- 1,153
Effective Jan. 1, 2025:
The financial strain caused by GLP-1 drugs has been evident in insurers' financial reports throughout the year. Pittsburgh-based UPMC reported an operating loss of $371 million for the nine months ended Sept. 30, 2024. The loss was largely due to UPMC Health Plan's increased medical use and rising pharmacy costs, which include expenses for GLP-1 drugs.
[EXTERNAL LINK] - The GLP-1 dilemma persists into 2025
Pittsburgh-based Highmark Health, which operates BCBS affiliates in four states, noted in its third quarter financial report that its health plans continue to face "high prescription drug costs, particularly GLP-1s, and BCBS Massachusetts reported a $114 million operating loss in the first nine months of 2024, partly due to a 250% increase in claims for GLP-1s.
- Oakland, Calif.-based Kaiser Permanente will drop base coverage for GLP-1s for commercial and ACA members in California when those drugs are prescribed solely for the purpose of weight loss for patients with BMI less than 40.
- Independence Blue Cross will stop covering weight loss drugs unless prescribed for conditions such as type 2 diabetes or cardiovascular disease. Members using these drugs solely for weight loss will need to pay out-of-pocket after the policy change.
- BCBS Michigan said it will no longer cover GLP-1 drugs to treat obesity. The change will affect nearly 10,000 members in fully insured, large group commercial plans.
- Minneapolis-based Allina Health will no longer cover GLP-1s prescribed for weight loss under its employee health plans.
- Point32Health is implementing new formularies in Maine and Rhode Island for small group and individual markets starting in 2025, resulting in the removal of coverage for some weight loss drugs and stricter prior authorization requirements for medications like Ozempic and Mounjaro.
- MassHealth is transitioning coverage for anti-obesity drugs, designating Zepbound as the preferred option starting in January 2025, with Wegovy and Saxenda being discontinued for most adult members.
- The BCBS Federal Employee Program standard and basic plans will reduce coverage for GLP-1 drugs such as Wegovy, with some medications moved to excluded or non-covered formulary tiers due to rising costs.
The financial strain caused by GLP-1 drugs has been evident in insurers' financial reports throughout the year. Pittsburgh-based UPMC reported an operating loss of $371 million for the nine months ended Sept. 30, 2024. The loss was largely due to UPMC Health Plan's increased medical use and rising pharmacy costs, which include expenses for GLP-1 drugs.
[EXTERNAL LINK] - The GLP-1 dilemma persists into 2025
Pittsburgh-based Highmark Health, which operates BCBS affiliates in four states, noted in its third quarter financial report that its health plans continue to face "high prescription drug costs, particularly GLP-1s, and BCBS Massachusetts reported a $114 million operating loss in the first nine months of 2024, partly due to a 250% increase in claims for GLP-1s.
