By Amina Niasse <\/p>\n
NEW YORK, Nov 14 (Reuters) – CVS Health said employers and other health plan sponsors could break even on GLP-1 drugs if they are priced below $350 per month as reduced use of medical services, such as hospitalizations and \u200cemergency room visits, lower spending enough to offset drug costs. <\/p>\n
CVS said that an analysis of its Aetna insurance claims data found \u200cthat across patients with obesity, diabetes or other conditions, the current prices for GLP-1 drugs add to spending because they are too high to be impacted by lower \u200bmedical costs. <\/p>\n
The analysis looked at patients who were newly taking highly popular GLP-1 medicines \u2014 which mimic the GLP-1 hormone and reduce appetite \u2014 from Eli Lilly and Novo Nordisk, and compared them to similar patients who were not taking the drugs. <\/p>\n
The drugs included Mounjaro and Ozempic for diabetes and Zepbound and Wegovy for obesity. The analysis covered periods of up to three years, with patients starting the medicines between 2023 and 2025. <\/p>\n
The analysis did not \u200cbreak out figures for obesity patients alone. <\/p>\n
GLP-1 COVERAGE \u2060FALLS OVER COST <\/p>\n
Coverage of GLP-1 drugs for obesity is falling as corporations and other health plan sponsors try to bring down premiums expected to be up by over 9% in 2027. About 14% of companies have already \u2060dropped or plan to drop the drugs in 2027. <\/p>\n
Zepbound and Wegovy can cost about $299 and $349 for cash-pay customers. Employers and other health plan sponsors pay between $617 and $766 monthly for the drugs, according to a 2025 study by the Employee Benefit Research Institute. CVS declined to comment on the average prices paid. <\/p>\n
Dr \u200bAmy \u200bCompton-Phillips, chief medical officer at CVS Health, said that the drugmakers’ direct-to-consumer prices \u200bsuggest they can still profit by charging less than $350 \u200ca month, while also helping to lower overall healthcare costs. The United States pays more for healthcare than any other country. <\/p>\n
“I hope that we can reach that price sooner rather than later,” she said in an interview ahead of the HLTH USA conference in Las Vegas, where CVS will present the findings on November 15. <\/p>\n
The US government agreed on a deal with Lilly and Novo last year to pay $245 per month for injectable GLP-1 weight-loss drugs in an 18-month pilot testing their cost-effectiveness for Medicare beneficiaries aged 65 and older or with disabilities. <\/p>\n
HOSPITALIZATIONS FALL <\/p>\n
CVS said GLP-1 \u200cuse for obesity, diabetes or other conditions was associated with 10-12% lower emergency \u200broom visits in the first and second year of use. It examined records for \u200b60,000 people during the first year and 20,000 people for \u200ba second year. <\/p>\n
An analysis of records for 4,000 people still taking the drug after three years showed a \u200cdecrease in hospitalizations of 34-42%, according to the report. <\/p>\n
When looking \u200bat spending and savings across those \u200bthree years, plan sponsors saved $9,400 per person on medical bills, but spent $13,300 more on prescriptions, adding costs of $3,900 per person. <\/p>\n
The company, which also operates pharmacy benefit manager Caremark and a network of retail pharmacies it plans to spin off, said the price at \u200bwhich GLP-1s start saving money overall depends on \u200chow healthy or sick a patient is. <\/p>\n
“An older person with diabetes is going to have a higher risk for hospitalization \u200bthan a younger person who is obese without diabetes,” said Compton-Phillips. “The higher-risk the person is, the quicker you get \u200bto a return on investment.” <\/p>\n
(Reporting by Amina Niasse; editing by Caroline Humer) <\/p>\n","protected":false},"excerpt":{"rendered":"By Amina Niasse NEW YORK, Nov 14 (Reuters) – CVS Health said employers and other health plan sponsors…\n","protected":false},"author":2,"featured_media":964430,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[1778,64,63,99,174,164,186,10346,137,5476,21130,10347,1603,490,21131,8792,184,5482,1003,1793,5473,10348,10349,2004,21132,4961,21133],"class_list":["post-964429","post","type-post","status-publish","format-standard","has-post-thumbnail","category-medication","tag-401k","tag-au","tag-australia","tag-business","tag-business-news","tag-economy","tag-finance","tag-financial-information","tag-health","tag-investing","tag-investment-tools","tag-investor","tag-market-news","tag-medication","tag-mortgage","tag-mutual-funds","tag-personal-finance","tag-quote","tag-real-estate","tag-retirement","tag-stock","tag-stock-research","tag-stock-valuation","tag-stocks","tag-suze-orman","tag-tax","tag-track-portfolio"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/964429","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=964429"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/964429\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/964430"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=964429"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=964429"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=964429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}