Reasonably priced Care Act (ACA) Market plans not often cowl GLP-1 medication permitted solely for treating weight problems, in line with a brand new KFF evaluation of 2024 federal plan knowledge. Wegovy, a drug permitted for weight reduction, is roofed by only one% of market drug plans, in comparison with 82% of market drug plans for Ozempic, which comprises the identical energetic ingredient as Wegovy (semaglutide) however is permitted alone. for diabetes.

When GLP-1 medication are lined for the remedy of diabetes, virtually all plans use at the very least one utilization administration technique to regulate prices, akin to prior authorization or amount limits. Of the few Market plans that cowl GLP-1 medication permitted for weight problems, all plans require prior authorization.

Utilization administration instruments are meant to steadiness price containment and entry, however can nonetheless create limitations for folks with a medical want to make use of these medicines. Whereas insurers obtain rebates to offset a few of their prices, checklist costs of GLP-1 medication are about $1,000 per thirty days, and rising demand for these medication might put upward stress on premiums.

This evaluation examines publicly out there formularies of plans out there on the federally facilitated ACA marketplaces in 2024 and doesn’t embody states that function their very own marketplaces, the place protection patterns might differ. The ACA Marketplaces symbolize a small portion of individuals with personal medical health insurance, as most individuals with personal protection have plans sponsored by their employers. Though details about employer plan formularies is just not publicly out there, these plans usually tend to cowl weight reduction medicines than the ACA Market plans given the will to draw staff, though they might make use of comparable utilization administration methods.