Blue Cross Blue Shield of Michigan won’t cover popular weight-loss drugs
- Blue Cross Blue Shield of Michigan will no longer cover GLP-1 weight-loss drugs like Wegovy, Zepbound and Saxenda
- The change comes as the cost for the drug skyrocketed, according to the health insurer
- The company will begin phasing out coverage for the drugs starting Aug.1 and eliminate coverage by Jan. 1.
Weight-loss drugs like Wegovy, Zepbound and Saxenda, which have recently gained popularity, will no longer be covered by Blue Cross Blue Shield of Michigan.
Starting Aug. 1 the state’s largest health insurer will begin phasing out coverage for large group commercial insurance plans and eliminate coverage by Jan. 1, according to Dr. James Grant, chief medical officer for the insurance company.
“It’s just unaffordable and we have to make difficult decisions,” Grant said. “We didn’t make this decision lightly. There was a lot of discussion, a lot of analysis, to come to this conclusion.”
Wegovy, Zepbound and Saxenda are injectable drugs that are FDA-approved to help people with obesity manage their weight. They are part of the family of GLP-1 agonists, which make people feel full by mimicking the effects of a hormone called glucagon-like peptide 1.
RELATED:
Blue Cross Blue Shield of Michigan will continue covering GLP-1s prescribed to treat Type 2 diabetes, including Ozempic, Rybelsus, Victoza and Mounjaro.
“The costs are a huge implication, and obviously we have to look at all drugs that we have to pay for, but we also have to look at effectiveness and we have to look at how our members are using these resources,” Grant said.
“When we got somebody a GLP-1, more than 30% of the time they actually stopped using it after the first month. So what they're doing is, they're actually not waiting long enough to see the positive effects of the drug.”
Annual claims for weight-loss drugs have skyrocketed from $8 million in 2021 to $100 million so far this year, Grant said. The company is on track to spend nearly $200 million by 2025, he added.
The average monthly list price for semaglutide, the clinical name for Wegovy, is over $1,000, according to a brief by Blue Health Intelligence commissioned by the Blue Cross Blue Shield Association. Similar weight-loss drugs can cost between $900 and $1,100 monthly.
Blue Cross Blue Shield of Michigan’s decision to eliminate coverage for weight-loss drugs puts the company in line with other insurers in the state that don’t cover the costs of those drugs.
A survey conducted last October by the International Foundation of Employee Benefit Plans found that 76% of employers said they would cover GLP-1 drugs for diabetes, while 27% said they would cover them for weight loss.
“It can be incredibly frustrating for families when the insurance coverage is switching,” Hanna Jaworski, medical director of Pediatric Health Optimization Services at Helen DeVos Children’s Hospital. “So to have that consistent insurance coverage is incredibly important. “
She said calculating the drugs’ benefits means looking beyond how much weight people lose.
“The important component of this is how does that translate into health? How does that translate into reduced risk of things like Type 2 diabetes, heart attacks, strokes? Those are all devastating diseases and events and also from an insurance perspective, very costly from a care perspective.”
Although some weight-loss drugs will no longer be covered by Blue Cross Blue Shield, Michigan is one of just 16 states that cover the cost of drugs for weight loss as well as Type 2 diabetes through their Medicaid programs.
See what new members are saying about why they donated to Bridge Michigan:
- “In order for this information to be accurate and unbiased it must be underwritten by its readers, not by special interests.” - Larry S.
- “Not many other media sources report on the topics Bridge does.” - Susan B.
- “Your journalism is outstanding and rare these days.” - Mark S.
If you want to ensure the future of nonpartisan, nonprofit Michigan journalism, please become a member today. You, too, will be asked why you donated and maybe we'll feature your quote next time!