Telehealth companies hired by employers play a gatekeeping role in GLP-1 obesity drug coverage

GLP-1 drugs such as Wegovy and Zepbound have become blockbuster treatments for obesity and related conditions, and employers covering them face high ongoing costs. In response, a growing number of employers have turned to telehealth companies — including Vida Health, Omada Health, and Virta Health — to manage both the lifestyle support and cost controls around these prescriptions, according to NPR's reporting.

David Davis, a 57-year-old power plant worker in Aptos, California, had a Zepbound prescription from his primary care doctor for obstructive sleep apnea when his employer added a new requirement: he had to obtain a new prescription through Vida Health. A Vida nurse told Davis he was a candidate for the drug but required him to first try naltrexone and bupropion — neither approved for sleep apnea. Davis said a patient advocate at his insurer told him that was "not a rule." He eventually stopped pursuing insurance coverage and began paying out of pocket for a compounded version. Vida Health did not answer questions about Davis's care; it said in a statement that its providers follow "clinical eligibility criteria and plan sponsors' coverage policies."

Penny Byer, a 64-year-old Virginia homemaker, had reached a healthy body mass index on Wegovy before Virta Health was added to her family's benefits package and discontinued her prescription in December. Her weight and cholesterol returned to pre-treatment levels. Virta said its own research shows patients can sustain weight loss after stopping the drugs — a position that NPR noted is at odds with a systematic review published in The BMJ covering 37 studies and 9,341 patients, which concluded that stopping obesity medicines leads to "rapid weight regain."