Insurers and employers face ongoing challenges in covering costly GLP-1 medications, with coverage rates varying significantly based on the individual's insurance plan and employer.
Becker's has gathered the latest research and analysis on weight loss drug policies to offer insight into current coverage trends.
10 key numbers:
1. Among U.S. adults, 80% say insurers should cover weight loss drugs for adults diagnosed as overweight or obese, according to an August 2023 survey from KFF. Half of respondents also said insurance should cover the drugs even if it would increase premium costs.
2. Over 42% of U.S. adults (57.4 million) under 65 with private insurance could be eligible for GLP-1 drugs, based on current FDA indications, according to a Sept. analysis from KFF.
3. In 2023, more than 61% of Ozempic prescriptions (accounting for 70% of all semaglutide fills) went to patients with commercial health insurance, and less than 10% of all semaglutide prescriptions went to Medicaid enrollees, according to an August study published in JAMA Health Forum.
4. In 2023, 34% of large employers covered GLP-1 drugs for weight loss, and 57% covered the drugs to treat Type 2 diabetes, according to a June survey from the International Foundation of Employee Benefit Plans, which polled 279 employers.
5. Among 500 U.S.-based individuals overseeing employee health benefits at companies with at least 5,000 employees, 26% said they planned to offer weight loss drug coverage in 2024, according to a September 2023 survey published by Found, a weight management platform.
6. In 2024, 96% of employers say they cover GLP-1s as a treatment for diabetes, 67% for obesity, and 34% for cardiac conditions, according to an August survey from the Business Group on Health, which surveyed 125 large businesses with a total of 17.1 million employees.
7. Cigna executives said in September that around 50% of their large employer clients served by Evernorth cover GLP-1 drugs for weight loss. A smaller percentage of clients the company provides health benefits to have opted to cover the cost of the drugs for their employees, but that trend is ticking upwards.
8. At least 16 states provide coverage of GLP-1 drugs for weight loss to state employees, according to data from Leverage and the Robert Wood Johnson Foundation.
9. The majority of ACA marketplace plans cover GLP-1 drugs approved for diabetes, though fewer than 1% of plan formularies include drugs solely approved to treat obesity, a June analysis from KFF shows.
10. Eleven state Medicaid programs offer broad coverage for weight loss drugs as of July 2023, according to a Bloomberg survey of every state's Medicaid program.