Drug Companies Have a Sneaky Idea to Get Insurance to Pay for Drugs Like Zepbound

In a new bid to get insurers to cover popular weight loss medications, one of the pharma companies behind the new treatments is making an interesting gambit: sponsoring studies into whether they can help treat other conditions.

As the Wall Street Journal reports, Eli Lilly, the manufacturer of the weight loss and type 2 diabetes drugs Zepbound and Mounjaro, is hoping to force the hand of insurers — which heretofore been reticent to pay for the drugs — by showing that the drugs are an effective treatment for sleep apnea.

In two recent studies funded by Lilly, more than 60 percent of the combined 470 participants experienced reduced sleep apnea severity when taking Zepbound as compared to placebo. The results were promising enough that the Indianapolis-based company has sent them to the Food and Drug Administration as part of its application to officially include sleep apnea as one of the conditions Zepbound treats.

“It builds this wall of evidence,” explained Derek Asay, Lilly’s senior vice president of government strategy and federal accounts. “It helps give that reason to believe there’s more than weight loss here.”

Known as glucagon-like peptide-1 (GLP-1) agonists, drugs like Zepbound and Novo Nordisk’s Ozempic and Wegovy are becoming known not just for inducing weight loss as they mimic the gut’s feeling of fullness, but also for seemingly helping with other conditions ranging from alcoholism and dementia to arthritis and Parkinson’s.

As more and more of these off-label uses begin cropping up in anecdotal evidence and studies, the companies that have made a killing off of them are hoping to get broader insurance coverage once regulatory agencies approve them for conditions outside of weight loss and diabetes.

Already, some of these efforts have borne fruit.

In March, the FDA approved Novo’s Wegovy weight loss injectable as a treatment for heart disease and stroke risk — a move celebrated by doctors who consider the drugs to be life-changing.

“The hope,” explained Cedars-Sinai cardiologist Martha Gulati in an interview with NPR earlier this year, “is that insurers will start understanding that this is not a vanity drug.”

Despite all the buzz, however, it remains unclear whether these seemingly outsize off-label effects are the result of the weight loss itself or of some other, undiscovered mechanism present in the drugs — a question that may be difficult to answer because despite all the hype, the medical industry still isn’t entirely sure how GLP-1s work in the first place.

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