"Rising Weight Loss Medication Costs Pose Threat to Patient Access and Budgets"

Many patients who have found success with powerful new weight loss medications like Wegovy and Zepbound are facing insurance denials, leaving them with difficult choices. Most employer insurance plans and Medicare do not cover these medications, and some employers are now narrowing the criteria for coverage, creating hurdles for patients. Economists argue that while the medications are expensive, they could lead to substantial cost savings by preventing other serious medical conditions. However, insurers are hesitant due to uncertainties about the long-term effects and a misalignment of incentives. Patients and healthcare providers are struggling with time-intensive prior authorizations and changing coverage requirements, leading to tough discussions and tough choices for patients like Macarena Khoury, who has resorted to using a compounded version of her old weight loss drug after insurance denials.