LANSING, Mich. (Michigan News Source) — Blue Cross Blue Shield of Michigan has announced plans to phase out coverage for popular anti-obesity drugs by January 1, a decision that could leave almost 9,500 Michigan residents struggling to afford their weight-loss medications. The phase-out will affect medications known as GLP-1s, including Wegovy, Saxenda, and Zepbound, initially developed for Type 2 diabetes but now widely used for weight loss. 

The cost of GLP-1s is “prohibitively” high, ranging from $1,200 to $1,500 per month, according to Blue Cross. Without insurance, many might have to discontinue their treatments. Jake Beaven-Parshall from Wyandotte, who lost over 100 pounds on weight-loss medications, told The Detroit News that for many, these medications are a necessity for managing their health, not a luxury (The Detroit News).

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James Grant, Blue Cross Blue Shield’s senior vice president and chief medical officer, explained that the decision was driven by the need to stay competitive and manage rising costs. The insurer’s annual claims for GLP-1 medications have increased from $8 million to $100 million over the past three years. 

Grant argued that the decision was necessary for long-term sustainability: “If your competitors aren’t paying for it, it makes it really tough for you to continue to pay for it at the same time,” Grant said, according to The Detroit News.

Grant continued: “The 9,500 people who might lose coverage are not a huge percentage of the 4.5 million Blue Cross Blue Shield customers in Michigan.” 

Despite the coverage cuts, however, Grant assured that GLP-1 medications for treating Type 2 diabetes, such as Victoza and Mounjaro, will still be covered. Additionally, weight-loss versions of these drugs will remain available under Michigan’s Medicaid plans for low-income residents. 

New research from the University of Southern California quantifies the soaring demand for semaglutide, the active ingredient in drugs like Ozempic and Wegovy, as reported by USA TODAY. Between January 2021 and December 2023, prescriptions for semaglutide increased by 442%, reflecting the growing recognition of these medications’ effectiveness. 

This demand exacerbates the challenge of securing insurance coverage, however, especially for patients covered by Medicaid and Medicare, who face barriers. 

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In fact, a study published in  JAMA Health Forum found that patients with private insurance were far more likely to have their prescriptions filled. Moreover, in December 2023, 90% of Wegovy prescriptions were filled by privately insured patients, while Medicare and Medicaid patients represented only a small 1.2%. 

Federal spending on weight-loss drugs has increased, as well, with Medicare’s expenditure on drugs like Ozempic, Rybelsus, and Mounjaro rising from $57 million in 2018 to $5.7 billion in 2022 (USA TODAY). 

“That’s a caution with these medications, is that I think a lot of patients want a quick fix, and then they do it in an unhealthy way,” Amy Somerset, a bariatric surgeon at the Detroit Medical Center, told The Detroit News. “They went from eating poorly to now just not eating. And that’s not what we want. We want to make it such that you’re able to make healthier choices.”