More U.S. employers covering GLP-1s for weight loss

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Good morning! Extra U.S. employers are overlaying a buzzy class of medicines known as GLP-1s for weight reduction, a survey discovered. 

Roughly one-third of employer well being plans within the U.S. mentioned they’re overlaying GLP-1 drugs like Novo Nordisk‘s Ozempic and Wegovy for each diabetes and weight reduction, up from 26% final yr. 

GLP-1 medicine for weight reduction additionally grew as a portion of employers’ total annual medical claims spending, making up practically 9% in 2024 in comparison with roughly 7% the yr prior. 

That is based on the survey launched Thursday by a nonprofit organization, the Worldwide Basis of Worker Profit Plans, which incorporates greater than 33,000 member corporations or public establishments. The survey was carried out in Could on nearly 300 employer well being plans within the U.S. 

The rise in protection is a win for sufferers, who usually battle to shoulder the hefty $1,000 month-to-month worth tags of those medicine with out insurance coverage and different rebates. It is also excellent news for the producers of those therapies, Novo Nordisk and Eli Lilly, that are working to extend insurance coverage protection for the medicine and affected person entry total. 

Notably, most worker well being plans and different insurers do not cowl medicine for weight reduction, together with GLP-1s similar to Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound. The federal Medicare program additionally would not pay for weight reduction therapies except they’re accredited and prescribed for one more well being situation. 

GLP-1s for diabetes, similar to Ozempic and Eli Lilly’s Mounjaro, are sometimes lined by plans. 

Each weight reduction and diabetes medicine have skyrocketed in reputation within the U.S. — whereas drawing rising investor curiosity — for serving to individuals obtain dramatic weight reduction over time. They work by mimicking a number of hormones produced within the intestine to suppress an individual’s urge for food and regulate their blood sugar. 

Some 57% of employer well being plans mentioned they solely cowl the drugs for diabetes administration, up from 49% in 2023, based on the survey. 

However a considerable share — round 19% — mentioned they’re contemplating whether or not to cowl them for weight reduction.

“This new survey information reveals that within the final six months, GLP-1 protection has elevated for each weight reduction and diabetes,” Julie Stich, the vp of content material on the Worldwide Basis of Worker Profit Plans, mentioned in a launch. 

Stich mentioned new regulatory approvals and medical trials, together with rising demand for GLP-1 drugs within the U.S., have contributed to broader protection.

For instance, Novo Nordisk’s Wegovy is now cleared in U.S. for slashing the danger of great coronary heart problems. 

Insurance coverage business consultants beforehand instructed CNBC that the approval won’t automatically translate to widespread insurance coverage protection of the load loss drug. On the very least, some plans will take discover of Wegovy’s new use and begin assessing whether or not to cowl the remedy after they subsequent replace their formularies, these consultants mentioned. 

Novo Nordisk and Eli Lilly are additionally conducting a slate of research on their GLP-1 medicine in numerous sufferers. That features these with continual kidney illness, sleep apnea and a sure fatty liver illness. 

However there is not any doubt that the drugs can placed on a pressure on any well being plan’s price range. 

Round 85% of employers which might be overlaying GLP-1s are relying “closely” on necessities that goal to regulate prices, based on the survey. 

That features sure eligibility guidelines, similar to requiring workers to have a sure BMI, or physique mass index, to obtain protection. It additionally consists of “step remedy,” which requires its members to attempt different lower-cost drugs or technique of shedding pounds earlier than utilizing a GLP-1.

In the meantime, different insurance coverage are pulling again protection of the drugs for weight reduction. Blue Cross Blue Protect of Michigan, the state’s largest insurance coverage firm, mentioned it’ll begin eliminating coverage of various weight reduction medicine subsequent yr.

There’s additionally an even bigger subject at hand, at the same time as insurance coverage protection improves amongst employers: Novo Nordisk and Eli Lilly have been struggling to make sufficient provide of their therapies to fulfill demand. That’s one other a part of the GLP-1 story that we are going to proceed to observe. 

Be happy to ship any suggestions, recommendations, story concepts and information to Annika at annikakim.constantino@nbcuni.com.

Well being-care corporations which might be exploring new makes use of for synthetic intelligence are profitable large with enterprise capital traders. 

One in each 4 health-care funding {dollars} goes towards corporations which might be utilizing AI, and deal exercise in AI for well being care has grown twice as quick as AI offers within the tech business as an entire, based on a recent report from Silicon Valley Financial institution, which is now a division of First Residents Financial institution. 

The report mentioned VCs invested $7.2 billion in health-care AI final yr, and the determine is on monitor to achieve $11.1 billion this yr. 

Administrative functions of AI in well being care are drawing round 60% of the funding, the report mentioned. Clerical duties like paperwork are a serious burden for the health-care sector, and they’re contributing to doctor burnout and staffing shortages.

Greater than 90% of docs report feeling burnt out regularly, and 64% of those docs mentioned overwhelming administrative workloads are a serious cause for it, based on a February survey from Athenahealth. Physicians are spending a median of 15 hours per week exterior their regular hours maintaining with administrative duties, the survey mentioned.

In different phrases, administrative work is an enormous drawback for the health-care sector. VCs are notably thinking about it because it often faces much less regulatory oversight than medical resolution help instruments or patient-facing options do, SVB’s report mentioned. 

Though health-care AI corporations are anticipated to boost extra funds this yr than they did final yr, SVB mentioned accessing high quality information and enough computing energy to coach fashions may very well be boundaries to adoption. 

That is notably true for AI-powered affected person diagnostic instruments, which make up 52% of complete funding in medical options, based on the report. As of now, there’s a “important hole” in entry to the mandatory computing energy and information to coach a mannequin that may precisely diagnose a affected person. 

“Corporations that may entry information, associate with clinicians and hospitals to leverage affected person information, and associate with large tech corporations are higher suited to deploy AI at scale,” the report mentioned. 

Be happy to ship any suggestions, recommendations, story concepts and information to Ashley at ashley.capoot@nbcuni.com.