Michigan Insurer Drops Coverage for Weight-Loss Drugs Amid Cost Concerns

By Madz Dizon

Jun 13, 2024 03:29 AM EDT

Michigan Insurer Drops Coverage for Weight-Loss Drugs Amid Cost Concerns — Xenadrine EFX capsules are photographed on January 4, 2007 in Glendale, California. The marketers of four weight loss products, Xenadrine EFX, One-A-Day Weight Smart, CortiSlim and TrimSpa, were fined $25 million by the Federal Trade Commission on January 4 for making false advertising claims.
(Photo : Illustration by David McNew/Getty Images)

Weight-loss drugs from Novo Nordisk A/S and Eli Lilly & Co. will no longer be covered by many plans run by Michigan's largest health insurer. The decision comes as companies evaluate their cost-effectiveness.

Michigan Axes Coverage for Obesity Drugs

Starting in January, Blue Cross Blue Shield of Michigan will no longer cover GLP-1 obesity drugs in fully covered large-group commercial plans. This decision will impact nearly 10,000 individuals who rely on these medications.

The insurer's spokesperson mentioned the decision was based on the drug's effectiveness, safety, and cost. However, they did not provide any information regarding the specific safety concerns.

GLP-1s like Novo's Wegovy and Lilly's Zepbound are gaining immense popularity. However, insurers are hesitant to embrace the high cost of $1,000 a month or more for a single user and are attempting to restrict their widespread usage.

The US Medicare health program for the elderly does not provide coverage for obesity despite offering coverage for similar drugs used to treat diabetes.

BCBS Michigan Imposes New Limits on Drug Coverage for 800K

Blue Cross Blue Shield of Michigan is implementing new restrictions from August to December to limit the use of drugs in their large group plans, which provide coverage for approximately 800,000 individuals.

The new regulations now require that individuals seeking the latest obesity medications must be adults and visit a prescriber in person rather than through telehealth, Bloomberg reported.

Additionally, they must have a body mass index (BMI) of 35 or higher. The drugs have been authorized for use in children aged 12 and older, as well as adults with a BMI of 30 or higher who are seeking obesity treatment.

Novo expressed disappointment in the insurer's choice to discontinue coverage, stating that it goes against the efforts of many to broaden access to these crucial medications.

According to a spokesperson, approximately 50% of commercial insurance plans provide coverage for Wegovy.