Michigan insurer plans to drop coverage for weight loss drugs

June 14, 2024

(NewsNation) — As weight loss drugs like Ozempic and Wegozy are soaring in popularity, some insurers are looking to drop the medications, possibly costing patients thousands in out-of-pocket expenses.

Blue Cross Blue Shield of Michigan is one such insurer. Beginning in January 2025, around 10,000 people in the state will lose coverage.

Companies aren’t entirely rejecting the drug, and Blue Cross Blue Shield emphasized that the decision will not impact people who are prescribed the medications, known as GLP-1 agonists, for Type 2 diabetes or cardiovascular risk factors will not be impacted.

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Patients using drugs like Ozempic for weight loss, however, will no longer be able to have them covered. The insurer has also implemented restrictions on the medications for those already taking them. Beginning in August, people will have to have an in-person doctor visit and a body mass index of 35 or higher to qualify for coverage, and no children will be covered.

The company said it made the decision after examining the drugs’ cost, safety, access and efficacy. Recent research from the insurer found that more than 50% of those prescribed GLP-1 agonists stopped taking them before seeing a meaningful benefit.

Health care experts are pinning the high cost of the drugs and the popularity that has led many more patients to seek them out. It costs Blue Cross Blue Shield of Michigan more than $1,300 each month to cover Wegovy for a patient.

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Ozempic has a similar price point, coming in with a list price between $1,000 to $1,200 per month. If patients can’t get coverage from insurance, they will be on the hook for that cost if they want to take the medication.

Insurers around the country have been making similar decisions, with major providers like Ascension dropping coverage and insurers in Connecticut, North Carolina, Texas and Washington also dropping coverage. Some in Delaware are considering it.

For those on Medicare, the medications are only covered if they are prescribed for diabetes or cardiovascular risk factors but not for weight loss.