Mayo Clinic Employee Health Insurance Limits Weight Loss Drug Coverage – Announcement

ROCHESTER — Starting in 2024, Mayo Clinic employees insured through Mayo Health Plans will have new lifetime limits on weight loss drugs.

In a letter provided to The Washington Post, those taking FDA-approved weight loss drugs, including Wegovy, Saxenda, Contrave and others, will be covered for up to $20,000 of their drug costs starting on January 1, 2024. Sent by Alluma, the health insurance plan’s pharmacy benefit manager.

The Mayo Clinic said in a statement that it will continue to cover the weight-loss drugs through its employee health plan, and “the new terms reflect a lifetime maximum benefit of $20,000 for prescriptions filled after January 1, 2024.”

“Mayo Clinic continually carefully evaluates our prescription coverage and makes adjustments annually to balance affordability and coverage in the best interests of our plan members,” the statement continued. “Plan members are encouraged to contact their providers Talk to your caregiver who can help determine safe and effective care treatment options and plans.”

Currently, the Mayo Clinic’s employee health insurance plan (offered through Medica) does not have a lifetime maximum benefit for these drugs. Through the end of the year, weight loss drug prescriptions will be subject to “the plan’s standard copay or unlimited coinsurance,” the letter said.

Currently, Mayo Clinic is an exception among employer-sponsored health insurance plans. According to the International Foundation of Employee Benefit Plans, only 22% of U.S. employers cover the cost of prescription weight loss drugs.

The Mayo Clinic says this new lifetime maximum benefit does not apply to “approved diabetes GLP-1 prescriptions.” Semaglutide, the active ingredient in Wegovy, is a glucagon-like peptide 1 agonist that has been approved by the FDA for the treatment of type 2 diabetes under the trade name Ozempic. Both Wegovy and Ozempic are administered via weekly injections.

“Mayo Health Plans provide Ozempic coverage for adults with type 2 diabetes without being subject to the $20,000 lifetime benefit maximum,” the Mayo Clinic said in a statement.

Dr. David Lau, a weight loss expert and professor emeritus in the Department of Medicine, Biochemistry and Molecular Biology at the University of Calgary, said most weight loss drugs work “by acting centrally in the brain to suppress appetite and promote satiety.” Cumming School of Medicine, Alberta, Canada.

“This applies to GLP-1 receptor agonists such as semaglutide…liraglutide 3 mg (Saxenda), tezepatide (Mounjaro)…Contrave, Qsymia, Lomaira and Imcivree,” Lau said. “GLP-1 RAs also delay gastric emptying and improve glycemic control.”

Lau said semaglutide is a “game-changing weight loss drug because it is the only drug that can cause weight loss of more than 10 percent.”

The list price for a month of Wegovy injections is $1,349, according to the Peterson-KFF Health System Tracker. That price is high compared with the price of the drug in Germany and the Netherlands, where one month of Wegovy costs $328 and $296, respectively.

Ozempic also comes with a hefty price tag in the U.S. — a list price of $936 for four injections. In other countries, including Canada, Switzerland, the United Kingdom and Australia, monthly supplies of Ozempic cost no more than $200, according to Health System Tracker.

Liu said these weight-loss drugs are medications that patients may continue to take long-term to control obesity, which is “now widely recognized as a chronic disease that requires long-term treatment.” Patients may regain weight after stopping taking weight loss medications.

“By limiting lifetime caps on weight loss medications, obese patients are being discriminated against because many health authorities and third-party insurance payers still mistakenly believe obesity is a body image (issue) rather than a health problem,” Liu said. “I should stress that the lifetime cap was introduced primarily to control costs.”

The FDA may expand Wegovy’s approved uses in the near future. CNBC reports that Novo Nordisk, the Danish pharmaceutical company that makes the drug, has submitted an application for Wegovy in hopes of getting approval as a treatment to reduce the risk of cardiovascular disease in patients.

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