Expensive weight-loss drugs force employers to make ‘moral decisions’ about insurance coverage

Ozempic, Wegovy and Mounjaro. You’ve probably seen TV commercials or heard celebrities talk about taking these weight loss medications. The FDA just approved a new drug called Zepbound.

These drugs also help people with other health problems, but are controversial because they cost more than $1,000 a month.

When it comes to insurance coverage, benefits experts say it forces employers to make a “moral decision.”

Kate Moher is President of Employee Health and Benefits at Marsh McLennan Agency, a subsidiary of Marsh, the world’s largest insurance brokerage.

“That’s why we’re helping human resources departments determine what benefits to offer their employees,” he said.

Moher says claims data he tracks show increased spending over the past 18 months on the injectable drugs Wegovy, Ozempic and Mounjaro.

“So what’s happened is a lot of overprescribed medications have been prescribed to people who don’t actually fall into those disease codes or states that we’ve described: diabetes, heart, obesity,” Moher said. “So if all of these weight loss drugs are being given to people who don’t really need them, off-label, as you say, then those patients who need them haven’t been able to get them.”

“There are a lot of people who are prediabetes and overweight, and their doctors are making the case for them to take it,” said Dr. Archelle Georgiou, 5 EYEWITNESS NEWS medical expert.

But is that wrong?

“That’s a very good question,” Georgiou said. “Because doctors have the authority, the legal authority, to prescribe any FDA-approved drug for any indication.”

Dr. Mike Miedema of the Minneapolis Heart Institute says new research by Novo Nordisk, the maker of Wegovy, released last weekend at an American Heart Association conference, shows why cardiologists are turning to these drugs to lose weight more frequently.

In the five-year study of more than 17,000 overweight or obese people with heart disease, Wegovy dramatically reduced heart attacks, strokes and cardiac deaths, and people also lost weight.

“The goal of these medications is to improve cardiovascular health,” Miedema said. “And so, with weight loss, we see reductions in blood pressure. We see reductions in blood sugar, we see an increase in good cholesterol, and we see a decrease in triglycerides. All of those things improve cardiovascular risk and that’s how you improve cardiovascular health.”

But according to Georgiou, “Prescribing a medication and receiving it is different from whether or not your insurer has an obligation to pay for it.”

He adds that being overweight or obese is the biggest public health problem in the United States.

“This is a really huge problem because more than 65% of the American population is overweight or obese,” he said. “And a large portion of them could benefit from this drug that costs $1,200 a month. And at the same time, if everyone who needs it got it, we would ruin the healthcare system. So here is a dilemma. what do we do? “It is what we need but it is too expensive.”

So where does this put entrepreneurs?

“Employers have a hard time deciding,” Georgiou said. “Are these weight loss medications covered?”

Moher calls it a moral choice.

“I think as an employer, if you care about your employees, you will do the best you can to cover what they need. But there is affordability. It’s this delicate balance,” she said.

“I suspect that all or most employers cover these diabetes medications,” Georgiou added. “That’s not the dilemma. The dilemma is: do they cover these weight loss medications?

So what does it take to reduce the cost of these popular medications?

“My hope is that this will be a big dilemma and a big stressor in the industry, among patients and doctors, until the drug becomes an oral pill, which is cheaper to manufacture,” Georgiou said.

“Yesterday I read an article in the New York Times: There are 70 weight-loss drugs in the works,” Moher said. “So when these start going through testing and start being approved by the FDA for weight loss, we’ll start to see Wegovy drop in price. And again, those that are similar to diabetes medications, you’ll see Ozempic and Mounjaro go down. “So it’s competition.”

And now, with Zepbound, there is new competition. Manufacturer Eli Lilly says it will be in pharmacies after Thanksgiving.

Both Eli Lilly, which also makes Mounjaro, and Novo Nordisk, which makes Ozempic and Wegovy, offer discount cards to help people pay for their medications, but the amount depends on whether their company offers insurance coverage. Consult your pharmacist for more information.

Another important note is that Miedema says that these medications are not a magic potion. They work best when combined with important lifestyle changes, such as diet and exercise.

The Minneapolis Heart Institute Foundation wants to tell you about a unique fundraising concert called Heart 360 at The Armory in Minneapolis on November 18, 2023.

The concert features Dierks Bentley and special guest Tyler Braden and benefits life-saving research and education for patients around the world.

Click here for ticket information.