Cigna announced on Thursday its intent to limit how much employers and health plans spend on weight loss drugs each year to expand insurance coverage for highly popular treatments.
The news comes amid insurance companies toying with whether they should cover the drugs or remove them from their plans altogether based on high costs.
Despite obscene prices, Americans continue to gravitate toward the treatments, including similar diabetes drugs. Prices range from $1,000 per month and can reach up to $15,000 per year.
The notion put forth by insurance giant Cigna has the potential to make weight loss treatments more affordable and more accessible.
Cigna's pharmacy benefits management unit intends to limit spending increases for weight loss and diabetes drugs to a maximum of 15% annually, a company spokesperson told CNBC.
The spokesperson revealed that some health plans are witnessing a rise in spending from 40% to 50% for drugs annually.
A spokesperson for Eli Lilly on Thursday said employers should "prioritize solutions that facilitate access to comprehensive and patient-centered" obesity care, given how the condition affects people around the world.
Healthcare's "First Financial Guarantee"
A Novo Nordisk spokesperson on Thursday said the company works with all payers "as part of our commitment to expand patient access to anti-obesity medicines."
The drugs, also known as GLP-1s, treat weight loss and diabetes by mirroring one or more hormones produced in the gut to suppress appetite and regulate blood sugar. The company has called the effort the healthcare industry's "first financial guarantee."
Cigna told CNBC it would be providing "financial predictability" through a cost cap, which would allow health plans and employers to better navigate GLP-1 spending.
In return, this would help establish vast access for qualifying patients.
Adam Kautzner, president of pharmacy benefits manager Express Scripts, said during the company's investor day that the market for GLP-1s could grow to $100 billion by the end of the decade."
"Many of them want to preserve access for patients or expand access for patients to treat diabetes. But at the same time, you are seeing some that are pulling back as well," Kautzner explained.
Two-hundred-and five companies participated in a survey organized by the International Foundation of Employee Benefit Plans in October. What they learned is that 76% of respondents provided GLP-1 drug coverage for diabetes, as opposed to only 27% that provided coverage for weight loss. However, 13% of plan sponsors suggested they were considering coverage for weight loss.
The initiative amplifies an existing program under the Evernorth unit called EncricleRx, which focuses on patients with diabetes, obesity, and cardiovascular disease.
Cigna is paid a separate monthly fee for health plans by employers as part of the program. It includes support for patients using the drugs and is tailored to lifestyle changes like diet and increased exercise.
