Ozempic, Wegovy and other GLP-1 medications have grown substantially in popularity over the last year, affecting all physician specialties.
One in 8, or 12%, of adults said they have taken GLP-1s, and 6% of adults said they currently take the drugs, according to a May report from KFF.
In addition, in recent years, more prescriptions for GLP-1 drugs were written to treat obesity than Type 2 diabetes.
While the medications are growing in popularity, some insurance companies are skeptical of providing coverage.
Here are seven updates on insurance and GLP-1s:
1. Most health plans cover the diabetes medications, but weight loss indications and off-label prescribing are complicating insurance coverage. For a four-week supply, the list prices of GLP-1s approved for weight loss range between $1,050 and $1,350. After these drugs grew in popularity in late 2022, many commercial and state health plans slowed or stopped covering GLP-1s for weight loss. Demand has not ebbed. In 2023, the U.S. healthcare industry spent $38.6 billion on semaglutide (Ozempic, Rybelsus and Wegovy) and $13.2 billion on tirzepatide (Mounjaro and Zepbound). Compared to 2022, expenditures increased 100.1% and 373.1%, respectively.
2. Multiple health systems have removed weight loss drugs from their employer-sponsored plans, including West Orange, N.J.-based RWJBarnabas Health and Minneapolis-based Hennepin Healthcare. Austin-based University of Texas System, Bloomington, Minn.-based HealthPartners, Minneapolis-based Fairview Health Services, Rochester, Minn.-based Mayo Clinic and St. Louis-based Ascension have also trimmed coverage.
3. After the FDA approved Wegovy for certain heart conditions in March, Elevance Health, Kaiser Permanente and CVS Health expanded GLP-1 coverage. Sentara Health Plans did the same.
4. In March, The Cigna Group launched EncircleRx, a program aimed at helping employers control the cost of GLP-1 drugs for weight loss. Cigna describes EncircleRx as the "first-ever" GLP-1 management program with a financial guarantee for health plans. The program will cap yearly increases at 15%.
5. Cigna struck deals with GLP-1 manufacturers Eli Lilly and Novo Nordisk to help its initiative.
6. Insurance covers some of the costs for GLP-1 drugs for weight loss for around 1 in 4 Americans, according to data from Leverage and the Robert Wood Johnson Foundation.
7. In seven states, fewer than 1 in 10 have insurance coverage for new-generation weight loss drugs, including GLP-1s. Here is the percentage of insured individuals with coverage for weight loss drugs in each state.