Independence Blue Cross (IBX), the region’s largest health insurer, will no longer cover anti-obesity drugs like Ozempic and Wegovy when prescribed solely for weight loss, starting January 1. The decision comes as the high costs of these prescription medications have led to a significant increase in premiums.
The cost of GLP-1 receptor agonists, which mimic the effects of the GLP-1 hormone to regulate blood sugar levels, is almost 10 times higher in the US compared to other countries. Without insurance, these drugs can cost $1,000 or more per month, prompting several insurers to make similar decisions.
IBX’s decision affects all members who receive weight loss prescriptions without any underlying medical condition. The company notes that this change only applies to weight loss drugs and not for FDA-approved conditions such as diabetes or cardiovascular disease.
The move has drawn criticism from doctors and patients who argue that abruptly stopping these medications can lead to weight regain and increase the risk of health complications. However, some have raised concerns about the potential side effects of these drugs.
In a bid to address high drug costs, President Joe Biden’s administration proposed a new rule to define obesity as a chronic health condition and cover GLP-1 drugs under Medicare and Medicaid. The proposal has sparked debate among lawmakers, with some expressing concerns about the potential conflict of interest if CMS covers these drugs under the leadership of physician-endorsed nominee Mehmet Oz.
In the meantime, IBX advises patients to discuss alternative options, such as using health savings accounts or flexible spending arrangements, which may cover weight loss medications. Patients can also explore nonprescription options like behavioral health and nutritional counseling for weight loss.
Source: https://www.inquirer.com/health/independence-blue-cross-drug-coverage-ozempic-wegovy-weight-loss-20241224.html