Health insurance coverage for GLP-1 drugs isn't getting better despite surging demand from Americans looking to lose weight or treat Type 2 diabetes.
The percentage of patients with no insurance coverage taking the GLP-1 drugs Victoza, Saxenda, Zepbound and Ozempic increased just between January and November, according to a report from drug-pricing website GoodRx.
"Coverage has become more restrictive for several popular medications," GoodRx said.
On the other hand, GoodRx said the share of people with restricted or unrestricted coverage taking Liraglutide and Wegovy rose and stayed flat for Mounjaro.
Unrestricted coverage means patients can use their insurance right away to pay for GLP-1 drugs, GoodRx said, while restricted coverage requires meeting additional steps, including getting authorization from an insurer or first using a similar medication that is covered.
Patients taking Liraglutide, a generic version of Victoza, enjoy the most unrestricted coverage at 35% of patients, followed by Mounjaro with 24%, GoodRx said, but unrestricted coverage still fell for both drugs in January from November.
There have already been some other big shifts in patient coverage among GLP-1 drugs in just a couple months.
The share of people with unrestricted coverage of Zepbound rose to 13% from 9%, improving access for at least 7.3 million people, but this was offset by a drop in restricted coverage to 66% from 73%, GoodRx said.
As a result, GoodRx said 4.9 million more people were left without insurance coverage of Zepbound and have to pay out of pocket.
Drugmaker Eli Lilly recently started offering lower prices for Zepbound for patients paying out of pocket.
Ozempic has also seen a rise in restrictions, with unresricted coverage falling to 15% from 26% of patients and restricted coverage rising to 71% from 67%.
"As a result, more people need to jump through extra hoops to access these medications, despite having insurance," GoodRx said.
Wegovy has been a bright spot with more than 7 million more people gaining some commercial insurance coverage of the GLP-1 drug, after the share of people with restricted coverage rose to 71% from 67% and unrestricted coverage rose to 14.6% from 14.2%.
What do GLP-1 drugs cost?
Without insurance, costs for GLP-1 drugs ranged from $337 for three Liraglutide pens to $1,628 for four Zepbound pens, according to GoodRx's website.
Patients can expect to pay more than $97 out-of-pocket per fill for medications prescribed for weight loss, including non-GLP-1 drugs or injectables, which is more than six times the national average for out-of-pocket spending per prescription in 2024, GoodRx said.
But Americans also overspent more than $200 million on weight-loss drugs in 2024 by paying the full retail price, GoodRx said, pointing to how patients can save money finding better prices on its website.
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