Healthy Returns: More than 50 million privately insured adults could be eligible for GLP-1 drugs

A version of this article first appeared in CNBC’s Healthy Returns newsletter, which brings the latest health-care news straight to your inbox. Subscribe here to receive future editions.

Good afternoon! A large swath of insured Americans could be eligible for a highly popular class of weight loss and diabetes medications called GLP-1s, such as Novo Nordisk‘s Wegovy and Ozempic. 

At least two in five U.S. adults — or more than 57 million people – under the age of 65 with private insurance could be eligible for GLP-1s according to clinical criteria, a new analysis from health policy research organization KFF found. That includes over 36 million people with an obesity diagnosis alone.

GLP-1s are approved to treat adults with Type 2 diabetes or obesity, or who are overweight with at least one weight-related health condition, such as cardiovascular disease, hypertension or high cholesterol. Novo Nordisk’s weight loss injection Wegovy is also the only GLP-1 approved for slashing the risk of heart attack, stroke and death in obese or overweight adults with cardiovascular disease. 

But here’s the catch: The number of adults eligible for those drugs may vary depending on additional requirements that their employer-sponsored health plans set. KFF said employers weigh the high cost of covering GLP-1s, which have list prices of roughly $1,000 per month, against their clinical benefits and demand from their workers. 

Employers could impose additional eligibility conditions for coverage, such as higher BMI requirements, KFF said. For example, if employers adopted a BMI threshold of 35 or greater, only 14.6 million adults under 65 covered by those health plans would be eligible. The current BMI cutoff for GLP-1s is 30 or greater (for patients with obesity) and 27 or more (for those who are overweight,) according to approval labels for GLP-1 drugs for obesity. 

Some plans may also only cover GLP-1s for diabetes management, not obesity. 

KFF also noted that there are only a “relatively modest number of people” enrolled in employer-sponsored health plans with a claim for a GLP-1 as of two years ago. Only 3% of adults with employer coverage had a prescription for one of the drugs in 2022, KFF said. Semaglutide, the active ingredient in Wegovy and Ozempic, is the most common GLP-1 drug since it joined the U.S. market in 2018. 

Still, KFF noted that “some evidence indicates that” GLP-1 use “has only continued to rise over the last two years,” beyond the most recent insurance claims data available. Around 6% of all adults, regardless of their insurance coverage, report that they are currently taking a GLP-1 drug, according to a KFF poll released in May. Roughly 12% report that they’ve taken one of those treatments at some point. 

More people may also be eligible for GLP-1s as they get approved for new uses. Novo Nordisk and Eli Lilly are both studying their respective drugs as potential treatments for fatty liver disease and chronic kidney disease, among others. The companies could see approvals for some of those conditions within the next year or so. 

Feel free to send any tips, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.

Apple on Monday held an event at its headquarters in Cupertino, California where it announced a host of new products and updates. The company unveiled its iPhone 16 lineup, the Apple Watch Series 10 and new AirPods, but I thought its new health-care features stole the show.  

“We’re incredibly proud to introduce a first-of-its-kind Hearing Aid feature, coming this fall with AirPods Pro 2, plus an innovative way to detect signs of sleep apnea with Apple Watch,” Apple CEO Tim Cook wrote in a post on X on Monday. “These life-changing tools will help people connect more deeply & live healthier.”

Here’s everything you need to know:

Apple Watch Series 10

Apple said its latest watch can help alert users to sleep apnea, a sleep disorder that can cause a person’s breathing to repeatedly start and stop throughout the night. 

Sleep apnea affects more than 1 billion people worldwide, but Apple said 80% of people with the condition are undiagnosed. If people with sleep apnea do not get treated, they could face a higher risk of heart problems, hypertension and Type 2 diabetes. 

To detect this condition, the Series 10 uses an accelerometer to measure breathing disturbances that occur overnight. Users can view their nightly metrics in the Health app. Apple will analyze this breathing disturbance data once a month and notify people if they show “consistent signs” of severe or moderate sleep apnea.

The company will also generate a “detailed report” that users can bring to their doctors. 

Apple said the detection algorithm for this feature was developed with “an extensive dataset of clinical-grade sleep apnea tests,” and was validated in a clinical study. The company expects the U.S. Food and Drug Administration and other regulators will clear the technology “very soon.”

The Series 10 launches Sept. 20, but it’s already available for preorder. It starts at $399. Sleep apnea notifications will also be available on the Apple Watch Series 9 and Ultra 2. 

AirPods Pro 2

Apple also introduced new AirPods Pro 2 features that can help users assess and protect their hearing. 

The company said hearing loss can be hard to detect since it often happens gradually, so it created a five-minute-long hearing test that users can perform at home. To take the test, users will simply need to put on the AirPods Pro 2 and tap their screen when they hear sounds at various frequencies and volumes.  

Apple said the test is clinically validated and designed based on real-world data. The results will be stored in the Health app, where users will see their personalized hearing profile. People can take the test regularly and access educational materials about hearing loss, the company added.

Once users take the hearing test, individuals with mild to moderate hearing loss can use their AirPods Pro 2 as a clinical-grade, over-the-counter hearing aid. Apple uses the results of the test to determine the sounds that a person needs to have amplified in real time, whether it’s elements within their environment or different parts of speech. 

“This will allow you to hear your surroundings better, to help keep you safe and connect you with people nearby so it’s even easier to hear and engage in conversations,” Dr. Sumbul Desai, vice president of health at Apple, said during the event.

Additionally, Desai said users’ hearing profiles are automatically applied to phone calls, music and movies across their Apple devices. 

Apple said it also expects the FDA and other regulators to approve the hearing tools soon. The hearing test and hearing aid features will be made available in a free software update this fall. AirPods Pro 2 are available for $249.  

Apple said it is also adding a “Hearing Protection” feature to AirPods Pro 2 that can minimize users’ exposure to potentially damaging environmental noise. 

The ear tips on the headphones help passively reduce noise, and Apple said machine learning on the H2 chip that powers the headphones “reduces louder, more intermittent noise at 48,000 times per second.” The hearing protection feature is on by default.

It’s worth reiterating that Apple is still waiting on regulatory approval, but I think these features firm up the company’s position as an innovative player in the health-care space. We have more health data at our fingertips than ever before, and Apple appears keenly aware of that. 

The lingering question is whether these health features will be enticing enough to encourage consumers to purchase new watches and headphones.

You can read more about Apple’s latest announcements here.

Feel free to send any tips, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.