![]() ![]() Manolakis said companies were basing their coverage policies in part on how long employees typically stayed in their roles. "As long as there aren’t generic or cheaper versions (of these drugs), I think this (situation) is what we can continue to expect," said Duke University medical professor Dr. Some employers ask patients to try cheaper weight-loss drugs or go through structured diet and exercise programs first, while others limit access to Wegovy if patients don’t show 4% weight loss in three months, according to doctors. Increasingly, they are introducing additional eligibility requirements, said Aon consultant Michael Manolakis. Novo Nordisk said Wegovy should be more broadly covered like medicines for other chronic diseases.Įmployers that cover weight-loss drugs have required medical practices to document patients’ need for Wegovy since it was approved. "We might see some employers saying, we covered this but now we're not covering it all, and others saying we will continue to cover them because we think it's really important, but we will put these restrictions on it so it will be harder for people to get."Įli Lilly declined to comment on employers’ coverage policies. "It’ll be very hard to keep healthcare affordable if that’s the case," Levin-Scherz said. Even if only half of eligible employees use such drugs, he said, the costs to employers of insuring all of those covered by their health plans could rise by 50%. That has fueled a 250% increase in costs for employer-sponsored health insurance in the first two months of 2023 combined compared to all of 2022, according to Willis Towers Watson consultant Dr. Use of Wegovy for weight loss has risen to around 135,000 new prescriptions per week in May from 45,000 in the last week of January, according to Barclays Research, and is widely expected to increase further. But they cost more than $1,000 per month, according to the drug company websites, and patients may need to use them indefinitely to keep the weight off. The arrival to market of Wegovy in 2021 and in 2022 Mounjaro, a similar diabetes treatment from Eli Lilly (LLY.N) that is being prescribed off-label but is not yet approved for weight loss, have changed that dynamic.īoth have been shown in clinical trials to help people lose around 15% of their body weight. Until late last year when Wegovy prescriptions began to rise, weight-loss coverage represented a marginal expense for employers because the available branded drugs were ineffective and little used, or readily substituted by cheaper generics, the healthcare consultants said.Įmployers also were supportive of treatments that could help reduce the risk of diseases that are exacerbated by excess weight including heart conditions and diabetes. Up to two-thirds of companies, most of them large employers, have been covering drugs for obesity for at least three years, according to healthcare benefits consultants Aon (AON.N), Mercer, part of Marsh & McLennan (MMC.N), and Willis Towers Watson (WTW.O), which advise employers on benefits. ![]() While many of these companies have been covering weight-loss drugs, Wegovy's high price and the huge increase in people taking it has them reconsidering when and how to reimburse use of such treatments to prevent a steep spike in health insurance costs, three healthcare industry experts say. Shawnte's experience is becoming more common among the tens of millions of Americans who get health insurance through large employers, defined as companies with more than 5,000 workers, according to two health care consultants and seven doctors interviewed by Reuters. Warner Bros Discovery Inc did not respond to a request for comment. "If I had just sat back and taken their no as an answer, I wouldn’t have been as successful with my weight-loss plan," she said, adding that she is still using the drug. But the employer only agreed to foot the bill for Wegovy after Shawnte's husband complained to his human resources department and a representative pushed to cover it. A new and more expensive version of the drug specifically for weight loss, called Wegovy, had been approved in 2021 by U.S. The health insurance plan, which Shawnte's husband received through his job at media company Warner Bros, said she wasn't eligible for Ozempic because she didn't have diabetes. ![]() She said she was directed to take cheaper weight-loss medications, which aren't as effective. June 27 (Reuters) - Shawnte struggled with her weight for years before she was prescribed Novo Nordisk’s (NOVOb.CO) diabetes drug Ozempic for weight loss in 2020, helping the former music industry professional from New York lose more than 50 pounds over two years.īut last year, the 46-year-old, who asked to be identified only by her first name to protect her privacy, was told her health insurance would not cover her weight loss treatment. ![]()
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