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. IBX did not respond to our request for clarification or comment about its decision.
