Expensive weight loss drugs force employers to make moral insurance decisions
Ozempic, Vegovi and Mounjaro. You’ve probably seen TV commercials or heard celebrities talk about taking these weight loss drugs. The FDA just approved a new drug called Zepbound.
These drugs also help people with other health problems, but they are controversial because they cost more than $1,000 a month.
When it comes to insurance, 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.
“So we help HR departments figure out what benefits to offer their employees,” she said.
Moher says the claims data he tracks show increased spending over the past 18 months on the injectable drugs Vegovi, Ozempic and Mounjaro.
“So what’s happened is there’s been a lot of overprescribing to individuals who really aren’t in those disease codes or states that we’ve described, diabetes, heart, obesity,” Moher said. So if you have all these weight loss drugs going to individuals who really don’t need it, off, as you say, off label, then those patients who need it, they couldn’t get it.
“There are many individuals who have pre-diabetes, who are obese, and their doctors create justification for them to take it,” said medical expert Dr. Archel Georgiou.
But is it wrong?
That’s a really 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 from Novo Nordisk, maker of Vegovi, released last weekend at an American Heart Association conference, shows why cardiologists are turning to these weight-loss drugs more often.
In a five-year study of more than 17,000 people who were overweight or obese and had heart disease, Vegovi sharply reduced heart attacks, strokes and cardiac deaths, and people also lost weight.
“The purpose of these drugs is to improve the health of the cardiovascular system,” Miedema said. And so with weight loss we see a reduction in blood pressure. We see a decrease in blood sugar, we see an increase in good cholesterol and 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 drug and receiving it is different from whether or not your insurer has an obligation to pay for it.
She adds that being overweight or obese is the biggest public health problem the United States has.
“This is a really big, big problem because over 65% of the American population is overweight or obese,” she 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 needed it got it, we would bankrupt the health care system. So there is a dilemma here. What can we do? It’s what we need, but it’s too expensive.”
So what position does this put employers in?
Employers are really struggling to make a decision, Georgiou said. Do they cover these weight loss drugs?”
Moher calls it a moral choice.
“I think as an employer if you care about your employees, you will do whatever you can to cover what they need.” But there is affordability. It’s this fine balance,” she said.
“I doubt that all or most employers cover these diabetes medications,” Georgiou added. It’s not a dilemma. The dilemma is, do they cover these weight loss drugs?”
So what will it take to lower the price of these popular drugs?
“I hope this will be a huge dilemma and a lot of stress in the industry, with patients with doctors, until the drugs are switched to an oral drug form, which is cheaper to manufacture,” Georgiou said.
“I just read an article in the New York Times yesterday that there are 70 weight loss drugs in the pipeline,” Mohr said. So when they start going through the tests and they start getting approved by the FDA for weight loss, you’re going to see Vegs drop in price. And again, the ones that are similar to the diabetes drugs, you’ll see Ozempic and Mounjaro coming down. So it’s competition.”
And now with Zepbound, there’s new competition. Manufacturer Eli Lilly says it will be on drugstore shelves after Thanksgiving.
Both Eli Lilly, which also makes Mounjaro, and Novo Nordisk, which makes Ozempic and Vegovi, offer discount cards to help people pay for their drugs, but the amount depends on whether your company offers insurance. For more information, contact your pharmacist.
Another important note is that Miedema says that these drugs are not a magic potion. They work best when paired with extensive lifestyle changes, such as diet and exercise.
The Minneapolis Heart Institute Foundation wants you to know about a unique fundraising concert called Heart 360 at the Minneapolis Armory on November 18, 2023.
The concert features Dierks Bentley and special guest Tyler Braden and uses research and education for patients around the world to save lives.
Click here for ticket information.
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