“It’s like having to jump through hoops to survive,” said Cooper Harris, 46, of Covington, Georgia, east of Atlanta.
Short supplies of these powerful drugs, called GLP-1 agonists, and insurance hurdles are preventing many people with diabetes and obesity from getting the drugs they need to stay healthy.
One of the roots of the problem is the extremely high prices set by pharmaceutical companies. About 54% of adults (including those with insurance) who took GLP-1 drugs said they had “difficulty” paying for them, according to the report. KFF Voting Results It was released this month. But patients with the lowest disposable income are being hit hardest. These people have few resources and struggle to see a doctor or buy healthy food.
In the United States, Novo Nordisk sells a one-month supply of Ozempic for about $1,000, and Eli Lilly charges a similar amount for Maunjaro. Ranges from $936 to $1,349 According to the Peterson-KFF Health System Tracker, before insurance coverage. According to the report, Medicare spending on three popular diabetes and weight loss drugs, Ozempic, Libersus, and Munjaro, will reach $5.7 billion in 2022, up from $57 million in 2018. Investigation by KFF.
“prohibitively expensiveSen. Bernie Sanders (I-Vt.), chairman of the U.S. Senate Committee on Health, Education, Labor and Pensions, said the prices “have the potential to bankrupt Medicare, Medicaid and our entire health care system” in a letter to Novo Nordisk in April.
High prices also mean that not everyone who needs the drug can get it. “They’re already at a disadvantage in many ways, and this is just one more thing,” said Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper-Harris, are underserved and enrolled in high-deductible health plans or receive public assistance programs such as Medicaid or Medicare.
Many drug companies have programs to help patients start and stay on their medications at little or no cost. However, for drugs like Ozempic and Trulicity, these programs are unreliable due to lack of supply.and the requirements of many insurance companies that patients receive Prior Authorization Or they may try a cheaper drug first, which could delay treatment.
By the time many of Rahman’s patients come to see her, their diabetes has been untreated for years and they are suffering from serious complications, such as leg scars and blindness. “And that’s the end of the road,” Rahman said. “I have to choose something else that is more affordable and not as good for the patient.”
GLP-1 agonists (a category that includes Ozempic, Trulicity, Mounjaro, etc.) were the first to be approved for the treatment of diabetes. Over the past three years, the Food and Drug Administration has approved rebranded versions of Mounjaro and Ozempic for weight loss, and demand has skyrocketed. And as the drug’s benefits become more clear, demand will only increase.
In March, the FDA approved a version of Ozempic, the weight loss drug Wegovy. treat heart disease, demand and spending may increase. Up to 30 million Americans, or 9% of the U.S. population, are expected to be taking GLP-1 agonists by 2030, the financial services company announced. JP Morgan estimates.
As more patients seek prescriptions for GLP-1 agonists, pharmaceutical companies are struggling to produce enough of the drugs.
Eli Lilly and Co. is asking people to avoid using its drug Munjaro for cosmetic weight loss to ensure supplies for people with pre-existing conditions. But despite side effects such as nausea and constipation, the drug’s popularity continues to grow due to its effectiveness and celebrity endorsement. In March, Oprah Winfrey aired a one-hour special on the drug’s effectiveness in helping people lose weight.
It may seem like everyone in the world is taking this type of drug, says Jodi Dashay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But not as many people are taking it as you might think,” he says. “No one is taking it in the first place.”
Even if drugs are in stock, insurance companies are cracking down and patients and providers are left navigating a thicket of ever-changing coverage rules.state medicaid plan different coverage ranges A drug for weight loss.medicare It won’t cover drugs. When prescribed as a treatment for obesity.and Commercial insurers are tightening access Because of the drug costs.
Healthcare providers put together care plans based on what’s available and what patients can afford. For example, Cooper Harris’ insurance company covers Trulicity, but she said she prefers Ozempic, which has fewer side effects. Rahman said when her pharmacy was outside of Trulicity, she had to rely more on insulin instead of switching to Ozempic.
One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust prescriptions for all 18 patients she saw because of drug availability and cost issues. Told. Addison said one patient had a teacher retirement health plan with a high deductible, but she couldn’t afford to take GLP-1 agonists.
“Until that deductible is met, it’s not a drug she can use,” Addison said. Instead, she gave the patient insulin. Its price is limited to a fraction of Ozempic’s cost, but it does not provide the same effect.
“Patients on fixed incomes are going to be the more vulnerable patients,” Addison said.
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