Injection pens of Novo Nordisk’s weight-loss drug Wegovy are shown on this photo illustration in Oslo, Norway, Nov. 21, 2023.
Victoria Klesty | Reuters
Cigna on Thursday said it is going to limit how much health plans and employers spend on weight reduction drugs every year in a bid to expand insurance coverage for those highly popular treatments.
The move comes as many insurers mull whether or not they should cover those drugs or drop them from their plans altogether due to their high costs. Americans have flocked to the treatments, together with similar diabetes drugs, despite their hefty list prices of roughly $1,000 monthly or up to $15,000 per 12 months.
The trouble by insurance giant Cigna could make weight reduction treatments more accessible. Most insurance plans cover diabetes treatments.
Cigna’s pharmacy advantages management unit will limit spending increases for weight reduction and diabetes drugs to a maximum of 15% annually, an organization spokesperson told CNBC. Currently, some health plans are seeing spending on the drugs rise 40% to 50% annually, according to the spokesperson.
As a part of that effort, Cigna’s Evernorth unit struck agreements with drugmakers Novo Nordisk and Eli Lilly, the spokesperson said. Cigna didn’t provide further details on what those agreements appear like.
A spokesperson for Eli Lilly said employers should “prioritize solutions that facilitate access to comprehensive and patient-centered” obesity care, given how the condition affects people all over the world.
Novo Nordisk didn’t immediately respond to requests for comment on the agreement with Cigna’s Evernorth.
The corporate called the hassle the health-care industry’s “first financial guarantee” for coverage of the drugs, that are also often known as GLP-1s. Those medicines treat weight reduction and diabetes by mimicking a number of hormones produced within the gut to suppress appetite and regulate blood sugar.
Cigna said providing “financial predictability” through a price cap will allow health plans and employers to higher plan to manage GLP-1 spending. That, in turn, would help ensure broader access for eligible patients.
Adam Kautzner, president of pharmacy advantages manager Express Scripts, said through the company’s investor day that the marketplace for GLP-1s could grow to $100 billion by the top of the last decade. Express scripts is owned by the Evernorth division. He called that a “completely unsustainable number” and said that Cigna’s insurance clients are “continuing to look to us for help.”
“Lots of them want to preserve access for patients or expand access for patients to treat diabetes. But at the identical time, you’re seeing some which might be pulling back as well,” Kautzner said through the event.
An October survey of 205 firms by the International Foundation of Worker Profit Plans found 76% of respondents provided GLP-1 drug coverage for diabetes, versus only 27% that provided coverage for weight reduction. But 13% of plan sponsors indicated they were considering coverage for weight reduction.
The trouble expands an existing program under the Evernorth unit called EncircleRx, which targets patients with diabetes, obesity and heart problems.
Health plans and employers pay Cigna a separate monthly fee for that program. This system includes support for patients on the drugs, that are supposed to be accompanied by lifestyle changes similar to eating regimen and increased exercise.
Cigna can be working with Omada Health on services to help patients with behavior changes.