The whiplash over the startlingly effective GLP-1 weight loss drugs is here: Soon, only the rich will be able to afford them.
Insurance companies are deciding Wegovy, Zepbound and their incredibly popular cousins, which can cost over $1,000 a month, are simply too expensive to reach the masses and become a potential “cure” for obesity.
- Insurance coverage for the medications has sunk 50% since December 2022, making them cost-prohibitive.
- In Michigan, BlueCross BlueShield just kicked 9,000 people off coverage for the weight-loss drugs.
- North Carolina and West Virginia have restricted coverage for public employees who take GLP-1s.
We know how this goes. Other insurers will follow suit because “everyone is doing it.”
Because of the sky-high cost and the reality that patients have to take the drugs forever for their benefits to continue, most people are being priced out. If your insurance doesn’t cover Wegovy and you take it for 10 years, it will cost over $160,000 based on the list price.
One potential solution is to buy through a manufacturer channel with advantageous pricing for cash patients.But, this can’t help patients if they don’t know the offer is available.
At RxLink, we integrate with e-prescribing platforms so doctors can see price options for patients based on various options: With insurance, using discount cards, buying through preferred channels when available, etc.
For instance, Eli Lilly offers a 30-day supply of Zepbound for $349 if prescribed and purchased directly through its LillyDirect service, less than half the cost of the uninsured price at the pharmacy.
One other area to watch out for: The potential for the drugs to get FDA approval for other conditions beyond Type 2 diabetes and obesity, which could open the door for more insurance approvals.
There are studies underway to gauge the drugs’ impact on seemingly every disease under the sun, and recently the FDA approved Zepbound for sleep apnea.
With quite literally tens of billions of dollars and the health of many Americans at stake, it’s going to be the biggest story in health care this year.