Coshocton County and other governments see higher insurance costs due to weight loss drugs

COSHOCTON − Doctors prescribing drugs used to treat Type 2 diabetes for weight loss not related to the disease is impacting insurance costs for governments across the country.

To help cut costs, some state, county and city governments are no longer approving such medications when used for weight loss. This includes Ozempic, Wegovy, Jardiance, Trulicity and Saxenda, among others.

Coshocton County covers these type of drugs for county employees now, but might not in the future depending on its insurance provider.

Mary Beck, administrator for Coshocton County commissioners, said they are experiencing some increased costs with their insurance provider, the County Employee Benefit Consortium of Ohio ( CEBCO ). It's through the County Commissioners Association of Ohio (CCAO). Compared to 2023, costs related to these drugs have gone up 310% and costs overall are up 987%, Beck said.

Beck said CEBCO officials expressed great concern over the cost of such drugs at a meeting in March. Discussed was the insurance provider no longer covering such drugs for weight loss only. Or, if they are covered, adding in counseling and other requirements prior to them being prescribed.

Beck said insurance representatives are coming in for a meeting on July 8 and they might know more than. The annual renewal meeting with CEBCO is in October.

There is a blockbuster class of weight loss medications called GLP-1 (glucagon-like peptide-1) receptor agonists. They were initially used to treat diabetes, but drug makers have since won approval to market these drugs for weight loss and heart disease.

More potential uses – and lucrative pharmaceutical company sales – are on the horizon as researchers study new ways to use these drugs. A late-stage study recently reported the diabetes and weight loss drug tirzepatide also may help treat sleep apnea for people with obesity.

Federal spending on weight-loss drugs surges

Medicare, the federal health program for adults 65 and older, is prohibited by law from covering drugs for the more than two in five Americans who are obese, but otherwise do not have serious risk factors. However, obese patients with diabetes or heart disease may qualify for coverage. The nonprofit health policy organization KFF estimates that one in four Medicare enrollees who are obese may be eligible for Wegovy to reduce their risk of heart attack or stroke.

A KFF analysis found Medicare spending on three drugs − Novo Nordisk's Ozempic and Rybelsus and Eli Lilly's Mounjaro − surged from $57 million in 2018 to $5.7 billion in 2022. That figure did not include rebates or other discounts negotiated by pharmacy benefit managers. Federal spending on these drugs is likely to grow, experts say. If just one in 10 eligible adults take Wegovy to prevent heart attack or stroke, KFF estimated it would cost Medicare's Part D prescription drug coverage nearly $3 billion each year.

The costs have increased so rapidly, even before Medicare plans are allowed to cover these drugs for weight loss, that the trajectory "has raised concerns about the fiscal impact of broad coverage of GLP-1 drugs on Medicare, other health insurers and patients," KFF said.

Ken Alltucker of the USA Today contributed to this article.

This article originally appeared on Coshocton Tribune: Coshocton County and other governments see higher insurance costs due to weight loss drugs