Cigna announced on Thursday its intention to impose annual spending limits on weight loss drugs within health plans and employer benefits, aiming to enhance accessibility to these increasingly popular treatments.
The move responds to considerations among insurers about whether to continue covering these drugs due to their high costs.
Despite monthly prices reaching approximately $1,000 or annual costs up to $15,000, Americans have shown significant interest in these treatments, along with similar diabetes medications.
Cigna’s initiative seeks to make weight loss therapies more affordable by restricting annual spending increases for these drugs to a maximum of 15%, a spokesperson informed.
Currently, some health plans experience annual expenditure rises of 40% to 50% on these medications.
As part of this effort, Cigna’s Evernorth division has reached agreements with drug manufacturers Novo Nordisk and Eli Lilly, although specific details were not disclosed by Cigna.
Eli Lilly responded positively, emphasizing the importance of prioritizing solutions that facilitate comprehensive and patient-centered obesity care.
Novo Nordisk reiterated its commitment to expanding patient access to anti-obesity medicines but referred to Cigna for specifics on the spending cap.
Cigna characterized this initiative as the health-care industry’s “first financial guarantee” for drug coverage, particularly for GLP-1s, medications that manage weight loss and diabetes by mimicking gut hormones to regulate blood sugar and suppress appetite.
By introducing a cost cap, Cigna aims to provide “financial predictability,” enabling health plans and employers to effectively manage spending on GLP-1s and ensure broader access for eligible patients.
During Express Scripts’ investor day, Adam Kautzner, president of the pharmacy benefits manager (PBM), expressed concerns about the sustainability of the GLP-1 market, projecting potential growth to $100 billion by the decade’s end.
He noted that Cigna’s insurance clients are seeking assistance in preserving or expanding patient access to diabetes treatments amid varying market responses.
A survey conducted by the International Foundation of Employee Benefit Plans in October revealed that while 76% of respondents covered GLP-1 drugs for diabetes, only 27% provided coverage for weight loss, with 13% considering such coverage.
Cigna’s initiative builds upon its existing EncircleRx program under Evernorth, which targets patients with diabetes, obesity, and cardiovascular disease, offering comprehensive support alongside drug coverage.
Additionally, Cigna collaborates with Omada Health to provide behavioral change services, reinforcing lifestyle modifications such as diet and exercise alongside drug therapy.
