As insurers drop GLP-1 coverage, patients lose access despite reported benefits
Vermont insurers and employers are scaling back GLP-1 coverage as costs rise, leaving some patients without access. The drugs remain in high demand as studies point to benefits beyond weight loss.
Vermont health insurers and private employers have been steadily scaling back coverage of the popular weight-loss drugs known as GLP-1s in an attempt to rein in costs. The drugs can be life-changing, but they’re also expensive, with some costing roughly $16,000 a year, and insurers say their exploding popularity has contributed to premium rate increases.
Since January 1, plans offered through Blue Cross Blue Shield of Vermont and MVP Health Care have stopped covering GLP-1s for weight loss alone. The same goes for the plans that cover public school teachers. Private employers, meanwhile, have yanked coverage or erected new hurdles that make it more difficult to get a prescription covered.
At the beginning of 2024, one patient learned that her employer’s health plan was only going to cover Wegovy and other GLP-1 weight-loss drugs for people over a certain body mass index. She had already fallen below that threshold. Instead of a small co-pay, the injections she expected to take for the rest of her life would now cost her $900 to $1,200 a month out of pocket.
Others have had no choice but to discontinue the drugs. One patient found out she no longer had coverage for Wegovy and that it would cost her $3,000. She left the pharmacy without the medication and has since regained the 20 pounds she lost.
That’s part of a national shift, and drugmakers are scrambling to respond. Lilly launched a self-pay option in 2024 featuring vials of Zepbound from which patients draw the drug using a syringe and then inject themselves. Last month, Novo Nordisk released a pill version of Wegovy that can be purchased directly from the manufacturer for just under $200 a month.
Medications that suppress appetite and increase feelings of fullness are allowing people to better manage diabetes and obesity. As prescriptions for weight-loss drugs soar, additional benefits and risks of GLP-1 drugs are emerging. New research reveals a potential link between GLP-1 drugs and improvements in myriad health conditions, including sleep apnea, joint pain, liver disease, heart disease, asthma, and even addiction.
Large clinical trials revealed a striking finding: GLP-1 drugs reduce the risk of heart attacks, strokes and cardiovascular death. A 2023 study of more than 17,000 patients published in the New England Journal of Medicine found that semaglutide reduced the risk of major cardiovascular events — including heart attack, stroke and cardiovascular death — by about 20% in overweight or obese adults who already have cardiovascular disease but not diabetes.
After clinical trials, the U.S. Food and Drug Administration has approved Wegovy (semaglutide) injection to treat metabolic-associated steatohepatitis in adults with excessive scar tissue in the liver. The FDA said about 6% of U.S. adults, about 14.9 million people, have MASH, and its prevalence is expanding.
The class of drugs known as GLP-1s mimic a natural hormone called glucagon-like peptide-1 that can influence a range of metabolic factors. The drugs were originally developed and prescribed to control diabetes, as they proved to help reduce blood sugar without some of the main side effects of insulin, such as weight gain. Experts soon realized that GLP-1s could actually reduce weight by slowing digestion and helping people feel fuller, and the drugs have also been found to reduce food cravings.