Weight loss drugs: The battle over coverage
>>> THE WEIGHT LOSS DRUG BOOM HAS CREATED A BATTLE OVER COVERAGE EMPLOYERS AND INSURERS ARE SETTING UP MORE HURDLES FOR PATIENTS BERTHA COOMBS HAS THIS STORY. >> REBECCA NEVER STRUGGLED WITH WEIGHT UNTIL SEVEN YEARS AGO. >> BREAKING MY ANKLE WHILE I WAS PREGNANT WITH MY SECOND CHILD WAS A BIG DETERMINANT IN MY WEIGHT AND OF COURSE THE PANDEMIC. >> Reporter: LAST YEAR, SHE TURNED TO AN ONLINE WEIGHT LOSS PROGRAM.
FOUND HEALTH FOUND’S DOCTOR STARTED HER ON AN INEXPENSIVE GENERIC FIRST. >> I TOOK IT FOR A COUPLE OF MONTHS AND HAD, YOU KNOW, LOST A FEW POUNDS FROM THAT, BUT I WASN’T SEEING A LOT OF WEIGHT LOSS AND AT THAT POINT, WE DECIDED, OKAY, WE’LL SWITCH TO A GOP 1. >> Reporter: SHE NOW LOST 40 POUNDS AND FEELS LUCKY HER EMPLOYER PLAN COVERS MEDS FOR WEIGHT LOSS. >> IT JUST BROUGHT ME BACK TO KIND OF THE WEIGHT THAT I WAS BEFORE I STARTED HAVING KIDS >> Reporter: BUT INSURANCE COVERAGE IS GETTING HARDER TO GET.
FOR WEIGHT LOSS, PREAUTHORIZED GOP 1 COVERAGE FOR FOUND HEALTH PATIENTS MORE THAN DOUBLED IN THE FIRST QUARTER TO 27% BUT HAS SINCE DROPPED TO JUST 9% THE PULLBACK JUST AS SHARP FOR TYPE II DIABETES. >> WE HAVE SEEN SOMETHING LIKE A 60% DECLINE IN PEOPLE WITH DIABETES HAVING COVERAGE FOR THESE MEDICATIONS SINCE DECEMBER AND THE REQUIREMENTS AROUND PRIOR AUTHORIZATION AND COVERAGE AT ALL HAVE CHANGED DRAMATICALLY. >> Reporter: LARGE EMPLOYERS LIKE AMAZON ARE TRYING TO STRIKE THE RIGHT BALANCE. >> OUR POSITION IS IT’S NOT JUST ABOUT AN INJECTION OR SURGERY, IT IS HOW YOU PUT TOGETHER A COMBINED SET OF RESOURCES THAT CAN HELP PEOPLE WHO ARE STRUGGLING WITH OBESITY. >> AND IN 2024, A LOT OF LARGE EMPLOYER PLANS WILL MAKE WORKERS TAKE STEPS LIKE REBECCA DID TO GET COVERAGE FOR THESE DRUGS. GETTING PREAUTHORIZATION, MAYBE TRYING THE GENERICS FIRST AND THEN HAVING TO ADHERE TO A SUPERVISED PROGRAM ONE OF THE THINGS WE JUST HEARD BACK FROM REBECCA SHE HAD HER ANNUAL PHYSICAL AND SHE NOW DOESN’T HAVE TO TAKE HYPERTENSION DRUGS BECAUSE HER BLOOD PRESSURE IS NOW BACK TO NORMAL SO, THERE ARE A LOT OF BENEFITS TO THESE DRUGS THE QUESTION IS, HOW DO YOU PAY FOR THEM RIGHT NOW, AT THIS PRICE, FOR A LOT OF PEOPLE, IT’S KIND OF LIKE A STATTEN, THEY HAVE TO BE ON IT FOR QUITE A WHILE.
>> THE SELECT DATA FROM NOR VOE NOR TIS, I THINK INSURERS MUST PAY THEY EXPECT THEY HAVE TO PAY FOR IT BECAUSE IT REDUCES CARDIOVASCULAR EVENTS. >> IT BECOMES LIKE A LIPPER TO 15 YEARS AGO WE WERE TALKING ABOUT LIPITOR, 4, $500 A MONTH IT BECOMES MORE OF AN ESSENTIAL DRUG THEY’LL HAVE THE REST OF THE DATA LATER THIS FALL, BUT IF THAT’S THE CASE, IT’S GOING TO BE MORE DIFFICULT TO RESTRICT IT.
IT ALSO BECOMES AN EQUITY PROBLEM BECAUSE IF YOU’RE ON AN EMPLOYER PLAN, YOU’RE MORE LIKELY TO HAVE IT COVERED. BUT THEN TALK ABOUT PEOPLE ON MEDICAID WHO CAN MEDICAID PLANS TO AFFORD TO DO THIS AND PEOPLE WHO MAY NOT HAVE A CADILLAC PLAN, OR GOLD PLAN COVERAGE, HOW MUCH ARE THEY GOING TO HAVE TO PAY THEY CAN GET COUPONS, WHICH HELPS. AND THAT HAS BROUGHT REBECCA,
