Do insurers cover Ozempic, Wegovy and Mounjaro for weight loss?

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Ozempic, Wegovy and Mounjaro might be all the rage for weight loss, but don’t expect to have the pricey drugs covered by your insurance plan.

Government and private insurers are balking at the high price and unknown long-term benefits for those hoping the medications will help them shed pounds.

“These seemingly are unicorns, because such a large percentage of the population is eligible for weight loss treatment and would want to take these drugs,” says Michael Thompson, chief executive of the National Alliance of Healthcare Purchaser Coalitions, which includes groups representing employers.

“Obesity is a huge issue, and traditional treatments such as diet and exercise have not been particularly effective,” he says. “So, while you can’t ignore a new and fresh approach, it’s a big ask to expect insurers [to] foot the bill when there is little information on long-term outcomes and sustained benefits to patients taking the drugs for weight loss.”

How much does Ozempic, Wegovy and Mounjaro cost

A significant hurdle for patients wanting to use the drugs to lose weight is that Ozempic and Mounjaro are approved only for type 2 diabetes treatment, and Wegovy is approved for weight loss if certain criteria are met. In addition, as Thompson notes, the ongoing, high costs of treatment are coupled with concerns about long-term effectiveness. In a study funded by Novo Nordisk, the producer of Ozempic and Wegovy, study participants regained two-thirds of the weight lost during treatment within a year of stopping treatment.

And the drugs are pricey: While costs vary, each typically costs between $1,000 and $1,300 per month for treatment with no insurance coverage. In addition, they are designed for long-term use. Novo Nordisk tags the price of a monthly Ozempic pen injection at $892 without insurance. You can find more information and potential savings discounts for injections here. Some companies, such as GoodRx, provide discounts and savings on the drugs.

Ozempic and Wegovy are actually the same drug but marketed and distributed at different doses. They are semaglutides, a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. The drugs, which are injected via pens, trigger the body to produce more insulin, which reduces blood glucose. Mounjaro, developed by Eli Lilly, is also injectable and acts similarly to activate GLP-1 pathways to help regulate blood sugar.

Wegovy is a larger dose of the semaglutide than Ozempic and was approved for weight loss in 2021 by the U.S. Food and Drug Administration, but with specific guidelines for prescriptions. Patients with a body mass index of 27 or greater and have at least one weight-related condition (such as high blood pressure or type 2 diabetes) are eligible for treatment under the FDA guidelines.

All three drugs are available only via prescription and there are no generic forms currently on the market.

Is there an urgent need for weight loss intervention?

There is an urgent need for more effective treatments for both type 2 diabetes and weight loss. The Centers for Disease Control and Prevention estimates that 11.3% of the U.S. adult population has diabetes (a total of type 1 and type 2), and that 38% of the adult population has pre-diabetes, which means they have elevated blood sugar levels that puts them at risk of developing type 2 diabetes.

The majority of pre-diabetics can avoid contracting diabetes through diet, exercise and weight loss, according to the Mayo Clinic.

The CDC also estimates that 40% of U.S,. adults aged 20 to 39 years are obese, with an obesity rate of 44% among those aged 40 to 59, and 41.5% for adults 60 and older. Using 2019 data, the CDC estimates that the medical costs of obesity was nearly $173 billion, and medical costs for obese adults was $1,861 higher than treatment for people in a healthy weight range.

Thompson believes that insurance companies will eventually reach a “middle ground” in which they cover a substantial amount of the costs of the drugs for weight loss, as long as patients meet them in the middle.

“I expect we will end up at a point where these drugs are covered by insurance for a subset of the patient population that is farther along on the obesity spectrum but is also committed to a diet and exercise program,” he says.

Do insurers cover Ozempic, Wegovy and Mounjaro for weight loss?

How much does Ozempic, Wegovy and Mounjaro cost

Is there an urgent need for weight loss intervention?

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