Insurance plan ends coverage for GLPs

In an effort to control health insurance costs for the city of Kingsland, its health insurance provider is ending coverage of popular GLP (glucagon-like peptide) medications used to treat type-2 diabetes and for weight loss at the end of the year.

As it is, the city will still pay a 14% increase in premiums over last year under an agreement approved by the Kingsland City Council this week. It was a 14% increase in premiums from the previous insurer that led the city to change plans and providers, but both the employee benefits advisor and city council members agreed that if the city had not made a change, it was looking at around a 20% premium increase.

The city budgeted for a 12% increase already, so that leaves it looking for another $45,000. The bottom-line difference between this year’s costs and next year’s costs is more than $300,000, from around $2.16 million to around $2.46 million.

“What I can tell you is that what we came into is, I think, over the past 12 months, 20 of your health plan members - which is 10%-plus - had about $20,000 in claims, or more,” said Matt Robinson, an employee benefits advisor with Lighthouse Benefit Advisors. “I think eight had more than $30,000 in claims. So, there are some medical and prescription claim issues that we need to address .”

As it is, Robinson said, the city is on pace to spend $100,000 a year on GLP medications.

“The ones that are the most concerning to me are over $1,000-a-month per prescription,” Robinson said. “Now, we were able to reduce that cost by about half through a program that we’ve developed internally, but it’s still a lot of money and a lot of health plans these days don’t cover weight-loss drugs. At least not the GLPs, if you will.”

He added that it would benefit people to adopt healthier habits before turning to medications, noting that his company’s seen “incredible misuse and abuse” of GLPs.

“A lot of folks these days, whether it’s in Southeast Georgia or in the Midwest or whatever it may be, I think there’s become this tendency to just take a pill or take a shot and not have any responsibility for your health,” Robinson said. “Not change your diet, not change your environment, not look at your stress levels, not change your exercise habits.”

Councilman Farran Fullilove took exception with some of Robinson’s characterizations.

“I’m a little bit upset, because I’m a type-2 diabetic, and I know that when my doctor tells me this is what I need, this is going to make me better, this is going to make me function better and do the things I need to do, including what you just said - doing what I need to do to make my life better,” Fullilove said.

“You’re going to tell me now that you’re not going to give me what the doctor says is going to work best for me, you’re going to make me do what you want me to.”

Robinson said he understood where Fullilove was coming from, and explained that Folkston Pharmacy, a compounding pharmacy, can make the same sort of medication used in Ozempic and similar drugs, but at a fraction of the cost, which he said would probably be around $100. With many people’s copays already at $100 for the name-brand drugs, he suggested the change would end up as a wash for most city employees using GLPs.