When prescribing the popular weight-loss drug Wegoby, Dr. Angela Fitch sends her patients on an adventure she likens to The Hunger Games.
You may have to spend several days calling drugstores to find one that has the right amount of first doses. Then repeat the same thing a second time, and maybe a third time. And that’s only if patients have insurance or can afford the drugs, which can cost more than $1,300 a month.
“This is not for the faint of heart,” said Fitch, president of the Obesity Medicine Society and a consultant to pharmaceutical companies.
Physicians and patients across the country say supply issues and insurance complexities are making it difficult for people to start and stay on Wegovy and similar drugs that are revolutionizing obesity treatment. It is said that there is. They say it will take persistence and a good deal of luck to get the in-demand shots.
People starting Wegovy must receive injections that gradually increase in strength before reaching a continuing so-called maintenance dose.
The drug’s maker, Novo Nordisk, says demand has forced it to limit the supply of small initial doses in the United States. The company also warned people taking another weight-loss drug, Saxenda, that they “expect to have difficulty filling their prescriptions for the remainder of the period.” Even after 2023. ”
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Another drugmaker, Eli Lilly, said it expected supplies of its diabetes drug Munjaro, also prescribed for weight loss, to be tight until the end of the year.
“Finding Wegovy can become a part-time job for patients,” said Dr. Diana Tiara, medical director of the Weight Management Clinic at the University of California, San Francisco.
Tiara said some people drive more than 45 minutes to get their prescriptions filled, creating a barrier for hourly workers who can’t leave their jobs or people without cars.
“Typically, we have patients who are a little more privileged, who can take time off from work to go for a drive,” Tiara says.
One of Fitch’s patients, Mike Boublis, has been taking Novo’s diabetes drug Ozempic, which contains the same active ingredient as Saxenda, Munjaro, or Wigovy, since about 2019. Over the past year, it has become much harder for him to find these drugs as they have become more popular. exploded.
I had to call five to seven pharmacies to refill my prescription.
“They all know what you want, but the answer is the same: ‘I don’t know.’ You’ll know tomorrow,” said the 35-year-old small business owner from a Boston suburb. .
Pharmacy technician Lizzie Nielsen started Wegovy earlier this year with inside information.
She regularly checked her drug wholesaler’s supply list, refreshed the screen every morning, and ordered Wegovy for her pharmacy as soon as she found it in stock.
“I was really lucky because back then there was always backorders,” said the 42-year-old West Springfield, Massachusetts, resident.
Over the past year, patients have had to deal with shortages of many medications, but patients taking weight loss drugs may also face insurance coverage issues.
Novo said the federal Medicare program for people 65 and older does not cover obesity drugs, but some privately run Medicare Advantage and Medigap plans do. Medicaid program coverage for low-income individuals varies.
Doctors and patients say many insurance companies have stopped covering Ozempic and Munjaro outside of their approved use for diabetes. Some insurance companies and employers don’t pay for his Wegovy.
Novo Nordisk also provides a form letter on the Wegovy website for physicians to apply for insurance coverage.
Boublis, who lives in the Boston area, said his insurance company stopped covering Munjaro earlier this year. He then tried to return to Ozempic, only to find that it was no longer covered either.
He is taking the remaining Ozempic at low doses until he can find insurance coverage.
“I know insurance companies don’t want to pay out claims, but we need to find some kind of good compromise between insurance companies and the pharmaceutical industry, because these drugs are lifesaving. Because we can do that,” said Boubri, who suffered losses. He’s about 80 pounds since he started drinking.
Employers and insurance companies that pay for weight loss treatments often require patients to get prior approval or try other strategies, such as diet or exercise, first.
To maintain insurance coverage, some require patients to demonstrate a 5% weight loss after six months of taking the drug. Supply issues make that difficult, Tiara points out.
“Many patients don’t stay in treatment because they don’t have access to it,” she says.
Dr. Laura Davison estimates that less than 30% of patients with insurance through their employer or private plan have coverage for obesity drugs.
Davison is leading a weight-loss program in West Virginia, a state consistently ranked as having one of the highest obesity rates in the nation. The state’s Medicaid program does not cover Wegobee, but neighboring Pennsylvania does.
“For me, it’s either they have insurance coverage or they don’t have insurance,” she said. “No one can afford it.”
As with other bariatric treatments, such as bariatric surgery, coverage may improve over time.
Mercer, a benefits consultant, says about 46% of large U.S. employers cover obesity drugs like Wigoby. Additionally he is under consideration by 18%. Mercer experts said employers have yet to learn what the additional costs will be and what other supports patients will need.
Dr. Deborah Horne believes supply issues and insurance coverage will eventually level out, but said it could take several years. He noted that the FDA may soon approve Munjaro as an obesity treatment, which could improve coverage.
Pharmaceutical companies are also developing other weight loss drugs, including pills that are easier to take.
Meanwhile, Horn, an obesity medicine specialist at UT Health Houston, said more patients are realizing that they can get medical help for their disease and don’t have to manage it themselves.
“I feel like this is the beginning of a change in obesity care. As the years go by, better medicines will come to market and people will be able to take control of their disease,” she said. “We’re in a really difficult time…right now.”
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