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Challenges in Obtaining Popular Weight-Loss Medications Due to Supply and Insurance Issues

by Joshua Brown
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Weight-loss Medication Challenges

When Dr. Angela Fitch prescribes the widely sought-after weight-loss drug Wegovy, she compares the journey her patients embark on to “The Hunger Games.” It’s a quest that demands determination and persistence. Patients must tirelessly call multiple drugstores over several days to find one that stocks the correctly sized initial dose. They repeat this process for their second and third doses, assuming they have insurance or the financial means to afford a medication that can cost upwards of $1,300 per month.

“This is not for the faint-hearted,” cautions Dr. Fitch, who serves as the president of the Obesity Medicine Association and consults for pharmaceutical companies.

But the challenges don’t end there. Patients starting on Wegovy must undergo a series of injections, gradually increasing in strength, until they reach the maintenance dose. Demand for these injectable weight-loss drugs is high, and obtaining them often involves an element of luck.

Novo Nordisk, the manufacturer of Wegovy, has been compelled to limit the supply of smaller initial doses in the U.S. due to overwhelming demand. The company has also issued warnings to those using another weight-loss drug, Saxenda, to brace for difficulties in filling prescriptions throughout 2023 and beyond.

Eli Lilly, another pharmaceutical company, anticipates tight supplies of its diabetes treatment Mounjaro, also prescribed for weight loss, until the end of the year.

For many patients, securing Wegovy becomes a part-time job. Dr. Diana Thiara, the medical director of the weight management clinic at the University of California, San Francisco, reports that some individuals must travel 45 minutes or more to find a pharmacy that can fill their prescriptions, presenting a significant barrier for hourly workers and those without access to transportation.

Dr. Fitch’s patient, Mike Bouboulis, has been using Saxenda, Mounjaro, or Ozempic (a Novo diabetes drug with the same active ingredient as Wegovy) since 2019. However, he has encountered increasing difficulty in obtaining these drugs over the past year, as their popularity has surged. Refilling his prescription now involves contacting five to seven pharmacies, all with the same uncertain response.

While shortages of medications have been a concern over the past year, individuals taking weight-loss drugs also face complications related to insurance coverage. The federal Medicare program for people aged 65 and older does not cover obesity medicines, although some privately administered Medicare Advantage or Medigap plans do provide coverage. Coverage from Medicaid programs for low-income individuals varies.

Many insurers have ceased covering Ozempic and Mounjaro for uses outside their approved indications for diabetes. Some insurers and employers do not cover Wegovy at all. Novo Nordisk even provides a form letter on its Wegovy website to assist doctors in requesting coverage.

Bouboulis found that his insurer stopped covering Mounjaro earlier this year. When he attempted to switch back to Ozempic, he discovered it was also no longer covered. Consequently, he is now relying on low doses of leftover Ozempic until he can secure coverage.

Employers and insurers that do cover weight-loss treatments often require patients to obtain pre-approval or attempt alternative strategies such as diet and exercise first. Some mandate that patients demonstrate a 5% reduction in body weight after six months on the drugs to maintain coverage, a challenge compounded by supply issues.

Dr. Laura Davisson estimates that less than 30% of her patients with insurance through an employer or individual plan have coverage for obesity medicine. In a state like West Virginia, which consistently ranks among the highest in obesity rates, Medicaid does not cover Wegovy, although neighboring Pennsylvania does.

The issue of coverage may improve with time, as it has for other obesity treatments like bariatric surgery. Approximately 46% of large U.S. employers currently cover obesity medicines like Wegovy, with another 18% considering it. Experts at Mercer, a benefits consulting firm, suggest that employers are still assessing the impact of the added cost and the additional support that patients may require.

Dr. Deborah Horn believes that supply problems and coverage issues may eventually be resolved, but it could take a couple of years. She notes that FDA approval of Mounjaro for obesity treatment could improve coverage. Additionally, pharmaceutical companies are working on developing more accessible weight-loss medications in the form of pills.

In the interim, more patients are recognizing that they don’t have to manage their obesity alone; medical help is available. Dr. Horn, an obesity medicine expert at UTHealth Houston, sees this as the beginning of a positive shift in obesity care, with better medications entering the market each year and more people gaining control over their disease. She acknowledges that the current challenges are just a part of the journey toward better obesity care.

(Note: This article is based on the provided text and does not reflect the personal opinion of the author.)

Frequently Asked Questions (FAQs) about Weight-loss Medication Challenges

Q: Why is it so challenging for patients to obtain popular weight-loss medications like Wegovy?

A: Patients face several challenges in obtaining weight-loss medications like Wegovy. One major issue is the high demand for these drugs, which has led to supply shortages of smaller initial doses. Additionally, the cost of these medications, often exceeding $1,300 per month, can be prohibitive for many individuals. This combination of high demand and limited supply, along with cost barriers, makes it difficult for patients to access these drugs.

Q: How does the manufacturer Novo Nordisk address the supply issue of weight-loss medications?

A: Novo Nordisk, the maker of Wegovy, has been forced to restrict the supply of smaller initial doses of the drug in the United States due to high demand. They have also issued warnings to users of Saxenda, another weight-loss drug, to expect difficulties in filling prescriptions for an extended period. These actions are a response to the supply challenges the company is facing.

Q: What insurance coverage challenges do patients encounter when seeking weight-loss medications?

A: Patients seeking weight-loss medications often encounter insurance coverage complications. The federal Medicare program for individuals aged 65 and older typically does not cover obesity medicines, although some privately administered Medicare Advantage or Medigap plans may provide coverage. Medicaid coverage for low-income individuals varies by state. Many insurers have ceased covering these drugs for uses outside their approved indications for diabetes, creating additional hurdles for patients.

Q: How do employers and insurers approach coverage for weight-loss treatments?

A: Employers and insurers that do cover weight-loss treatments often have specific requirements. Patients may need to obtain pre-approval or attempt other strategies such as diet and exercise before receiving coverage. Some insurers mandate that patients demonstrate a 5% reduction in body weight after six months on the drugs to maintain coverage. These requirements can be challenging, particularly when supply issues make it difficult for patients to consistently access the medications.

Q: Are there any potential improvements on the horizon for addressing these challenges?

A: While the current situation is challenging, there is hope for improvements. FDA approval of drugs like Mounjaro for obesity treatment could lead to better coverage options. Additionally, pharmaceutical companies are working on developing more accessible weight-loss medications in the form of pills. Over time, coverage for obesity treatments may become more widespread and accessible to those who need them.

More about Weight-loss Medication Challenges

  • Novo Nordisk: The official website of the pharmaceutical company responsible for manufacturing Wegovy and Saxenda.
  • Obesity Medicine Association: The website of the Obesity Medicine Association, where Dr. Angela Fitch serves as the president. This organization focuses on obesity treatment and related issues.
  • Medicare: The official website of the U.S. federal Medicare program, which provides information on coverage and eligibility.
  • Medicaid: The official website for Medicaid, offering information about the program and its coverage.
  • Mercer: The website of Mercer, a benefits consulting firm, which may provide insights into employer coverage trends.
  • UTHealth Houston: The website for UTHealth Houston, where Dr. Deborah Horn, an obesity medicine expert, is mentioned.

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