Obesity prevalence has soared in America, from 30.5% in 1999 to 42% in 2017, according to the CDC. That has led to the emergence of and hysteria with several weight loss medications such as Ozempic, Mounjaro, Wegovy, Saxenda, and Rybelsus.
As the popularity of these medications increases, it’s likely to become a hot topic of conversation for your company’s health plan over the next 12 months. Depending on the size of your company and the flexibility of your benefit plan, you may have to take a position on whether or not to cover these medications.
At the heart of the issue is the financial impact on employer-sponsored health plans. Weight-loss medications carry a hefty price tag, ranging between $12,000 to $18,000 per member per year, leaving it up to the largest employers to take decisive action.
The University of Texas System recently ceased coverage for Wegovy and Saxenda. Their costs spiked from $1.5 million to $5 million per month over the last year and a half for these two medications. UT System’s decision mirrored that of Ascension Healthcare, the second-largest private healthcare system in the U.S., which discontinued coverage for the same medications earlier this year.
They are the only two FDA-approved “weight-loss” medications, while Ozempic, Mounjaro, and Rybelsus require an accompanying Type 2 Diabetes diagnosis.
The increased popularity has already led to shortages. Individuals that truly need these medications may not be able to fulfill their prescriptions due to the low supply.
As an employer, it’s crucial to understand how the fast-changing pharmacy landscape can dramatically impact your overall claims spend. We have experience implementing pharmacy programs that focus on maximizing clinical value and total net cost to both the employer and plan members.
Reach out to us for a pharmacy contract and opportunity analysis.
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The right advisor partnerships make all the difference in a highly competitive environment, and we’re here to help. If you have any questions on your insurance program, please contact Rich Hejny, Executive Vice President & Partner at CCIG at Rich.Hejny@thinkccig.comBack to Resources