Let's chew on the fat for awhile: The GLP-1 dilemma persists into 2025

[Duaine]

Effective Jan. 1, 2025:

• 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 2025 policy updates follow a series of coverage restrictions implemented by major health systems and insurers in 2024. West Orange, N.J.-based RWJBarnabas Health ended coverage for GLP-1s prescribed for weight loss, citing adherence concerns. Minneapolis-based Fairview Health Services limited coverage of Wegovy and Saxenda to employees with a BMI of 40 or higher, anticipating $10 million in annual costs without the restriction. Rochester, Minn.-based Mayo Clinic imposed a lifetime limit of $20,000 for weight loss drugs under its employee health plan, while St. Louis-based Ascension dropped coverage entirely for its 139,000 employees in July 2023, citing cost-effectiveness and safety concerns.

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.

 

[somarco]

GLP-1 has almost replaced bariatric surgery for those who are morbidly obese. However, GLP-1 "therapy" is not necessarily a permanent solution, and it is not without a downside risk.


Drugs like Ozempic, Wegovy, Zepbound and Mounjaro have been around for years, but they've recently been making headlines due to a rise in popularity as weight loss agents. They all belong to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RAs), which mimic a hormone (GLP-1) in the body that helps control insulin and blood glucose levels and promotes feelings of satiety.

These drugs are extremely effective for blood glucose control and weight management, which, combined with their relatively limited side effect profile, makes them very appealing for diabetes treatment — the purpose for which they originally received FDA approval.

However, off-label use fueled by celebrities and social media is a growing concern. And even when physicians are prescribing GLP-1RAs for their intended uses, it's not a magic formula — there are complex considerations such as dosages, costs, side effects and comparisons between specific drugs.

"It's also important to note that the long-term side effects of these drugs are not yet well-studied," Yuan said. "If large swathes of the general public start taking them off-label for weight loss and then we find out years later that there are bad side effects, it could be a real issue."

Research shows GLP-1 drugs are effective but complex - UChicago Medicine

Studies show that while GLP-1RA drugs like Ozempic and Mounjaro are effective for weight loss and Type 2 diabetes treatment, there's no one-size-fits-all solution and physicians and patients have to consider issues like cost and side effects.

www.uchicagomedicine.org

 

[Fisher]

Not if Elon has anything to say about it.

 

[Tahoe Ray]

Not if Elon has anything to say about it.

Elon vs. RFK Jr.

The wars on Twitter today are pretty hilarious if you ask me.

 

[Fisher]

RFK's not a fan of the fat pill? I'm not a Twitterer.

 

[Tahoe Ray]

RFK's not a fan of the fat pill? I'm not a Twitterer.

Haha...he wants to totally get rid of it.

And then Elon and Vivek are pushing for more H-1B visa applications allowed because Americans are "retards".

This shit writes itself lol.

 

[scagnt83]

Haha...he wants to totally get rid of it.

And then Elon and Vivek are pushing for more H-1B visa applications allowed because Americans are "retards".

This shit writes itself lol.

Dont forget "unmotivated"

 

[annon123]

And then Elon and Vivek are pushing for more H-1B visa applications allowed because Americans are "retards".

Actually enlarging the numbers of that group of people legally in this country makes sense. They add to our tax base as usually they have higher than average wages as they have specialized skills we need in occupations/jobs we have a shortage of skilled workers, if there are enough of them they help offset the proportion of younger people vs older people in this country...