The makers of Ozempic, Wegovy, and Mounjaro are racing to prove that this incredibly popular drug has health benefits beyond weight loss and diabetes. They say that would make it easier for patients to get insurance that covers expensive drugs.
Clinical trials are underway to see if the drug can reduce the risk of heart attack, stroke, kidney disease and other chronic diseases in obese people.
Although obesity is associated with many health risks, Insurance companies often do not cover the cost Weight loss drugs can cost more than $1,000 for a month’s supply.
“The reason for this exclusion is that obesity is considered a cosmetic issue rather than a chronic disease,” said Dr. Peminda Kabandumanga, an endocrinologist at the Cleveland Clinic. “But in addition to helping you lose weight, these drugs can also benefit your heart, lower blood pressure, help with cholesterol, and cure sleep apnea.”
Another barrier is a 2003 law that prohibits Medicare from: cover weight loss drugs, cutting off a huge group of potential patients. Private insurance companies also often take cues from federal programs about what they cover.
“We recognize that these drugs are priced very high by the drug companies,” said Dr. Beverly Chan, an endocrinologist at Weill Cornell Medicine in New York. “Coverage and accessibility will undoubtedly be the biggest challenges in advancing the treatment of patients with obesity.”
Benefits beyond weight loss
In August, Novo Nordisk, the maker of Ozempic and Wegovy, announced that in a large-scale clinical trial, medicine provides health benefits Beyond weight loss and diabetes management. A Phase 3 study of more than 17,000 obese adults showed Wegovy reduced the risk of cardiovascular events such as heart attack and stroke by 20%. (Ozempic, which is approved for type 2 diabetes, and Wegovy, which is approved for weight loss, both contain the same drug called semaglutide.)
Professor Chan said previous clinical trials of drugs such as semaglutide for diabetes and weight loss found that the drug also improved blood pressure and cholesterol, two risk factors for heart disease, but the Food and Drug Administration has not been able to improve heart health. He said an independent study was needed to investigate the issue. Companies can say that their drug has such benefits.
Last week Novo Nordisk announced Results from another clinical trial found that Ozempic slowed the progression of kidney disease in people with type 2 diabetes.
Eli Lilly, the maker of the diabetes drug Munjaro, expects the drug to be approved for weight loss by the end of this year or early next year.Lilly spoke at the 2023 ObesityWeek conference in Dallas on Sunday. presented complete results From the SURMOUNT-3 exam, TirzepatideThe drug, discovered in Munjaro, caused people who took a placebo to lose more weight after 72 weeks. Both groups were asked to make intensive lifestyle changes 12 weeks before starting medication, including eating a low-calorie diet, exercising, and attending weekly counseling sessions.
Lilly also hopes to win approval for another weight loss drug called . Retatortidewithin the next few years.
At the same time, pharmaceutical companies are also conducting several clinical trials to see if their drugs can treat. obstructive sleep apnea, Non-alcoholic fatty liver disease and other chronic diseases.
Dr. Nadia Ahmad, Eli Lilly’s obesity clinical development medical director, said the drug offers “many benefits.” After losing weight, “cardiometabolic efficiency was even greater, blood pressure was further reduced, insulin levels were further reduced, and lipids were further improved.”
Ahmad said the clinical trial will provide important insight not only for doctors treating patients, but also for insurance companies and governments when deciding whether to include weight loss drugs in their insurance coverage.
“All this data helps make decisions, whether those decisions are made by the provider or the government,” she said.
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Mike Bergman, 38, of Fort Myers, Florida, was initially lucky to have insurance that covered his prescription for Wigobee.
Bergman said she struggled to lose weight until she started taking Wigoby in December, even though she ran about four miles a day for about a year.
“I was like, ‘Let’s try this,'” he said. “I work as a mortgage loan officer, so I’m in the office from early morning until late most nights.”
In just a few short months, he lost about 50 pounds and his desire to drink alcohol decreased.
He said he might have been able to lose more weight if his insurance hadn’t unexpectedly cut off prescription coverage over the summer. The insurance company argued that the drug was not medically necessary and suggested diet and exercise instead.
Without insurance, she would not have been able to cover the out-of-pocket costs of her medications (approximately $1,300 per month).
But Bergman said he would have continued if he could.
The tide may be changing
There are some signs that insurance companies and lawmakers may be warming to the idea of covering weight loss drugs.
In 2021, the House of Representatives Obesity Treatment and Reduction Act, which would have allowed the federal government to expand Medicare Part D coverage to include weight loss drugs. The bipartisan bill had 154 co-sponsors. According to Congress.govbut did not receive a vote on the House floor before the end of the term.
Additionally, the Congressional Budget Office said this month The group is calling for new research supporting the use of weight loss drugs under Medicare and the potential savings they provide.
Employers may also be preparing to cover weight loss drugs. (Since most Americans obtain health insurance through their jobs, employers play an important role in determining the offerings of their company’s insurance plans.)
Human resources executives and benefits consultants have overwhelmingly positive opinions about weight loss drugs, which make employees feel more in control of their weight and improve their overall They agree to improve their quality of life.
However, the findings, based on a survey conducted from May to December 2022, show that these employers and consultants are trying to justify the high cost before offering insurance to their employees. have also indicated that they want more data on the additional health benefits of medicines.
Kimberly Guzune, Ph.D., associate professor of medicine at Johns Hopkins University, said, “HR benefits professionals have a potential role to play in improving and treating obesity and other related diseases, and improving the quality of life for employees.” I actually recognize that.” The results of the survey have been announced. “But we are now seriously considering and looking forward to further information regarding its financial aspects.”
In the meantime, Guzne said employees, even small businesses, may benefit from talking to their human resources representatives about why they don’t cover weight loss drugs.
“I think employees have a role to play as advocates,” she says.
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