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Are Changes Coming to Coverage for Anti-Obesity Drugs?

I’ve recently received notifications from several insurance companies about upcoming changes in the coverage of anti-obesity medications. Currently, most of my clients’ insurance plans do not cover these drugs for weight loss only.

However, there is a notable exception for individuals who are prescribed anti-obesity medications as a first-line treatment for diabetes. In these cases, some insurance plans are providing reimbursement. Companies like Empire Life and Sun Life are among those that will be increasing their scrutiny on these reimbursements. Here’s what you need to know about the upcoming changes:

Empire Life

In September 2023, we added Ozempic, Rybelsus, Trulicity and Victoza to our prior authorization program, which all were already covered by step therapy. At that time, we only required new claimants to have their prescription approved through prior authorization. We granted an exception for members already claiming these drugs, grandfathering their coverage with no conditions. 

Starting November 1, 2024, plan members who were grandfathered and do not have other diabetes medications in their claims history will be required to have their prescription for Ozempic, Rybelsus, Trulicity and Victoza approved through prior authorization.

Sun Life

Anti-Obesity medications are currently an optional drug category at Sun Life. As Anti-Obesity medications continue to evolve, we remain committed to drug plan sustainability.

What’s Changing

Starting October 15, 2024, Sun Life will add Anti-Obesity medications to the Prior Authorization program. This change will help plan sponsors better manage the financial impact of these medications to their plan.

As these medications become more widely used, it’s crucial to understand the specifics of what your insurance carrier offers and ensure this information is clearly communicated to your employees.

If you’d like to work with an Employee Benefit Broker who fully understands the details of the contracts they manage, please call Glendinning Insurance Services, Pamela at (250) 215-2355.

We are your Trusted Advocates.