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Cigna’s pharmacy benefits management unit, Evernorth Health Services, said on March 7 that it will limit how much employers spend on GLP-1 weight loss medications annually, Healthcare Brew reported.
Under the deal, which Evernorth branded an “industry-first financial guarantee for GLP-1 spend,” clients won’t see the cost of weight loss and diabetes drugs increase more than 15% each year, Evernorth spokesperson Justine Sessions told HR Brew. Evernorth inked agreements with two major GLP-1 manufacturers, Novo Nordisk and Eli Lilly, on the spending cap.
For some health plans, the annual cost of these drugs is increasing by 40%–50% annually, CNBC reported. Lowering employer spending on GLP-1s is one way to expand insurance coverage for them, the outlet suggested.
Why GLP-1 costs are a major employer concern. The drugs offer great promise for the 40% of the US population struggling with obesity. They also have the potential to help companies attract talent, as 44% of adults with obesity would consider switching jobs to get covered for this treatment, an April 2023 survey by virtual care company Ro found.
And while a higher share of HR decision-makers aim to cover these medications this year than last year, according to a separate survey by personalized healthcare firm Accolade, employers are running into cost concerns.
GLP-1s cost an estimated $1,000 per patient per month, and recently some employers have started putting restrictions on which workers can qualify for the drugs, or dropped coverage entirely, the Wall Street Journal recently reported. RWJBarnabas Health System in New Jersey, for example, stopped covering GLP-1s for weight loss, though it will still cover them for diabetes, another condition these drugs commonly treat.
In order to ensure they’re effective in helping employees lose weight, some employers are pairing the drugs with other lifestyle changes, such as fitness and exercise, HR Brew recently reported. EncircleRx, the program to which Evernorth is adding a GLP-1 spending cap, also enrolls patients on these medications in a “lifestyle modification program with behavior change support,” according to its website, in partnership with virtual care company Omada Health.
Labcorp, which covers GLP-1s through a partnership with WeightWatchers for Business, is monitoring the use of these drugs very closely. “Like any other payer or employer who’s bearing that cost, we want to be extremely responsible,” Brian Caveney, its chief medical and scientific officer, told HR Brew in February.