JPMorgan’s annual survey of 40 executives shows that coverage of popular weight-loss drugs continues to slowly increase annually but still remains low compared to the coverage of the same drugs for diabetes.
While 80% of companies cover diabetes drugs like Novo Nordisk’s (NVO) Ozempic and Eli Lilly’s (LLY) Mounjaro, the number of those covering them for weight loss is at 45%.
The executives were comprised of large employers whose total annual healthcare spending is $10 billion, according to JPM.
Of the 45% currently covering GLP-1 weight-loss drugs, such as Novo’s Wegovy and Lilly’s Zepbound, only 65% said they would continue to do so, which could keep the total coverage under 50% in the coming year.
The coverage of these drugs has increased in the last couple of years, but the high demand from patients, especially as more diseases are approved for treatment by the medicines, creates more pressure for companies to weigh coverage in their benefits plans.
Of the 55% not currently covering the drugs, only 13% said they plan to cover them for weight loss in the future, while 54% said they do not. The remainder were unsure about future plans.
The lack of coverage for weight loss highlights an ongoing struggle employers face as they worry about the cost of these in-demand injectable treatments.
That’s because the number of adults who would be eligible for coverage is significant, and even with prior authorization rules in place, it would make premiums even more expensive for employees and employers alike.
“Coverage for these weight-loss drugs has significant cost implications for employers, as a previous KFF analysis estimated that almost 50 million adults in employer plans meet the clinical criteria for taking such drugs, which can cost thousands of dollars annually per person,” according to a report from Kaiser Family Health (KFF) in October.
The federal government has also balked at covering the drugs solely for weight loss, though the Biden administration has proposed changing those rules. Employers could follow suit, taking the lead if Medicare does allow coverage. Currently, Medicare only allows coverage of Wegovy for cardiovascular benefit; Lilly’s Zepbound could soon follow if the FDA approves it as a treatment for sleep apnea.
Anjalee Khemlani is the senior health reporter at Yahoo Finance, covering all things pharma, insurance, care services, digital health, PBMs, and health policy and politics. That includes GLP-1s, of course. Follow Anjalee on social media platforms X (Twitter), LinkedIn Bluesky @AnjKhem.