Why GLP-1 Coverage is Important for Menopause

This past May, Pharmaceutical Executive reported that CVS Health decided to return Eli Lilly’s Zepbound to its list of covered medications, along with the addition of the company’s new oral GLP-1 Foundayo. CVS previously removed Zepbound from its formularies due to pricing negotiations with Lilly’s competitor Novo Nordisk.

This story is just the latest example in the ongoing issues GLP-1s face when it comes to coverage. While the drugs are known to be effective and safe, they are also in high demand and effective. As a result, coverage providers have struggled to include the medications, especially considering the wide swath of indications they can be prescribed for.

One area that’s been of particular interest is employer coverage. Companies want to be able to promote that their employees are covered for these in-demand drugs, but they also must consider other factors.

Pharmaceutical Executive spoke with Susan Thomas, chief commercial officer at LucyRx, about the company’s efforts to provide coverage models for GLP-1s and why its so important to provide these medications for general health purposes.

Pharmaceutical Executive: Why is GLP-1 coverage important for menopause?
Susan Thomas: Women in that age range are disproportionately impacted by cardiovascular risk because of the metabolic changes that occur during perimenopause and menopause. The reduction in estrogen creates a cascade that directly affects cardiovascular risk in that population, with or without obesity. Over the course of a decade or two, from roughly age 45 to 65, women tend to gradually increase their weight, accumulating belly fat and visceral fat, which we know carries a direct correlation to cardiovascular risk.

If a plan sponsor has chosen not to cover GLP-1s for weight loss, women in that high-risk category are left without access to these medications unless they pay out of pocket, which runs roughly $350 to $450 a month and is largely unaffordable for most people. So women who gradually accumulate weight and cardiovascular risk over a decade or more are simply left without options.

That's a population we're particularly focused on at LucyRx. We want to help plan sponsors understand that cohort and build benefits around it, not just to reduce the likelihood of a stroke or heart attack, but to advance benefits equity within their plans. Women in this stage of life are often at the peak of their careers, and helping them navigate the symptoms of menopause, manage the associated cardiovascular risk, and sustain their career vitality is something we take very seriously.