Mayo Clinic employee health insurance to limit coverage of weight loss drugs

ROCHESTER Mayo Clinic employees insured through the Mayo Medical Plan will see a new lifetime limit on weight-loss drugs starting in 2024.

In a letter provided to the Post Bulletin, those prescribed FDA-approved weight-loss drugs, including Vegovi, Sakenda, Contrave and others, will have the cost of those drugs covered up to $20,000 starting Jan. 1, 2024. The letter was sent by Alluma, a pharmacy manager health insurance plan benefit.

In a statement, the Mayo Clinic said it will continue to provide coverage for these weight-loss drugs through its employee health plan “with a new provision that reflects a maximum lifetime benefit of $20,000 for prescriptions filled after January 1, 2024.”

“The Mayo Clinic continuously and carefully evaluates our prescription coverage and annually makes adjustments that balance availability and coverage, in the best interests of our plan members,” the statement continued. “Plan members are encouraged to speak with their providers, who are able to help determine safe and effective treatment options and care plans.”

There is currently no lifetime maximum benefit set for these drugs under the Mayo Clinic employee health insurance plan offered through Medica. By the end of the year, according to the letter, prescriptions for weight-loss drugs are subject to “standard plan payment or coinsurance without limits.”

Currently, Mayo Medical Plan is outstanding among employer-provided health insurance plans. According to the International Foundation for Employee Benefit Plans, only 22% of American employers cover prescription weight loss drugs.

The Mayo Clinic says this new lifetime maximum benefit does not apply to “approved GLP-1 prescriptions for diabetes.” Semaglutide, the active ingredient in Vegovi, is a glucagon-like peptide 1 agonist and is FDA-approved for the treatment of type 2 diabetes under the brand name Ozempic. Vegovi and Ozempic are given through weekly injections.

“Mayo Health Plan provides coverage for Ozempic for adults with type 2 diabetes and this coverage is not subject to the $20,000 lifetime maximum benefit,” Mayo Clinic said in a statement.

Most weight-loss drugs work by “suppressing appetite and promoting satiety (satiety) through central effects on the brain,” said Dr. David Lau, a bariatrician and professor emeritus in the departments of medicine and biochemistry and molecular biology at the University of Calgary. Cumming School of Medicine in Alberta, Canada.

“This applies to GLP-1 receptor agonists such as semaglutide … liraglutide 3 mg (Sakenda), tirzepatide (Mounjaro) … Contrave, Ximia, Lomaira and Imcivree,” Lau said. “GLP-1 RAs also delay gastric emptying and improve blood sugar control.”

Lau said semaglutide is “a game-changing weight loss drug because it’s the only drug that can lead to more than 10% body weight loss.”

According to the Peterson-KFF Health System Tracker, the list price for a one-month supply of Vegovi injections is $1,349. That’s a high price compared to the price of the drug in Germany and the Netherlands, where Vegovi costs $328 and $296 a month, respectively.

Ozempic also comes with a hefty price tag in the US, with a listed price of $936 for four injections. In other countries, including Canada, Switzerland, the United Kingdom and Australia, a monthly supply of Ozempic is no more than $200, according to Health System Tracker.

These weight-loss drugs are drugs that patients can continue to take long-term to manage their obesity, which is “now widely accepted as a chronic disease that requires long-term treatment,” Lau said. Patients may regain weight when they stop taking weight loss drugs.

“By limiting weight loss drug coverage to a lifetime limit, patients living with obesity are being discriminated (against) because many health authorities and third-party insurers still mistakenly believe obesity is a body image (issue) and not a health problem,” Lau said. “I should emphasize that the duration limit is introduced primarily to control costs.”

The FDA may expand Vegovi’s approved uses in the near future. CNBC reports that Novo Nordisk, the Danish pharmaceutical company that makes the drug, has filed for Vegovi to be approved as a treatment to reduce patients’ cardiovascular disease risk.