The discussion over new weight-loss drugs, which can cost more than $10,000 a year, has shifted from efficacy to price. The American Medical Association's house of delegates earlier this month adopted a resolution calling on insurers to cover the cost, "including FDA-approved medications without exclusions or additional carve-outs."
"The AMA will urge health insurers to provide coverage of available FDA-approved weight-loss medications, including GLP-1 medications, to demonstrate a commitment to the health and well-being of our patients," said Dr. Bobby Mukkamala, an AMA trustee.
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Many insurers have been reluctant to cover the cost of GLP-1 drugs such as Ozempic and Wegovy for weight loss, noting they have to be taken indefinitely to be successful. Federal law bars Medicare from paying for weight-loss drugs. Some employers will pay for the cost of weight- loss drugs for their employees but others, including Mayo Clinic and other health systems, have limited or dropped coverage because of the high cost.
For workers in employer-sponsored health plans, coverage of GLP-1 medications for weight loss lags far behind coverage of that class of drugs for diabetes. Although more than three-quarters of employer-sponsored plans cover these drugs for diabetes, only about one in four covers the medications for weight loss, according to a survey conducted in late October by the International Foundation of Employee Benefit Plans.
Only 13% of the more than 200 employer plans surveyed were considering covering GLP-1 drugs for weight loss. 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.
Related: Can we afford not to pay for obesity care?
These drugs cost 10 times more in the United States than in Western Europe, according to CEO Andrew Witty of UnitedHealth Group, and prices must come down for more people to have access. "We need the manufacturers to move," Witty said. "It's as simple as that. And we remain extremely open-minded to any model that works."
The AMA agreed that the high cost of drugs can be a "significant access barrier" for patients if their health plan does not cover the cost.
"Providing evidence-based treatment options that include weight-loss medications aligns with a comprehensive, multimodal approach to effectively manage obesity and is important to reduce health complications," Mukkamala said.
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
