Weight-loss drugs from Novo Nordisk A/S and Eli Lilly & Co. will lose coverage under many plans run by Michigan’s largest health insurer as companies grapple with whether the drugs are worth the cost.
Blue Cross Blue Shield of Michigan will drop coverage of GLP-1 obesity drugs in fully insured large group commercial plans starting in January, a spokesperson said, citing consideration of their “efficacy, safety and access, and cost.” The insurer didn’t immediately respond to questions about how many patients will be affected or what the potential safety concerns were.
GLP-1s such as Novo’s Wegovy and Lilly’s Zepbound are exploding in popularity. But with list prices of $1,000 a month or more for a single user, insurers are balking at cost and trying to limit how widely they’re used. The US Medicare health program for the elderly doesn’t cover them for obesity at all, although it covers similar drugs for diabetes.
Some states’ Medicaid plans that cover low-income residents pay for GLP-1 drugs, but even that has been contentious. North Carolina’s health plan for state employees dropped coverage of the drugs for weight loss earlier this year after projecting a $1.5 billion loss by the end of the decade. Health plans offered through the Affordable Care Act Marketplace rarely cover the treatments for obesity, according to an analysis from health researcher KFF.
Novo is “disappointed” in the decision, a spokesperson said, “as it is contrary to actions that many throughout our country are taking – which is to expand coverage for these important medicines.” About half of all commercial insurance plans cover Wegovy, the spokesperson said.
