Diabetes Drug Priced at $1349 per Month Leads to Weight Loss, Prompting Payer Coverage Debates

Wegovy, a type 2 diabetes drug that costs $1349 per month, can lead to weight loss. This side effect is leading to widespread interest from consumers, providers, and payers. Although weight loss reduces the risk of a substantial number of diseases, including hypertension, diabetes, and heart disease, many payers, including Medicare, do not cover prescription drugs aimed at reducing weight.

James Gelfand, senior vice president for health payer policy at ERIC, a group for self-insured employers, remarks, “The metric we try to use is value,” adding,“If we pay for this drug, how much is this going to cost and how much value will it provide to the beneficiaries?” Read more here.

(Source: Julie Appleby, 7/30/21)