A recent survey by JPMorgan of 40 executives reveals that while coverage for popular weight-loss drugs is slowly increasing, it still lags significantly behind the coverage of these same medications for diabetes.
According to the survey, 80% of employers provide coverage for diabetes medications like Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro. However, only 45% offer coverage for the same drugs when used for weight loss. The executives surveyed represent large employers with a combined annual healthcare spending of $10 billion, as reported by JPMorgan.
Of the 45% of companies covering GLP-1 weight-loss drugs such as Novo’s Wegovy and Lilly’s Zepbound, only 65% indicated they would continue this coverage. This suggests that overall coverage for weight-loss medications could remain below 50% in the coming year. While coverage has increased in recent years, high demand from patients, coupled with expanding uses for these medications, has put pressure on companies to reconsider their benefit plans.
Meanwhile, 55% of companies do not currently cover weight-loss drugs. Among them, only 13% plan to offer coverage in the future, while 54% do not intend to include them. The remainder are undecided.
The lack of widespread coverage for these drugs reflects the ongoing concerns employers have about the costs of these injectable treatments. A significant number of adults could qualify for coverage, and even with prior authorization requirements, premiums could rise for both employees and employers.
According to an October report from the Kaiser Family Foundation (KFF), nearly 50 million adults in employer plans meet the clinical criteria for weight-loss drugs, which can cost thousands of dollars per person annually.
The federal government has also been hesitant to cover the drugs solely for weight loss. However, the Biden administration has proposed changes that could pave the way for broader coverage. If Medicare expands its coverage, employers may follow suit. Currently, Medicare only covers Wegovy for cardiovascular benefits, though Lilly’s Zepbound may also be included if approved by the FDA for treating sleep apnea.
This shift in coverage could have a significant impact on both the cost of healthcare and the accessibility of weight-loss treatments for millions of Americans.
