Goodroot Releases Guide for Healthcare Payers Weighing Coverage of Ozempic, Wegovy and Mounjaro

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Jun 14, 2023, 08:54 ET

COLLINSVILLE, Conn., June 14, 2023 /PRNewswire/ -- The clinical team from Goodroot and its affiliate companies — including RemedyOne, AlignRx, Nuwae and Sola — released a guide today titled "Balancing the Scales: A Comprehensive Guide for Healthcare Payers on the Value and Viability of New Weight Loss Medications." As breakthrough obesity drugs Ozempic and Wegovy rapidly gain in popularity, the free guide is designed to help healthcare payers make decisions on covering these high-cost medications.

"Our team is fielding questions about Ozempic and other weight-loss drugs from employer groups and plan sponsors every day," says AlignRx CEO and founder Kevin Kobielski. "There are a lot of factors to consider when deciding if or how to cover these drugs, and the answer may be different for each organization. This guide compiles all of the available information to help payers make informed decisions."

Initially approved for type 2 diabetes, the guide outlines which drugs have been approved for weight loss use, which are in the pipeline for approval and which are seeing off-label use. It also breaks down the costs of these drugs — which tend to be over $1,000 for a four-week course.

"In the private sector, the perception of obesity drug coverage is undergoing a shift," reads the guide. "Historically viewed as cosmetic and therefore often excluded, private health insurers are becoming increasingly cognizant of the high healthcare costs linked to obesity. While this awareness has spurred an investment in weight reduction strategies, there is still a considerable journey ahead before universal acceptance of weight loss medication coverage becomes the norm among healthcare payers."

Though difficult to ascertain on a per-person basis, the guide provides figures on the cost of obesity and associated conditions — estimated to be $1.39 trillion nationally. The prevalence of obesity in the U.S. has nearly doubled in the past 30 years and affects more than 40 percent of Americans.

"With average weight reductions around 15 percent, there is no question that these drugs are incredibly effective and have tremendous preventative value," says Nuwae president Ralph Pisano, who led the clinical team that created the guide. "However, the price point makes long-term use of these drugs a major challenge for payers and patients alike. The pharmaceutical industry continues to innovate life-changing medications, but the impact is limited if patients can't access them due to cost barriers."

The guide aims to address all potential variables employer groups and plan sponsors should consider, regardless of their decision to cover these medications. These factors range from issues such as prior authorization to the integration of weight management programs, potential off-label use and beyond.

"Our mission at Goodroot is increasing access and affordability in healthcare," says Goodroot CEO Mike Waterbury. "In our complex healthcare system, at times those objectives can be at odds. Our clinical team has provided this resource to help payers strike the balance that fits for their members, and we continue to work directly with employers, pharmaceutical manufacturers and healthcare organizations as they navigate this challenge."

Download the guide here.

About Goodroot

Goodroot is a community of companies reinventing healthcare one system at a time. With a shared mission of increasing affordability and access in healthcare, Goodroot provides business infrastructure to help visionary healthcare professionals launch their own companies to fix chronic problems in the system. Goodroot's affiliate companies — AlignRx, Breez, CoeoRx, Emry Health, Nuwae, Penstock, RemedyOne and Sola — offer innovative services and strategic guidance for healthcare stakeholders such as employers, brokers, PBMs, health plans, third-party administrators, pharmaceutical manufacturers and hospitals. Goodroot was named a 2023 Top Impact Company by Real Leaders. goodrootinc.com

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SOURCE Goodroot