Emmaus, Pennsylvania – Doctors have found a drug used for diabetes to be very effective for those struggling to lose weight. In fact, the FDA recently approved the same class of drugs that were originally prescribed to diabetics, specifically for weight management. But for those with insurance that doesn’t cover it, the out-of-pocket costs can be enormous.
“Rather than just looking at people and saying, ‘Maybe if I get on the treadmill or lift weights,'” says Becky Schaefer. “There’s more to it than that.”
Shaffer, who lives in Emmaus with her husband and four children, said her weight has always been a struggle.
“Always on the heavy side,” she said. “I had no idea why, because I wasn’t necessarily eating bad food, but I was very active, doing a lot of sports and so on.”
As time went on, inspection revealed even more.
“I came to find out that something like PCOS is at the root,” she said.
Polycystic ovary syndrome is associated with symptoms such as weight gain. Johns Hopkins Medicine.
“And my A1C was always just a little bit higher.”
That means she is pre-diabetic. By the time her fourth child was born, she says her hormones had gone through her wringer.
“I could literally run on a treadmill 20 out of 24 hours a day, but I just don’t fall like some people do,” she said.
Schaefer recently learned about GLP-1 drugs such as Ozempic.
Adam Biener is an assistant professor of economics at Lafayette University. He is also a former salaried consultant for Novo His Nordisk, which manufactures Ozempic and Wegovy.
“GLP-1, or glucagon-like peptide agonists, are drugs that were originally developed to treat diabetes,” said Professor Beener.
Doctors say GLP-1 drugs like Ozempic, which were originally created to treat diabetes, are very effective for people with underlying conditions trying to lose weight.
“They need to use none or less of other types of drugs to treat diabetes,” said Dr. Tim Loh, chief medical officer of Himark and a Kentucky practitioner. Stated. “But lo and behold, at the same time they’re losing 40 pounds in six months.”
Doctors say drugs such as Ozempic and Munjaro are labeled for people with diabetes. However, other products such as Wegovy and Saxenda have also recently received FDA approval specifically for weight loss.
For people like Schaefer, it could be a game changer.
“If you have a car and the engine breaks down, you can still push it and go,” she said. “But you can’t run unless you fix the engine.”
But the drug doesn’t come cheap, with prices reaching thousands of dollars due to explosive demand.
“Monthly injections can cost upwards of $1,000 a month,” Biener said. “That translates to $12,000 a year in drug maintenance.”
Like many policies, Schaefer’s policy only covers diabetes medications that don’t help with weight loss.
“I had all my doctors fax me all the information about PCOS, weight gain, etc.,” she said. “And they were just like, ‘Well, that’s a shame.’ You know, they don’t care.”
Some patients have gotten lucky with coupons like: Ozempic again Good RX.
Schaeffer said state insurance does not allow the use of certain coupons. But for her and many others, losing her weight is more than just a matter of vanity.
“It affects the heart, liver and kidneys,” she says. “It’s affecting my joints.”
That’s why these new drugs have the potential to be game changers. So why are there so many obstacles?
“Historically, drugs and treatments that are considered cosmetic are usually not covered by insurance,” says Veener.
These drugs are so new and complex that only doctors prescribe them at this time, Biener said.
“So there is a lack of cheaper alternatives that are equally effective,” he says.
And those high prices may make it very difficult to get insurance coverage, experts say, because companies have to pay a lot.
“Unfortunately, obesity has a bad stigma,” Dr. Lo says. “If you have a small company with 50 employees, and you’re trying to insure them all, this is probably omitted, but he’s one.”
Low said about 88 percent of the GLP-1 prescriptions that pass through the company are for diabetes. Only 12% for weight loss.
“But you have to meet certain criteria. As you know, BMI has to be above a certain level in such cases,” he said.
The law states that certain guardrails have been put in place to ensure patients do not use drugs for cosmetic reasons only. Still, some say the drug is not available to those who really need it because the requirements are too great.
“Make it more difficult or limit the cases that are covered,” Mr. Beener said. “You must have other complications, such as diabetes or coronary heart disease.”
Given the current novelty and demand for new drugs, experts say not much can be done until the drug becomes more widespread.
“So we’re really in the middle of rock and hard,” Lo said. “You can get it cheaper in other countries, I know. But they have even more supply chain problems than we do.”
