A significant portion of privately insured Americans could be eligible for GLP-1 medications, such as Novo Nordisk’s Wegovy and Ozempic, according to a new analysis by the health policy research organization KFF. The study reveals that over two in five U.S. adults under 65 with private insurance—more than 57 million people—meet clinical criteria for these popular weight loss and diabetes treatments. This includes over 36 million individuals diagnosed with obesity.
GLP-1s, which are approved for treating Type 2 diabetes, obesity, and overweight individuals with related health conditions (such as cardiovascular disease, hypertension, or high cholesterol), have gained prominence for their efficacy. Wegovy is also noted for being the only GLP-1 drug approved to reduce the risk of heart attack, stroke, and death among obese or overweight adults with cardiovascular issues.
However, eligibility for these drugs may be influenced by additional requirements set by employer-sponsored health plans. Employers face the challenge of balancing the high cost of GLP-1s—approximately $1,000 per month—with their clinical benefits and employee demand. As a result, some employers may impose stricter criteria, such as a higher Body Mass Index (BMI) threshold for coverage. For instance, if employers set a BMI cutoff of 35 or greater, only about 14.6 million adults under 65 with these health plans would qualify. Currently, the standard BMI thresholds for GLP-1 eligibility are 30 or greater for obesity and 27 or more for overweight individuals.
Additionally, some health plans may restrict GLP-1 coverage to diabetes management only, excluding obesity treatment. KFF noted that as of two years ago, a relatively small proportion of those with employer-sponsored insurance had a GLP-1 prescription, with only 3% of adults covered by such plans having received one in 2022. Semaglutide, the active ingredient in Wegovy and Ozempic, has been the most prevalent GLP-1 drug since its U.S. market debut in 2018.
Despite this, there is evidence suggesting a rise in GLP-1 usage beyond recent insurance claims data. According to a KFF poll from May, around 6% of all adults, regardless of insurance coverage, are currently taking a GLP-1 drug, while roughly 12% have used such treatments at some point.
The potential for expanded eligibility may increase as GLP-1 drugs are being studied for new uses, including treatments for fatty liver disease and chronic kidney disease, with possible approvals from Novo Nordisk and Eli Lilly expected in the near future.
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