Only 18% of Employer Health Insurance Plans Cover Weight Loss Drugs

Fewer than 1 in 5 employer-sponsored health insurance plans cover weight loss drugs, according to a survey in the journal Health Affairs. 

That’s not changing anytime soon, either: Only about 3% of employers that don’t cover GLP-1 antagonists for weight loss—like Wegovy and Zepbound—said they’d be “very likely” to do so in the next year. 

Weight loss drugs can be quite pricey—over $1000 for monthly supplies. Nevertheless, most large firms don’t want to pay for them.

“Employers are really trying to thread the needle right now,” said Matthew Rae, author of the study and associate director for the program on the healthcare marketplace at KFF.

“They’re trying to figure out what is the right balance between the advantages to employees, potential health benefits, and the cost of these drugs. And at this point, all of those things aren’t sorted out.”

The exact numbers aren’t crystal clear—it was a survey, and surprisingly almost a third of respondents knew if they covered GLP-1 antagonists or not. So while only 18% of employers said they definitely did cover them, the reality might be slightly higher. 

Last year, VICE spoke to a weight loss specialist about what was then called the Ozempic craze. He explained that people weren’t taking these drugs just for the hell of it. “For the most part, doctors are not recklessly giving this medication to people who don’t need the weight loss. If people don’t need weight loss and go on Ozempic, they often get low blood sugar and don’t feel very well. So they don’t really want to be on it anyway.

So while Congress is hoping companies will lower the price of weight loss drugs, the high cost and lack of coverage remains an issue for those in need. 

“People who are rich can afford to pay the $1,000 per month for this medication,” said Susan Spratt, an endocrinologist and senior medical director for the Population Health Management Office at Duke Health in North Carolina. “We are just widening health disparities by making it harder for patients to access life-changing medication.”

The study’s author clarified that employers aren’t necessarily at fault for this, either. The price of such plans is simply unmanageable for even the largest firms. 

“The average health insurance premium is $25,000 for a family of four, just over $8,000 for a single person,” said Rae. “If you’ve got a third of your workers taking a $10,000 drug, that’s obviously going to have a significant impact.”