Want obesity drugs covered by insurance? Telehealth companies have a big say

David Davis, a 57-year-old power plant worker near Santa Cruz, Calif., struggled to fill his Zepbound prescription after his employer mandated approval through Vida Health, a telehealth company. Though he had a prescription from his primary care doctor for obstructive sleep apnea, Vida required additional steps, including blood work and video visits, before approving the drug. The company insisted Davis try naltrexone and bupropion—neither approved for his condition—before considering Zepbound. Davis eventually abandoned the process and purchased a cheaper, compounded version of the drug online. Vida Health declined to comment on his case but stated its providers follow clinical guidelines and employer coverage policies. His insurer, Blue Cross and Blue Shield of Texas, confirmed it adheres to plan benefits but did not address Davis’ specific situation. Telehealth companies like Vida Health originally focused on diabetes management but pivoted as obesity drugs like Zepbound and Wegovy became blockbusters. Employers increasingly hire these firms to control costs, offering lifestyle support while restricting drug access. Jayne Hornung, chief clinical officer at MMIT, noted the shift, saying these companies now provide wraparound services tied to weight-loss medications. Omada Health, another telehealth provider, reported a 51% membership increase in the past year, signaling growing employer adoption. While these services may improve patient adherence, critics argue they create unnecessary barriers, as seen in Davis’ case. His experience underscores how telehealth firms influence drug access, prioritizing cost savings over patient needs.