Blue Cross Blue Shield of Michigan won鈥檛 cover popular weight-loss drugs

Popular drugs like Wegovy will no longer be covered by Blue Cross Blue Shield of Michigan except for customers with Type 2 diabetes. (Shutterstock)
by
Weight-loss drugs like Wegovy, Zepbound and Saxenda, which have recently gained popularity, will no longer be covered by Blue Cross Blue Shield of Michigan.
Starting Aug. 1 the state largest health insurer will begin phasing out coverage for large group commercial insurance plans and eliminate coverage by Jan. 1, according to Dr. James Grant, chief medical officer for the insurance company.
鈥淚t just unaffordable and we have to make difficult decisions,鈥 Grant said. 鈥淲e didn鈥檛 make this decision lightly. There was a lot of discussion, a lot of analysis, to come to this conclusion.鈥
Wegovy, Zepbound and Saxenda are injectable drugs that are FDA-approved to help people with obesity manage their weight. They are part of the family of GLP-1 agonists, which make people feel full by mimicking the effects of a hormone called glucagon-like peptide 1.
Blue Cross Blue Shield of Michigan will continue covering GLP-1s prescribed to treat Type 2 diabetes,听including Ozempic, Rybelsus, Victoza and Mounjaro.
鈥淭he costs are a huge implication, and obviously we have to look at all drugs that we have to pay for, but we also have to look at effectiveness and we have to look at how our members are using these resources,鈥 Grant said.
鈥淲hen we got somebody a GLP-1, more than 30% of the time they actually stopped using it after the first month. So what they’re doing is, they’re actually not waiting long enough to see the positive effects of the drug.鈥
Annual claims for weight-loss drugs have skyrocketed from $8 million in 2021 to $100 million so far this year, Grant said. The company is on track to spend nearly $200 million by 2025, he added.
The average monthly list price for semaglutide, the clinical听name for Wegovy, is over $1,000, according to a听brief by Blue Health Intelligence听commissioned by the Blue Cross Blue Shield Association. Similar weight-loss drugs can cost听between $900 and $1,100听monthly.
Blue Cross Blue Shield of Michigan decision to eliminate coverage for weight-loss drugs puts the company in line with other insurers in the state that don鈥檛 cover the costs of those drugs.
A survey conducted last October by the听International Foundation of Employee Benefit Plans听found that 76% of employers said they would cover GLP-1 drugs for diabetes, while 27% said they would cover them for weight loss.
鈥淚t can be incredibly frustrating for families when the insurance coverage is switching,鈥 Hanna Jaworski, medical director of Pediatric Health Optimization Services at Helen DeVos Children Hospital. 鈥淪o to have that consistent insurance coverage is incredibly important. 鈥
She said calculating the drugs鈥 benefits means looking beyond how much weight people lose.
鈥淭he important component of this is how does that translate into health? How does that translate into reduced risk of things like Type 2 diabetes, heart attacks, strokes? Those are all devastating diseases and events and also from an insurance perspective, very costly from a care perspective.鈥
Although some weight-loss drugs will no longer be covered by Blue Cross Blue Shield, Michigan is one of just 16 states that cover the cost of drugs for weight loss as well as Type 2 diabetes听through their Medicaid programs.
You must be logged in to post a comment Login