the Netherlands, where a month’s worth of Wegovy costs $328 and $296, respectively.

Ozempic is also priced high in the United States, with the listed cost for four injections being $936. In other countries, including Canada, Switzerland, the United Kingdom and Australia, the monthly supply of Ozempic does not exceed $200, according to the Health System Tracker.

These weight-loss medications are medications that patients can continue to take long-term to manage their obesity, which is “now widely accepted as a chronic disease and requires long-term treatment,” Lau said. Patients may gain weight again when they stop taking weight-loss medications.

“By limiting coverage of weight-loss drugs with a lifetime cap, patients with obesity are discriminated against because many health authorities and third-party insurance payers still mistakenly believe that obesity is a problem. body image rather than a health issue,” Lau said. “I must emphasize that the lifetime cap is introduced primarily to control costs.”

The FDA may expand approved uses of Wegovy in the near future. CNBC reports that Novo Nordisk, the Danish pharmaceutical company that makes the drug, has submitted an application for approval of Wegovy as a treatment to reduce patients’ risk of cardiovascular disease.