Weight loss drugs Ozempic and Wegovy are life-changers for those who can afford them

Demand for weight-loss drugs has soared over the past year, that semaglutide — better known by the brand names Ozempic and Wegovy — has been in short supply in pharmacies across the country. Doctors who treat obesity patients are increasingly frustrated that people who really need injection drugs are not getting them.

Seventy percent of Americans are overweight or obese and have an increased risk of type 2 diabetes and heart disease. According to the Centers for Disease Control and Prevention, non-Hispanic black adults have the highest rates of obesity, followed by Hispanic adults.

However, black adults, as well as uninsured or low-income women, and other groups with higher rates of obesity — people whose health might benefit most from significant weight loss — are least likely to have access to expensive medications, obesity doctors say. .

Ozempic, which is approved for diabetes but prescribed off-label for weight loss, and Wegovy, which is approved for weight loss, can carry a price tag of over $1,000 per month. Neither drug for weight loss is covered by most insurance plans.

“The majority of my patients can’t afford to pay $1,300 a month, especially for medication that they need long-term,” said Dr. Veronica Johnson, an obesity specialist at Northwestern Medicine in Chicago. “As a black woman and treating patients who look like me, knowing that a lot of black women suffer from obesity, unfortunately, I cannot treat many of my patients in the best way I would like to.”

The lack of access to this new class of weight-loss drugs in such high-risk groups is “infuriating,” said Dr. Jennifer Meres, chair of diversity and inclusion and professor of cardiology at Northwell Health in New York.

“These are the communities with the highest obesity rates, the highest cardiovascular disease burden, and the highest cardiovascular disease mortality,” Meres said. “It’s a crime because heart disease is preventable.”

Novo Norodisk, the manufacturer of both drugs, said 81% of its patients on Wegovy are women. The company hasn’t broken it down by race.

However, these statistics do not mean that the majority of women who may need medicines receive them.

“Best we’ve ever seen”

Ozempic and Wegovy are the same drug, semaglutide, but they come in different doses. They act as appetite suppressants and help control blood sugar levels by prompting the body to release insulin. Wegovy is approved as a weight-loss drug for adults who are obese, as well as people with a BMI of at least 27 who also have a weight-related condition, such as high blood pressure or high cholesterol. Studies have shown that Wegovy can reduce body weight by 15%.

“These anti-obesity drugs are the best we’ve ever seen,” said Dr. Shauna Levy, an obesity medicine specialist and medical director of the Tulane Bariatric Center in New Orleans. “It’s a huge boost to our sequence of obesity treatments.”

That is only if patients can actually get them, Levy said.

“The patients I see want their knees to feel better, their buttocks to feel better, their blood pressure to improve, and their diabetes,” Levy said. “But when they come, I have to tell them, ‘I’m sorry, I’ll prescribe this to you, but it’s going to be $1,200 a month because your insurance doesn’t cover it.’ Sad thing.”

That’s exactly what Levi told Tanya Matua, 26, of Metairie, Louisiana.

Matua began struggling with her weight after the birth of her son, Kaylan, in 2021. She tried intermittent fasting, cutting carbs and adding aerobic exercise to her exercise routine.

“I kept seeing the number go up on the scale,” she said. “I was like, ‘Obviously something is wrong.'” She wanted to help shed extra pounds to reduce her chances of developing type 2 diabetes.

“I may not have it now, but it runs in my family. Almost everyone in my family has it,” Matua said. “The whole point is that I don’t develop it, and I will stay healthy.”

“Dr. Levy was like, ‘Well, I have bad news,’” Matua recalls. Even though she had private insurance through her employer, Levy said the health plan wouldn’t pay for her new weight-loss drugs. At 5’1″ and 182 lbs. Matoa has a BMI of 34.4.

However, weight loss surgery is covered. But taking time off to have such a procedure and recover from it is an outlier for Matua.

“I have to work,” she said. “I have to take care of my baby.” “I can’t even take two days off work because I’m going without pay. It’s not an option.”

Are weight loss medications covered by insurance?

The vast majority of health plans — especially those that serve seniors and low-income families — don’t cover weight-loss drugs.

A spokesperson for the Centers for Medicare and Medicaid Services told NBC News that Medicare pays for bariatric surgery but not obesity medications, including medications for anorexia, weight loss and weight gain.

And fewer than 20 Medicaid programs nationwide pay for it, according to the 2022 report from the Urban Institute, a nonprofit research organization.

AHIP, a group that represents the insurance industry, maintains that there is not enough evidence yet to show that medications are effective options for long-term weight loss.

“Evidence suggests that patients may not be able to maintain weight loss once they stop taking the medication,” said David Allen, a spokesperson for AHIP. “There is also limited long-term evidence to show that patients taking these medications see lasting benefits in reducing the risk of comorbidities such as diabetes or cardiovascular disease.”

The drugs’ effect on weight loss may not reflect their true health benefits, said Dr. C. Noel Berry Mears, scientific advisor for the Women’s Heart Alliance and director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute in Los Angeles. . They were developed as type 2 diabetes medications. As such, the drugs “have a clear cardiovascular benefit,” regardless of a person’s weight loss, she said.

To be clear, semaglutide is not the answer for everyone who struggles with obesity. It can cause serious side effects, such as vomiting and nausea. As with the treatment of other diseases, different types of treatment may be required.

The huge gap in insurance coverage for weight-loss drugs is rooted in weight discrimination, said James Zervius, vice president and task force chair of the Obesity Actions Coalition.

“As a society, we still very much have a mentality of obesity as a cosmetic issue, rather than a metabolic problem or disease,” Zervius said.

He said most patients who seek a doctor’s help with their weight are often advised to simply “try eating less and moving more” or start a food diary.

“It’s not that the behavioral components have no place in the treatment plan, but they can’t be the only thing,” Zervius said.

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