Elevance Health does not cover weight loss drugs in most cases, CFO says

Elevance Health, formerly known as Anthem, does not cover GLP-1 drugs prescribed only for weight loss, except in states that require coverage of the drugs by law. 

On an April 19 investor call transcribed by Seeking Alpha, Elevance Health CFO John Gallina said the company does cover GLP-1 drugs meant for treating diabetes. 

"Certainly, we want to make sure that people who have diabetes that need access to those drugs are getting access to them, but to have the appropriate protocol, so that they're not utilized for purposes that are other than medical necessity for diabetes-type folks," Mr. Gallina said. 

GLP-1 drugs, including Ozempic, Trulicity, Victoza and Mounjaro are used to treat Type 2 diabetes. Wegovy and Saxenda are approved for weight loss.  

Payers typically do not cover newer drugs meant for treating obesity but do often cover drugs meant to treat diabetes, while Medicare never covers new weight loss drugs. GLP-1 drugs marketed for weight loss are typically not covered, though the same drug marketed for diabetes treatment is typically covered.

With obesity drugs expected to reach $70.2 billion in spending by 2026, payers are facing tough decisions about who they will cover the drugs for, The Wall Street Journal reported April 17. 

At an investor day conference in March, Mr. Gallina said weight loss and diabetes drugs were running "a bit hotter than expected," the Journal reported. The comment briefly sent stock prices down across the entire insurance industry.

In a April 14 investor call, UnitedHealthcare CEO Brian Thompson said on-label use of new drugs to treat Type 2 diabetes are well managed by current authorization requirements. 

"The overwhelming majority of that is in diabetic care, and it is as we had expected, low single digits in terms of weight loss use. I would say that our on-label usage has been well managed with our authorization requirements," Mr. Thompson said. 


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