August 10, 2023
Why are GLP-1 medications getting so much attention?
Glucagon Like Peptide-1 (GLP-1) drugs mimic a natural hormone that’s found in the human gut which is responsible for several key processes in the body that can help control blood glucose and increase satiety. GLP-1 medications have many benefits including lowering blood glucose, lowering blood pressure, improving cholesterol, reducing the risk of heart and kidney disease, and weight loss.
How are these drugs covered by Premera?
Premera covers GLP-1s under both our diabetes and drugs for weight management medical policies. The drugs covered on each policy varies based on the indications approved by the Food and Drug Administration. For example, Wegovy and Ozempic have the same active ingredient, semaglutide, but they’re not approved for the same indications.
- The diabetes policy is standard across all plans and outlines medical necessity criteria for GLP-1s approved for diabetes including requiring a diabetes diagnosis
- The drugs for weight management policy applies for employer groups who’ve chosen to add weight-loss drug coverage.
How can employer groups avoid paying for off-label use of these drugs?
- Premera utilization management ensures that weight-loss drugs are only approved on plans that cover weight-loss drugs when members meet criteria
- GLP-1s for diabetes are only approved when the medical policy criteria are met, including a diagnosis of type 2 diabetes.
If groups want to cover weight-loss drugs, how much will it cost?
Groups wanting to cover weight-loss medications should do so understanding the plan cost will continue to rise at an unpredictable rate. The annual cost of therapy for a GLP-1 can range from $15,000-$20,000 per member. We expect further increases in spend as new GLP-1 weight-loss drugs come to market. We’ve seen a tripling of utilization and plan cost in under two years for groups opting to cover weight-loss medications. The outlook is that we’ll see further increases in spend as new GLP-1 weight-loss drugs come to market.