ROCHESTER — Mayo Clinic employees insured through the Mayo Medical Plan will have new lifetime limits on weight loss drug coverage starting in 2024.
Starting January 1, 2024, people prescribed FDA-approved weight loss drugs, including Wigoby, Saxenda, Contrave and others, will have to pay up to $20,000 for the cost of those drugs, according to a letter provided to the Post. I will do it. This email was sent by her Alluma, a pharmacy benefits manager for a health insurance plan.
In a statement, the Mayo Clinic said it would make these weight loss drugs available through its employee health plans “with new provisions reflecting up to $20,000 in lifetime benefits for prescriptions filled after January 1, 2024.” It said it would continue to provide compensation.
“Mayo Clinic continually and carefully evaluates our prescription coverage and makes annual adjustments to balance affordability and coverage in the best interest of plan members,” the statement said. continuing. “Plan members are encouraged to consult with their health care provider to help determine safe and effective care treatment options and plans.”
At this time, Mayo Clinic’s employee health insurance plan, offered through Medica, does not have a lifetime maximum benefit for these drugs. Through the end of the year, prescriptions for weight-loss drugs will be subject to “the plan’s standard deductible or unlimited coinsurance,” according to the letter.
Today, the Mayo Medical Plan is an anomaly among employer-sponsored health insurance plans. According to the International Employee Benefit Plans Foundation,
22% of US employers cover insurance
Prescribed weight loss drugs.
Mayo Clinic says the new lifetime maximum benefit does not apply to “approved GLP-1 prescriptions for diabetes.” Semaglutide, the active ingredient in Wegovy, is
Glucagon-like peptide 1 agonist
It is also approved by the FDA for the treatment of type 2 diabetes under the brand name Ozempic. Both Wegovy and Ozempic are administered by weekly injections.
“Mayo Medical Plan offers Ozempic coverage for adults with type 2 diabetes, which is not eligible for the $20,000 lifetime benefit cap,” the Mayo Clinic said in a statement. Ta.
Most weight-loss drugs work by “suppressing appetite and promoting satiety (satiety) through central effects on the brain,” says obesity specialist and professor emeritus in the Department of Biochemistry and Molecular Biology, Faculty of Medicine at the University of Calgary.・Dr. Lau said. Cumming School of Medicine, Alberta, Canada.
“This is true for GLP-1 receptor agonists such as semaglutide…liraglutide 3mg (Saxenda), tirzepatide (Munjaro)…Contrave, Kushimia, Lomayra, Imsivly,” Lau said. “GLP-1 RAs also slow stomach emptying and improve blood sugar control.”
Lau said semaglutide is “a breakthrough weight loss drug because it is the only drug that can produce more than 10% weight loss.”
According to , the list price for a month’s worth of Wegovy shots is $1,349.
Peterson-KFF Health System Tracker.
This price is very high compared to the price of this drug in Germany and the Netherlands. In Germany and the Netherlands, his month’s supply of Wegovy costs $328 and $296, respectively.
Ozempic also commands a hefty price tag in the United States, with a listed cost of $936 for four injections. In other countries, including Canada, Switzerland, the United Kingdom and Australia, a month’s supply of Ozempic does not cost more than $200, according to Health System Tracker.
These weight loss drugs are drugs that patients may continue to take for long periods of time to manage obesity, which is “now widely accepted as a chronic disease and requires long-term treatment.” Mr Lau said. Patients may regain weight when they stop taking weight loss drugs.
“Limiting coverage of weight-loss drugs to lifetime limits discriminates against obese patients because many health authorities and third-party insurance payers believe that obesity is not a health problem but a body image problem. “We still mistakenly believe that it is,” Lau said. “It must be emphasized that the lifetime cap was introduced primarily to control costs.”
The FDA may expand Wegovy’s approved uses in the near future.
Novo Nordisk, the Danish pharmaceutical company that manufactures the drug, announced that it has applied for approval of Wegoby as a treatment to reduce patients’ risk of cardiovascular disease.
