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Employers and Insurers Push Back on GLP-1 Drugs Coverage

June 13, 2024

Just 33% of employers and health plans cover the drugs for obesity, according to a report published Tuesday by consultant firm Pharmaceutical Strategies Group. The biggest reason? The drugs’ high costs.

“Affordability is the main challenge, and we have seen a few employers offer coverage, then pull back after they evaluated the spend they incurred,” Renee Rayburg, the firm’s vice president of clinical strategy, told Endpoints News in an email.

Some organizations have stopped covering the drugs altogether or made them tougher to qualify for, such as requiring a higher body mass index, she said. Others are exploring options like programs to help manage lifestyle changes before making decisions about GLP-1 coverage, she said.

This week, Blue Cross Blue Shield of Michigan, the largest insurer in the state, said it will drop coverage of GLP-1 obesity drugs starting January 2025, citing the drugs’ effectiveness, safety and cost, Bloomberg News reported Wednesday.

According to the latest report, employers were more likely to cover GLP-1 drugs for obesity at 37%, compared to 23% of health plans. Notably, 37% of employers and health plans said they’ve never covered the drugs for obesity and don’t plan to. Another 19% said they were considering adding coverage.

Meanwhile, nearly all — 91% — of employers and health plans cover GLP-1 drugs to treat type 2 diabetes, according to the report.

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