Why your health plan doesn't cover GLP-1s, according to a ...

Consumers will have to wait for broader insurance coverage of GLP-1 weight-loss drugs until prices come down and clear evidence emerges that they will reduce health care costs, the CEO of CVS Health, which includes Aetna insurance, said in an interview.

Aetna's corporate customers who pay for private employee health insurance are not ready to swallow the high costs of the enormously popular drugs, CEO David Joyner said.

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"Everybody intuitively believes these medications create long-term health benefits, but the evidence hasn't yet demonstrated that paying today's prices generates enough downstream savings," he said. "The economics simply aren't there yet."

When GLP-1 drugs will bend the health care cost curve downward is a much-debated question. There is no dispute that helping people lose weight reduces cholesterol, blood pressure and improves heart health. But the return on investment of covering the drugs - in terms of reduced costly medical procedures and hospitalizations - has not yet been proved.

Joyner said another fundamental problem is the cost of the drugs, which are sold by Eli Lilly, which makes Zepbound and Foundayo, and Novo Nordisk, which makes Wegovy.

List prices of the drugs range above $1,000. Companies like CVS Caremark, CVS Health's pharmacy benefit management division, negotiate discounts called "rebates" with drug companies. Joyner said the rebates Caremark negotiates bring prices in insurance plans even lower than cash prices of $450 that consumers with no insurance can pay on Lilly's website.

But even that is not low enough for employers, who are already struggling with rising premiums, Joyner said.

"Eli Lilly has become an extraordinarily successful company - the first trillion-dollar health care company in the United States," he said. "They're not going to lower prices until competition forces them to."

The health care affordability crisis

Joyner sat down for a 30-minute interview in Washington last week after he appeared before the Economic Club of Washington D.C. Joyner rose through the ranks of Aetna and Caremark and retired from CVS Health at the end of 2019. After roaming the country in an RV with his wife and dog for several years, he was lured back to the growing CVS Health empire in 2023 and rose to the top job in October 2024.

At the time, CVS Health was struggling financially. He has led a financial turnaround, with moves that included pulling Aetna out of the Affordable Care Act marketplaces, or Obamacare, after hundreds of millions of dollars in losses.