"With roughly two in five U.S. adults affected by obesity, GLP-1 drugs have emerged as a promising solution - but their steep price remains a significant hurdle. For instance, GLP-1 drugs have a list price ranging from $936 to $1,349 before insurance coverage, rebates or other discounts are applied. Given the expense, several insurers have decided to stop covering GLP-1s for weight loss, leading to outrage among physicians and advocates, though they are still covering the drug for patients who have diabetes."
"Starting January 1, Blue Cross Blue Shield of Massachusetts (BCBSMA) will no longer cover GLP-1s for weight loss for employers with fewer than 100 employees. Employers with more than 100 employees can choose to cover these drugs at an additional cost. BCBSMA's policy applies to self-insured and fully-insured employers. Harvard Pilgrim Health Care - an insurer in Maine, Massachusetts, Rhode Island and New Hampshire - is also ending GLP-1 coverage for weight loss for most commercial plans starting January 1."
About two in five U.S. adults have obesity, and GLP-1 drugs provide effective weight-loss options but carry list prices of $936 to $1,349 before discounts. Insurers are increasingly refusing to cover GLP-1s for weight loss while maintaining coverage for diabetes patients. Starting January 1, Blue Cross Blue Shield of Massachusetts will stop coverage for employers with fewer than 100 employees, with larger employers able to pay extra for coverage. Harvard Pilgrim Health Care will end coverage for most commercial plans on the same date and require a six-month behavioral modification program before medication access. Insurers cite affordability and rising demand as reasons for policy changes.
Read at MedCity News
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