Blue Cross Blue Shield of Michigan will pull back on coverage for GLP-1 drugs amid rising costs for these products.
The insurer said in a statement to Fierce Healthcare that it will no longer cover GLP-1s in its large group fully insured plans as of Jan. 1, 2025, or on the plan sponsor's 2025 renewal date. In addition, BCBSM will change prior authorization requirements in this space on Saxenda, Wegovy and Zepbound beginning Aug. 1 of this year.
"Blue Cross made these changes after careful consideration of GLP-1 weight loss drugs’ efficacy, safety and access, and cost," the insurer said.
The news dropped as the cost and demand for GLP-1s was one of the dominant topics at the 2024 AHIP conference, with industry leaders expressing concern about the high price tags for many of these drugs even as questions remain about the long-term efficacy and impacts on patients.
For patients without insurance, the cost of drugs like Wegovy or Ozempic can reach $1,000 per month. An analysis from the Senate Committee on Health, Education, Labor and Pensions projected that if half of obese adults in the U.S. began to take GLP-1 drugs, total spending could reach $411 billion.
There are also challenges around access, as shortages due to the high demand remain.
"Diabetes and obesity are big things that we should be treating, the downstream cost of care is huge," said Timothy Law, chief medical officer for Highmark, on a GLP-1 panel at AHIP. "But we have to be fiduciary responsible to people who are paying premiums to that."