The Cost of Weight Loss Drugs: Cash Pay vs. Insurance Coverage
US Health Care providers wrote more than nine million prescriptions for GLP-1 drugs like Ozempic, Wegovy, Zepbound, Mounjaro and other similar Type 2 diabetes and weight loss drugs over the last three months of 2022 based on recently released sales data. GLP-1 drugs are a class of medications utilized in the treatment of type 2 diabetes and more recently weight loss. What makes these drugs so effective is that they suppress hunger signals and control the activity of the stomach and studies show that they can enable people to reduce their weight around 15%-20%, nearly double what was previously seen with weight loss drugs. Based on this break through in weight loss, the industry is expecting massive growth as demand for these drugs is skyrocketing and expectations that the drugs will generate 71 Billion in sales by 2032. It’s anticipated nearly 10% of the US population will be using these medications to treat obesity.
However, the cost of these medications are steep and can vary significantly, depending on whether one opts for cash payment, subscribes to a prescription assistance program or relies on insurance coverage. Currently all GLP-1 medications are brand name drugs leading to a high cost, as there aren’t any generics on the market. These GLP-1 medications are typically priced around $1,000 per patient per month. In this article, we will explore the factors contributing to the cost of weight loss drugs and compare the financial implications of paying out-of-pocket versus utilizing insurance benefits.
As more weight loss drugs enter the market and are able to keep up with demand, it’s expected that 10% of Americans will be using GLP-1 weight loss medications to help them lose weight.
Understanding the Cost Factors:
Drug Type and Brand vs. Generic Options:
Weight loss drugs come in various forms, including brand-name and generic versions. Brand-name medications are typically more expensive due to research and development costs, while generic options are more affordable. Currently all of the GLP-1 weight loss drugs in the marketplace are only brand-name options. But, in June 2024, there will be some generic alternatives available. Patients should discuss with their healthcare provider whether a generic alternative is available and suitable for their needs.
Insurance Coverage:
Insurance plans vary in terms of coverage for weight loss drugs. Currently about 40% of large employer insurance plans cover GLP-1 medications for treatment of obesity and another 20% are considering covering it, according to Mercer a staff health benefits consultant. Traditionally Medicare does not cover prescription drugs specifically for weight loss, but some of these drugs are covered to treat Type 2 diabetes. It is crucial for individuals to thoroughly review their insurance policy and consult with their insurance provider to understand the extent of coverage for weight loss medications.
Prescription Coverage Tiers:
Many insurance plans categorize medications into different tiers, each with a corresponding co-payment or coinsurance amount. Weight loss drugs may fall into different tiers based on efficacy, availability of generic alternatives, the insurance company's policies, and other factors. Patients should know their plan's tier structure to anticipate costs accurately.
Deductibles and Co-payments:
High-deductible health plans often require individuals to meet a substantial deductible before insurance coverage kicks in. Co-payments are fixed amounts insured individuals pay for prescription medications, usually determined by the drug's tier. Patients should factor in these costs when assessing the financial impact of weight loss drugs.
Additional Support Services Catering to GLP-1 medications
Even companies like Weight Watchers are jumping into the space of weight loss medications, with the launch of a WeightWatchers Clinic. Weight Watchers recently acquired a tele-health company that will now function as the WeightWatchers Clinic with a dedicated staff of tele-health weight loss management experts and doctors who can prescribe these new drugs for weight loss management. Weight Watchers will not directly profit off of the drugs, but it will charge its members an additional $99 a month on top of the monthly fee to access the WeightWatchers clinic that provides access to the weight loss drugs and it’s launching a program designed to help patients navigate how to maintain a weight when taking these medications.
Cost Estimates and Average Length of Use:
Cash Pay:
Cost Estimates: The cash pay cost for GLP-1 weight loss drugs varies depending on the drug being prescribed, but on average expect to pay around $1,000 monthly cash pay for these GLP-1 drugs which currently do not have any generic alternatives.
WeGovy costs on average about $270 per weekly dose, making the monthly total about $1,350.
Ozempic is specifically marketed and approved to treat Type 2 diabetes averages $892 a month. Ozempic and WeGovy are produced by the same manufacturer, but they come in different strengths and have different dosage schedules.
Mounjaro cash pay on average totals $1,200 monthly
Zepbound is about $1,000 a month.
Saxenda is about $1,349 a month.
Other weight loss brand-name medications (non GLP-1 medications) can range from $100 to $300 per month, while generic alternatives may cost between $50 to $150 per month.
Average Length of Use: Individuals may use weight loss medications for varying durations depending on their weight loss goals and response to the medication. Consult with your doctor or provider to identify the right amount of time to be on these weight loss medications. On average, many patients use these drugs for three to six months.
Insurance Coverage:
Cost Estimates: With insurance coverage, patients typically pay a fraction of the total cost determined by their plan's co-payment or coinsurance. Check with your insurance plan to understand the costs if this medication is covered by your insurance plan.
Average Length of Use: Insurance plans may cover weight loss medications for a specific duration, often ranging from three to six months. The length of coverage can vary, and some plans may require re-evaluation for continued coverage.
Financial Assistance Options & Savings
Each pharmaceutical company offers a co-pay assistance program to help with out of pocket costs if you have commercial insurance. To see if you’re eligible, we’ve included some links to GLP-1 pharmaceutical provider’s website tos understand the programs in more detail.
WeGovy Cost Check and Co-Pay Card Savings Opportunity - If eligible subject to maximum savings of $225 per 28-day supply (1 box) for up to 12 fills for commercially insured patients with Wegovy® coverage. Patients with commercial insurance who do not have coverage for Wegovy®, can save $500 per 28-day supply
Mounjaro Cost Savings Program - If eligible patient co-pay could be reduced to $25 mo
Zepbound Co-Pay Savings Program - If eligible patient co-pay could be reduced to $25 mo
Saxenda Co-Pay Savings Program - If eligible patient co-pay could be reduced to $25 mo
Conclusion:
The cost of weight loss drugs for patients involves a complex interplay of factors, including the type of medication, insurance coverage, and individual insurance plan details. While cash pay offers flexibility and immediate access, insurance coverage and financial assistance programs may provide financial relief for those with comprehensive plans. Patients should carefully assess their insurance policies, explore generic options, and discuss cost-effective strategies with their healthcare providers to make informed decisions on their weight loss journey. Ultimately, achieving a healthy weight is a multifaceted goal that requires consideration of medical interventions and the financial implications involved.