{"id":359152,"date":"2025-12-20T02:10:23","date_gmt":"2025-12-20T02:10:23","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/359152\/"},"modified":"2025-12-20T02:10:23","modified_gmt":"2025-12-20T02:10:23","slug":"employers-drop-obesity-drug-coverage-as-cash-pay-programs-grow","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/359152\/","title":{"rendered":"Employers drop obesity drug coverage as cash-pay programs grow"},"content":{"rendered":"

When HCA Healthcare, one of the largest hospital systems in the U.S., recently told employees it would stop covering blockbuster obesity drugs Zepbound and Wegovy next year, it pointed them to an alternative way to get the treatments: Buy them themselves.<\/p>\n

In a notice viewed by STAT, HCA said use of the GLP-1 weight loss drugs surged 90% this year, \u201csignificantly\u201d raising costs. It instead suggested employees enroll in discount programs introduced by the drugs\u2019 manufacturers, Eli Lilly and Novo Nordisk, which allow patients to buy the medicines without using insurance at cash prices that are lower than the list prices.<\/p>\n

\u201cAnother way of phrasing what HCA said is, \u2018I\u2019m gonna direct you to this manufacturer plan, because for me as a company, that\u2019s a lot cheaper than me buying you the drug,\u2019\u201d said Craig Garthwaite, director of health care at Northwestern University\u2019s Kellogg School of Management.\u00a0<\/p>\n

HCA declined to comment.<\/p>\n

It isn\u2019t the only company dropping coverage. Doctors and groups representing employers said they\u2019re increasingly hearing about companies cutting weight loss drugs out of health plans next year as costs mount.<\/p>\n

Experts say the growth of Lilly\u2019s and Novo\u2019s consumer offerings may be contributing to this shift. The drugmakers have heavily advertised these programs as a way to expand access, and President Trump has embraced them<\/a> as part of his drug pricing policies. But counterintuitively, these programs may be making it easier for employers to stop covering the injections through insurance, thereby making them less affordable for everyday people.<\/p>\n

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\n\t\t\t\tSTAT Plus: Is the White House\u2019s deal with pharma on GLP-1 drugs a game changer?\u00a0<\/a><\/p>\n

Because of the complicated nature of the U.S. health care system \u2014 which involves pharmacy benefits managers and manufacturer rebates \u2014 employers often don\u2019t know the actual price they pay for each medicine in their health plans. Some are starting to wonder whether they\u2019re paying more for obesity drugs than the cash prices being offered, which range from $200 to $450 a month depending on the dose, said Jim Winkler, chief strategy officer of the Business Group on Health, a coalition of large employers. That\u2019s leading companies to think it makes more sense for workers to get the drugs on their own, he added.<\/p>\n

In fact, HCA said in its notice, \u201cin many cases, the discounts available [through Lilly and Novo\u2019s programs] make the medications less expensive than what group health plans can negotiate with the manufacturers at this time.\u201d<\/p>\n

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\t\t\t\t\t\tIndividual plans<\/p>\n

\t\t\t\t\t\tGroup plans<\/p>\n

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\t\t\t\t\tSubscribe<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"When HCA Healthcare, one of the largest hospital systems in the U.S., recently told employees it would stop…\n","protected":false},"author":2,"featured_media":359153,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[244,48123,97,252,253,9046,986,247,248,3458],"class_list":["post-359152","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-biotechnology","tag-eli-lilly","tag-health","tag-health-care","tag-healthcare","tag-novo-nordisk","tag-obesity","tag-pharmaceuticals","tag-stat","tag-weight-loss"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/359152","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=359152"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/359152\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/359153"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=359152"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=359152"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=359152"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}