DETROIT – In addition to availability, the cost of weight loss drugs like Wegovy and Zepbound is a major barrier preventing many Americans from using these medications.
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In some cases, insurance may cover the drugs -- but a new survey finds that coverage is not meeting the need for the drugs. Many experts are hoping for a change.
There is a reason the term “morbid obesity” exists -- being significantly obese is not a vanity issue, it is a health issue and there is no question the downstream effects like diabetes, cardiovascular disease, cancers, breathing problems, and joint problems can all be reduced if medications like these were more available. With open enrollment around the corner, many people will be looking at their own plans.
GLP-1 weight loss drugs like Wegovy and Zepbound are effective at helping severely overweight people shed weight and avoid the dangers obesity poses. Unfortunately, these medications are out of reach for the average American because of their cost and according to a new survey of employer health benefits by the Kaiser Family Foundation, only 28% of companies with 5,000 or more employees cover GLP-1’s for weight loss. For smaller companies, with only 200 or more employees, that number drops to 18%.
When the medications were covered, there were frequently additional conditions or requirements associated with their approval -- like meeting with a dietitian, psychologist, or case worker -- or enrollment in a lifestyle or weight loss program before you could become eligible.
The decision to cover these expensive medications is not simple -- one-third of companies said the impact would be significant and covering GLP-1s impacts the ability to cover other medical conditions, but so is the cost of obesity and managing the illnesses that it causes.
In the survey, most employers who did not cover GLP-1s like Wegovy or Zepbound when used primarily for weight loss said they did not plan to do so in the next 12 months.
There were less expensive compounded versions of Wegovy and Zepbound available, but recently the approval to make compounded Zepbound was stopped after the FDA declared that it was no longer in short supply, leaving only compounded Wegovy as a legal option. Interestingly, Weight Watchers recently announced they would be selling compounded Wegovy at a much lower cost.
Big picture: right now options are limited but hopefully in time manufacturers will be more reasonable about their prices and insurance will be more open to the value.
Read more: How new weight loss drugs affect your entire body