Independence Blue Cross (IBX), a major insurance provider, has announced it will no longer cover weight loss drugs like Zepbound, citing the high costs associated with these medications. This decision is affecting patients like Patti Riley from Bucks County, who has relied on these drugs for weight loss and health management.
Riley, a nurse from Doylestown, received a letter from IBX notifying her that as of January 1, 2025, weight loss drugs will no longer be covered under her insurance plan. The letter stated that the decision was made after careful consideration of several factors. Riley, who has struggled with her weight for years, was devastated by the news. She had recently lost 56 pounds using Zepbound and had avoided health issues like pre-diabetes and hypertension, which run in her family. “I was pre-diabetic, I was pre-hypertensive. My dad died at 56 from heart disease. That was not going to be me,” Riley said.
The drugs, which are also used to treat obesity and diabetes, have proven life-saving benefits. However, without insurance coverage, many patients like Riley fear they won’t be able to afford the medication, which can cost about $1,000 a month. While the drugs are typically covered for conditions like diabetes, IBX and other insurers are increasingly unwilling to cover them for weight loss due to their steep price.
IBX stated, “The cost of these drugs in the U.S. is almost 10 times higher than in other parts of the world, making it extremely challenging to provide coverage to everyone who could benefit from them.”
Doctors, however, argue that these drugs are essential for managing obesity, a condition that leads to serious health risks such as heart disease and kidney failure. Dr. Christoph Buettner from the Rutgers Center for Metabolic Health and Weight Management emphasized that these medications can significantly reduce the risk of heart disease, a leading cause of death. “These drugs are game-changers,” Buettner said.
Despite the high cost, Riley says she cannot afford to pay for the medication without insurance help. IBX has suggested alternative programs, like counseling and gym memberships, but Riley feels these options are not enough. “And I don’t mean to laugh, but if you’re somebody like me, I’ve done all that already,” she said.
In response to concerns over the cost of the drugs, Eli Lilly, the maker of Zepbound, emphasized that obesity is a chronic disease that requires long-term treatment. “People with obesity deserve to have their condition treated like any other chronic disease,” a company spokesperson said.
While insurance companies will still cover the drugs for conditions like diabetes, Riley’s future remains uncertain. IBX has not yet responded to requests for further clarification on its decision.
