One week after Blue Cross Blue Shield made changes to its insurance coverage, patients using weight loss drugs in Michigan are feeling the impact.
Payton Scott, a 27-year-old who has struggled with polycystic ovary syndrome (PCOS) most of her life, recently had to switch medications. After trying Metformin, which caused painful symptoms, Scott and her doctor decided to switch to Ozempic.
“Once I switched to Ozempic, I had no symptoms. Everything was great,” Scott said. But now, she’s on her last box of Ozempic because her pharmacist informed her that she needs a new pre-authorization.
“It’s really frustrating. Taking one shot a week was much easier and had no side effects, unlike Metformin, where I’ll have to go back to taking four pills a day,” Scott said.
Dr. James Grant, the chief medical officer at Blue Cross Blue Shield of Michigan, said the decision to change coverage wasn’t easy.
“We’ve been discussing this for the past six to 10 months and struggled with it,” Grant explained. He said the decision came down to cost. “These drugs are extremely expensive, costing over a thousand dollars a month. We have to be competitive, and when other insurers aren’t covering them, it’s tough for us to cover them while trying to keep health care affordable.”
So far this year, Blue Cross Blue Shield has spent $100 million on claims for these drugs, which have become more popular recently.
Scott is one of about 9,500 members affected by the changes. She relies on the medication to help regulate insulin, which affects fertility.
“I feel awful for anyone in the same situation as me,” Scott said. “I just hope they figure this out soon.”