For the past year and a half, Tandra Cooper Harris and her husband, Marcus, both Diabetesstruggle to fill prescriptions for medications needed to control blood sugar levels.
without it Ozempic or similar drugs, Cooper Harris suffers a power outage, is too tired to watch her grandchildren, and struggles to earn extra money by braiding her hair. Marcus Harris, who works as a cook at Waffle House, needs Trulicity to prevent swelling and bruising on her feet.
The couple’s doctor tried prescribing it. similar drugs, which suppresses appetite by stimulating insulin production and mimics the hormones that control blood sugar levels. However, they are also often out of stock. Additionally, purchasing insurance through the Affordable Care Act Marketplace can result in lengthy approval processes and may result in copays that couples cannot afford.
“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 drug 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 charges about $1,000 for a month’s supply of Ozempic, and Eli Lilly charges a similar amount for Munjaro.Prices for one month of various GLP-1 drugs 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, an independent from Vermont who chairs the U.S. Senate Health, Education, Labor and Pensions Committee, said the prices “could bankrupt Medicare, Medicaid and our entire health care system.” stated in a letter. 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 continue taking their medications at little or no cost. However, for drugs like Ozempic and Trulicity, these programs are unreliable due to lack of supply. And many insurance companies require patients to get pre-authorization or try cheaper drugs first, further delaying treatment.
By the time many of Rahman’s patients come to see her, their diabetes has been uncontrolled for years and they suffer from serious complications, such as sores in their legs and blindness. “And that’s the end of the road,” Rahman said. “They have to choose something that is more affordable and not as good for them.”
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 weight loss drug wegobee, Ozempic version, treat heart problems, 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, drug companies are struggling to make enough doses.
Eli Lilly urges people to avoid using its drug Mounjaro for cosmetic weight loss To ensure that people with medical conditions have sufficient supplies.But despite this, the drug’s popularity continues to grow side effects Caused by its effects and celebrity endorsement, including nausea and constipation. March, oprah winfrey released a one-hour special about the ability of drugs to help with weight loss.
Jodi Duchey, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center, said it may seem like everyone in the world is taking this class of drugs. “But there aren’t as many people as you think,” she says. “There’s nothing.”
Even if drugs are in stock, insurance companies are cracking down and patients and providers are left navigating a thicket of ever-changing coverage regulations.state medicaid plan different coverage ranges A drug for weight loss.medicare It won’t cover drugs. If prescribed for obesity.and Private insurers are increasing 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 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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