Only about 1/5 of large companies cover drugs for weight loss

A survey of employers finds that only about a fifth of large companies cover drugs like Wegovy for weight loss. A majority of companies that do cover the medicines have requirements.

Transcript

ARI SHAPIRO, HOST:

Groundbreaking drugs like Ozempic and Wegovy have been helping people lose weight, but most employers' health plans don't cover the expensive weight loss drugs. NPR pharmaceuticals correspondent Sydney Lupkin has more on the coverage gap.

SYDNEY LUPKIN, BYLINE: Laura Ivey runs human resources for Epting Distributors, an HVAC distribution company that does work in Georgia, North Carolina and South Carolina. Insurance offered by Epting doesn't cover so-called GLP-1 drugs like Wegovy for weight loss, but does cover Ozempic, the version of the drug for diabetes for that condition.

LAURA IVEY: If they had cancer, you'd put them on a medication to cure the cancer. So if there's a medication out there for the weight loss, why are we not using it for weight loss? Why does it have to get to the point where you have diabetes to get it?

LUPKIN: She says her team is looking into ways to get insurance that covers the drug for weight loss in the future. Only 18% of large employers, those with 200 or more workers, offer insurance that covers GLP-1 drugs for weight loss. That's according to a new survey by the nonprofit polling and research organization KFF. Matthew Rae runs KFF's health care marketplace program, which conducted the survey.

MATTHEW RAE: On the whole, not all that many employers are covering GLP-1s for weight loss right now. So one-fifth - I mean, it's something, but not all that many. And among those that do, lots of them have different conditions or requirements baked into their coverage.

LUPKIN: That might mean someone has to see a dietitian or participate in some kind of weight loss program beforehand or in combination with the medication - beforehand or in combination with the medication. About half of employers said they required the additional steps before covering Novo Nordisk's Wegovy or Eli Lilly's Zepbound. Rae says employers are still figuring things out, and many of the largest companies worry the GLP-1s will send their prescription drug spending through the roof. The list prices for the drugs are around $1,000 a month or more.

RAE: Lots of employers were thinking about what the cost implications for this coverage would be and what the potential health ramifications would be for their workforces and all these sorts of messy issues here.

LUPKIN: Ivey, who runs an HR department, says a lot unfortunately comes down to money.

IVEY: So until these drugs can become more mainstream and much cheaper, I don't see it being something that's going to be covered for weight loss.

LUPKIN: Everyone wants to pay less and get more benefits, she says, but that it just doesn't work that way.

Sydney Lupkin, NPR News. Transcript provided by NPR, Copyright NPR.