Bank of America sees risks for employers as insurance coverage of weight loss drugs grows

Published Wed, Oct 11 202310:48 AM EDTUpdated Wed, Oct 11 202312:13 PM EDT

Christina Cheddar Berk @in/christina-cheddar-berk-b864404/

The eye-popping predictions for weight loss drug sales hinge on insurance companies agreeing to provide coverage of the pricey treatments, and momentum seems to be building on that front. But Bank of America analyst Allen Lutz is wondering whether employers know how risky the bet is that they are making. The hope is that spending today on GLP-1 medications such as Ozempic, which can cost $1,300 a month or more, will yield health-care savings tomorrow. "We wonder if employers adding coverage to GLP-1s in 2024 fully appreciate both the off label use of the drug (that takes place outside of the scope of the benefit) and the potential for more membership," Lutz wrote in a research note Monday. Lutz's comments come after a survey showed the number of employers planning to provide insurance coverage for these medications is set to nearly double. The poll was conducted by market researcher Savanta on behalf of Accolade , a provider of health-care benefits navigation services, and it questioned 500 human resources officials in August and September. In the survey, 43% said they planned to offer coverage of GLP-1s in 2024, which is an increase from 25% of employers that currently provide it. Accolade also said 81% of the HR representatives felt employees would be interested in having access to the medications. GLP-1 medications were approved first to treat Type 2 diabetes but are now being used for obesity and overweight. The drugs include Novo Nordisk's semaglutide, which is sold as Ozempic for diabetes management and as Wegovy for weight loss. Eli Lilly makes Mounjaro, also known as tirzepatide. It received U.S. Food and Drug Administration approval to treat Type 2 diabetes last year and could get the nod for obesity by the end of this year. Both drugs can help patients lose 15% or more of their starting weight. Unlike earlier generations of weight loss medicines, their side effects have been largely mild and included diarrhea, constipation and nausea. Wegovy's label also includes warnings about pancreatitis and certain types of bowel obstruction . Although designed to treat overweight and obesity, the drug has been used off-label by people who have wanted to shed pounds for cosmetic reasons, which is one concern Lutz has raised. "Separately, employers continue to grapple with how to incentivize patients to make longer-term lifestyle and behavioral changes to support permanent weight loss, consider potential long-term side effects, while managing higher costs associated with coverage," the health-care services industry analyst said. Higher hospital labor costs as well as GLP-1 medications are contributing to the biggest jump in health insurance costs since 2012, Lutz said. He cited a recent estimate from consulting firms Mercer and Willis Towers Watson that predict a 6.5% jump in insurance costs from 2023 to 2024. Insurers are already feeling the pinch even though it is still early days for these medications. In a research note Wednesday, Citi analyst Peter Verdult estimated that GLP-1 sales could hit $30 billion for diabetes and $6 billion for obesity this year. "Penetration remains modest," Verdult said. He expects less than 10% of diabetes patients are taking the drugs, and fewer than one million patients with obesity are being treated. But those numbers will grow, especially as ongoing research continues to make the case for benefits beyond blood sugar control and weight loss. For example, the drugs have shown cardiovascular benefits as well as potential benefits to the kidney and liver. Novo Nordisk and Eli Lilly also are examining whether GLP-1 medications could help people with alcohol addiction, sleep apnea and other conditions. More than 40% of U.S. adults have obesity, according to the Centers for Disease Control and Prevention. Factoring in those who are overweight boosts the potential population for the drug to more than 70% of adults. Doctors see obesity as a chronic condition. Many patients who have successfully lost weight on a GLP-1 medication find they have regained weight after they stopped taking it. That has prompted some analysts to predict these drugs will have peak sales of more than $100 billion as they become as widely prescribed as cholesterol-fighting statins . — CNBC's Michael Bloom contributed to this report.