Cigna, one of the largest insurance providers in the United States, has announced that it will implement a limit on coverage for weight loss drugs in order to expand insurance coverage for these treatments. This move comes as many insurers are grappling with the decision of whether or not to cover these drugs due to their high costs. Despite their expensive price tags, weight loss drugs, along with similar diabetes medications, have become increasingly popular among Americans.
By implementing this limit, Cigna aims to make weight loss treatments more accessible to its policyholders. Currently, some health plans are experiencing annual spending increases of 40% to 50% on these drugs. Cigna’s pharmacy benefits management unit will now cap spending increases for weight loss and diabetes drugs at a maximum of 15% annually. This will provide “financial predictability” for health plans and employers, allowing them to better plan for managing the cost of these medications and ensure broader access for eligible patients.
As part of this effort, Cigna’s Evernorth unit has entered into agreements with drug manufacturers Novo Nordisk and Eli Lilly. Although further details about these agreements have not been disclosed, they are expected to contribute to facilitating access to weight loss treatments. Eli Lilly emphasized the importance of prioritizing solutions that enable comprehensive and patient-centered obesity care, given the global impact of this condition. Novo Nordisk echoed this sentiment, highlighting their commitment to expanding patient access to anti-obesity medicines.
Weight loss drugs, also known as GLP-1s, work by mimicking hormones produced in the gut to suppress appetite and regulate blood sugar levels. They have shown promising results in treating both weight loss and diabetes. Cigna’s move to implement a spending cap on these drugs is being hailed as the healthcare industry’s “first financial guarantee” for coverage of GLP-1s.
The weight loss drug market is predicted to become increasingly crowded in the near future. Companies are recognizing the potential for growth in this sector, with Express Scripts, owned by Cigna’s Evernorth division, projecting that the market for GLP-1s could reach $100 billion by the end of the decade. However, this figure is deemed unsustainable by industry experts, leading insurance providers like Cigna to seek solutions to manage costs while still providing access to these medications.
A survey conducted by the International Foundation of Employee Benefit Plans found that while 76% of respondents provided GLP-1 drug coverage for diabetes, only 27% provided coverage for weight loss. However, 13% of plan sponsors indicated that they were considering adding coverage for weight loss in the future. This suggests that there is a growing recognition of the importance of these medications in addressing obesity and its associated health conditions.
Cigna’s efforts to expand coverage for weight loss drugs build upon an existing program called EncircleRx, which focuses on patients with diabetes, obesity, and cardiovascular disease. Through this program, health plans and employers pay Cigna a separate monthly fee to receive support for patients on these drugs. Cigna is also collaborating with Omada Health to provide services that help patients make behavioral changes to support their weight loss journey.
In conclusion, Cigna’s decision to implement a limit on coverage for weight loss drugs is a significant move in expanding insurance coverage for these treatments. By capping spending increases and entering into agreements with drug manufacturers, Cigna aims to make weight loss medications more accessible to its policyholders. This step is crucial in addressing the rising costs of these drugs and ensuring that eligible patients have broader access to treatments that can improve their health and well-being.
