Pennsylvania woman speaks out after Independence Blue Cross drops weight loss drug coverage
Independence Blue Cross, a major insurance company, is no longer covering drugs like Zepbound prescribed solely for weight loss, blaming exorbitant costs. And now it's impacting Bucks County patient Patti Riley.
Doctors say the drugs that treat diabetes and obesity are life savers but they're expensive. Without insurance coverage, many say they won't be able to afford the drugs.
"I just kept reading and saying that this just can't be," Riley said.
She was shocked and angry about this notice she received from Independence Blue Cross (IBX).
The letter she received from the insurance company said, "Starting January 1st, 2025, weight loss drugs will no longer be a covered benefit. This decision was not made lightly, and several factors were taken into consideration."
Riley, a nurse who lives in Doylestown, says she's struggled with weight all her life and finally found success with Zepbound, losing 56 pounds.
"I was pre-diabetic, I was pre-hypertensive. My dad died at 56 of heart disease. That was not going to be me," Riley said.
She says she depends on the drug to keep the weight off and stay active with her grandchildren.
IBX joins a growing number of insurance companies not covering GPL-1 drugs for weight loss, blaming their high price indicating that could impact all members whether they use the drugs or not.
The drugs can cost about $1,000 a month and are usually covered for other conditions like diabetes.
IBX says in part: "The cost of these drugs in the U.S. is almost 10 times more than other parts of the world and that has made it extremely challenging to be able to continue to provide coverage to everyone who wants to lose weight or can benefit from the drugs."
Dr. Christoph Buettner, with the Rutgers Center for Metabolic Health and Weight Management, says controlling obesity with the new drugs has a number of life saving benefits.
"They really prolong life. They reduce heart disease. They reduce mortality from also kidney disease. They help sleep apnea and a major killer of all of us is heart disease," Buettner said. "These drugs are game-changers in that regard."
Riley says she can't afford to pay for the drug on her own. IBX suggests other benefits it covers like counseling and a gym membership.
"And I don't mean to laugh but if you're somebody like me, I've done all that already," Riley said.
Responding to complaints about high costs, Eli Lilly, maker of Zepbound, says in part: "Obesity is a chronic, progressive disease, and people with obesity deserve for it to be treated like one."
Doctors say insurance will still cover the drugs for things like diabetes. Riley says she doesn't know what she's going to do.
Statement from Independence Blue Cross (IBX)
CBS New Philadelphia reached out to IBX for clarification or a comment about its decision. On Wednesday IBX responded to the request with this statement:
"Independence Blue Cross's (IBX) decision to change its coverage for weight loss drugs was not made lightly. The company considered many factors, such as the responsibility it has to members and customers to provide the best value of health care coverage. This includes balancing drug coverage with associated increases in premiums to pay for the drugs. Higher premiums affect all members, whether they utilize weight loss drugs or not. The cost of these drugs in the US is almost 10 times more than other parts of the world and that has made it extremely challenging to be able to continue to provide coverage to everyone who wants to lose weight or can benefit from the drugs. Members should check with their doctor or pharmacist about drug pricing. Weight loss drugs may be Health Savings Account (HSA) and/or Flexible Spending Arrangement (FSA) eligible. To determine HSA-eligibility and/or FSA-eligibility, members should consult their employer.
IBX will continue to cover GLP-1 drugs for other FDA-approved clinical indications to treat medical conditions, such as diabetes and cardiovascular disease. This change only applies to weight loss drugs (e.g., GLP-1 and non-GLP-1 drugs) when they are prescribed solely for weight loss and not for any other medical conditions that the FDA has approved them for.
Our members also have other non-prescription options that are covered by IBX that they can choose from to help manage their weight loss journey. These include things like behavioral health and nutritional counseling, lifestyle management programs that offer clinically proven support for weight management, nutrition, and stress relief, reimbursements for fitness center fees, and bariatric surgery for members with health risks from being obese."