Dr. Laure DeMattier, a bariatric medicine specialist in Norman, Oklahoma, feels the frustration of patients struggling to lose weight.
Nearly all of her patients at her weight-loss clinic in the south suburbs of Oklahoma City could be helped by a new class of drugs, such as Ozempic or Wigovy, if they can afford it.
“My patients are already on Weight Watchers and Nutrisystem. They’ve achieved high protein, low carbohydrates,” she said. “They are already doing everything physically possible to change their diet and exercise.”
What many of them don’t do is take monthly injections of semaglutide or tirzepatide. DeMattia can give them her Wegovy or Zepbound prescriptions, but that’s just the beginning. They then face a complex and often frustrating battle to pay for their expensive drugs.
“Our Medicare and Medicaid populations are some of the most at-risk populations, and they do not have access to any anti-obesity drugs,” she said.
About half of U.S. adults are obese or severely obese, and this crisis means more people are at risk for heart disease, diabetes, or some types of cancer.
New data shows significant geographic and racial disparities in who has access to semaglutide, the active ingredient in Ozempic and Wigovy.
An estimated 85% of semaglutide prescriptions were filled to white people nationwide, an analysis of more than 4 million prescriptions written for semaglutide nationwide in 2023 shows. Black adults, who have significantly higher rates of diabetes and obesity, received about 12% of prescriptions, according to healthcare analytics firm Purple Labs.
In the seven years since semaglutide was approved for diabetes, new classes of weight loss drugs such as semaglutide and tirzepatide are increasingly being hailed as a revolution in obesity treatment. Celebrities like billionaire Oprah Winfrey promote drugs while showing off their trimmed bodies.
But as of 2023, only 1% of the U.S. population with government or private insurance had a prescription for semaglutide, the most popular weight loss drug, according to an analysis by Purple Labs. .
So much for the revolution.
The drug’s high price means that many people who need it most have little access to it. Insurers typically refuse to reimburse the approximately $1,000 monthly cost of the injections, or even if they do, they set high barriers to approving payment.
Dr. Peminda Kabandugama, an endocrinologist at the Cleveland Clinic, says, “A lot of what we’re doing in terms of obesity management is not for elites, but for people who actually have better insurance and can cover it.” ” he said.
Latest news about weight loss drugs
The data does not include other weight-loss drugs, such as Eli Lilly’s Zepbound, which just went on sale in December, or Munjaro, a diabetic version of tirzepatide.
Oklahoma has the third highest adult obesity rate in the United States at 40%, but it is not even in the top 25 states for semaglutide prescriptions.
Dr. Ryan Morgan, an obesity physician at Vitalis Metabolic Health in Oklahoma, said there is “weight-based discrimination” in which health care providers do not treat obesity as a chronic disease. He also noted that many insurance companies won’t cover the cost of drugs because they are too expensive, and he said patients must be made aware of that.
“I tell them that if you send it, it’s probably going to be rejected 99.9 percent of the time,” he said. “I feel like my tools are being taken away from me.”
Unlike Oklahoma, West Virginia has relatively high prescription rates. The state has the highest adult obesity rate in the nation, but ranks second in semaglutide prescriptions, according to Purple Labs.The relatively high rate of prescriptions may be due to West Virginia. It covers medication costs for state employees.
That all ended in February.
Dr. Laura Davison, director of West Virginia University’s Medical Weight Management Program, said helping patients pay for their medications is a challenge.
“We now have a real chance of turning around the health status of this country.” But patients’ inability to cover the costs “means health disparities will widen. .”
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Liz Shumate, 41, a mental health therapist from Oklahoma City, Oklahoma, has a family history of heart disease. She wants to lose about 20 pounds to reduce her risk of health complications. Several diet and other lifestyle changes did not help.
Shoemate, who is black, has tried signing up for Wegobee and Zepbound, but her insurance through work won’t cover her and she can’t afford the $1,000 monthly prescription.
She acknowledged that the situation is likely to be even more demoralizing for low-income groups.
“It makes no sense at all, considering it allows people to manage their weight in a healthy way, leading to better outcomes in the long run,” she says. “They say insurance doesn’t cover it, but then it covers open heart surgery and other life-saving procedures. Why not invest that money on the front end?”
Susan Beam, 67, of Norman, Okla., has high blood pressure and rheumatoid arthritis, which she said were made worse by her excess weight.
She wants to be prescribed weight loss medication, which doctors say may help alleviate her symptoms. But Medicare denies her coverage, so she can no longer afford the high co-pays for her medications.
“It’s very frustrating,” said Beam, who has struggled with her weight for years. “Even if it’s not covered by insurance, it’s only available to certain people who can realistically afford it. That certainly feels unfair.”
Will Medicare cover weight loss drugs?
Cleveland Clinic’s Kabandugama said insurance companies often refuse to cover the cost of weight-loss drugs because obesity is still considered a cosmetic problem rather than a chronic disease.
Another barrier, he added, is a 2003 law that prohibits Medicare from covering weight loss drugs, cutting off a huge group of potential patients. Private insurance companies often take Medicare’s lead in determining payment amounts.
“The issue has always been access,” Kabandugama said.
Indeed, the Food and Drug Administration’s expanded approval of Wegoby to reduce the risk of heart attacks and strokes could persuade more insurance companies to cover the drug. Pharmaceutical companies are racing to prove that their drugs offer health benefits beyond weight loss and diabetes.
A spokesperson for the Centers for Medicare and Medicaid Services said in a statement that the agency is currently considering FDA approval to expand the use of Wegovy to reduce the risk of heart attacks and strokes.
A spokesperson for America’s Health Insurance Plans (AHIP), an insurance industry trade group, said more employers are considering covering weight loss drugs in the future.Group cited 2023 report It found that 41% of employers cover weight loss drugs.
“However, the exorbitant and unsustainable prices charged by manufacturers (more than $1,000 per month) and lack of competition continue to pose barriers to access,” the spokesperson said.
If it’s not covered by insurance, it’s over.
Dr. Drake Belanger, an obesity medicine specialist at the Louisiana Obesity Center in Baton Rouge, worries about losing patients to the drug’s price.
“We find that the no-show rate is quite high,” he said. “Patients are slow to show up. And those patients typically look back at their medical records and find that these medications have been denied and they have had to take more of the older medications they may have been taking before. But it turns out they basically just gave up.”
West Virginia University’s Davison said the patients she sees have had lifelong weight problems and have tried other options.
“If insurance doesn’t cover it, that’s generally the end of the story,” she says. “That’s really, really unfortunate.”
