High cost of weight loss drugs like Ozempic may impact insurance plan costs for everyone

The heavy cost of weight loss drugs could be felt by everyone's insurance plans

One major con to the new weight loss drugs is the cost. Even if we aren't taking them we all may be paying for this drug one way or another.

FOX 2 (WJBK) - Few can question the effectiveness of popular weight loss injections like Ozempic, Wegovy and Mounjaro. Just look at the before and after pictures of Lina Escamilla.

She discovered and started taking Munjaro two years ago.

"I have lost about 115, 118 pounds," Escamilla said. "It curbed my appetite, it gave me more energy and motivation because I was seeing continuous progress."

Back in 2022, she says her doctor gave her a coupon for the new drug - and with her insurance, she gladly paid $25 a month for the treatment.

"I unfortunately don't get that anymore, but my doctor has switched me to Wegovy," she said.

Although she admittedly has good insurance, Escamilla is paying a co-pay for the drug each month. She is willing to pay for proven results.

But she also knows she is one of the lucky ones.

"These drugs, there a lot of people pay out of pocket for them," said Margaret Anderson. "So how does that translate to somebody who is having to wrestle with; am I going to have food this month? Am I going to be able to pay my car payment?"

Anderson is the senior VP for the Michigan-based non-profit health plan, HAP, which provides health coverage to people, companies and organizations.

"I've been in the healthcare space for 25 years and have not seen something as disruptive as this medication," she said.

Drugs that were designed and effectively treat Type 2 diabetes, but they are also effective at treating obesity. It makes them exponentially more desirable.

"There is no doubt this drug is a good thing," said Dr. Michael Genord, president and CEO of HAP. "It helps people, and we should be embracing it. But we as a nation, have to find a way to decrease the cost of this drug to make it available to everyone."

Where there is demand, there is big money to be made.

"The manufacturer spends about $1 or $2 to manufacture this drug - they charge $1,000 to $1,400," Genord said.

For HAP, the cost of simply covering diabetes patients who were prescribed this medication has skyrocketed.

Where it used to cost the insurance provider $1,000 a month - that cost has now doubled.

"I can't stress this enough; we want to provide access to quality affordable care," Anderson said. "The affordability piece of it right now is where we are struggling."

And whether you use the drugs or not, you may end up paying for it in the long run.

"As we continue to see the utilization increase, this affects the cost of healthcare in America which right now is 18% of our gross domestic product," Anderson said. "We are going to continue to see things like this create momentum (for that) rise to continue. We're working really hard to reverse that."

FOX 2: "In other words, if you never touch this drug at all you could be affected by it financially?"

"Yes," she said.

As a result, the insurance companies will need to raise their plans across the board to continue to pay for these high-demand drugs.

"That employer gets that premium increase a lot of times (and) your employee contributions go up when you get that renewal," Anderson said. "So your monthly contribution, even though you are not taking the drug, could go up."

Not all insurance plans cover the cost if the drug is purely used for weight loss. However, in Michigan, Medicaid does cover the use for obesity and diabetes.