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Many insurance companies do not cover the cost of newer weight loss medications. Getty Images
  • A new class of diabetes medication has proven effective in helping people quickly lose weight.
  • Many insurance plans don’t cover these drugs when used to treat obesity, making them prohibitively expensive.
  • Some people are forced to change their obesity treatment plans due to the cost.

It’s common knowledge that obesity is an ongoing public health issue in the United States, but you might find the magnitude of the problem surprising.

In an interview with Healthline, Dr. Atif Iqbal, FACS, FASMBS, board-certified general surgeon and medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, described the situation as “very unfortunate.”

“The United States is leading the entire world in obesity; we are number one. Obesity has continued to multiply and to multiply. It’s estimated that by 2035, 50% of the population of the United States will be obese. These are staggering numbers,” said Iqbal.

While obesity rates have been increasing for decades, recent years have introduced new challenges that we’re only beginning to grapple with.

“What really hit us hard was the last two-and-a-half years of pandemic. There was a significant increase in obesity on top of the already-high obesity rates because we were staying at home, ordering food, low physical activity, people lost their jobs. It’s increased the burden of the healthcare industry by trillions of dollars,” said Iqbal.

That may sound like an absurdly high dollar amount, but obesity is not an isolated condition. It can increase your risk for many other complications that require additional medical interventions and assistance.

“Obesity is the mother of all diseases. It leads to so many other health issues, including diabetes, high blood pressure, sleep apnea, high cholesterol, high lipids, back pain, acid reflux, heart disease, and even some cancers. You have to take obesity very seriously,” said Iqbal.

In order to control and reverse obesity, people have been turning to medication for a long time. In recent years, a new class of diabetes drug has been found to be exceptionally effective for promoting weight loss.

“We are still living in a very profound epidemic of obesity, but we do have a lot more treatment strategies today than we did even five years ago,” said Dr. Rutuja Patel, obesity medicine specialist at Northwestern Medicine Central DuPage Hospital near Chicago.

Patel shared with Healthline exactly how this new class of weight loss medication works.

“GLP-1 is a hormone secreted by our gut in response to food intake. It has multiple functions. One is to tell the brain that we’re full. It also makes food sit in the stomach longer, so it delays gastric emptying. And the third thing it does is help the insulin secretion—post-meals—be better,” explained Patel.

“This hormone effect is blunted in patients with obesity and diabetes. And when we treat them with a GLP-1 agonist like semaglutide, they tend to lose weight without having to struggle too much with hunger,” Patel added.

Semaglutide is the generic name for the obesity drug Wegovy. It’s also sold under the name Ozempic to treat diabetes.

“It’s the same medication but the dosages are slightly different for the diabetes drug versus the obesity medication,” said Patel.

A similar drug, tirzepatide, is currently used to treat diabetes under the name Mounjaro, but it’s expected to be reviewed by the FDA later this year for use as an obesity treatment.

“These are all once-a-week injections, regardless of whether they’re being used to treat obesity or diabetes,” said Patel.

With obesity at an all-time high and new, effective medications on the market, it seems at first like a natural pairing. But there’s a catch: insurance coverage.

“Coverage is getting better, but it’s not anywhere close to where it should be,” said Patel.

So, what’s the problem?

Many insurance policies are equipped to handle the treatment of severe diseases and immediate life-threatening conditions. But the prevention of severe disease, it seems, is an exception. Or — perhaps — an exclusion.

“Insurance plans sometimes have plan exclusions which completely exclude a certain benefit. They might say, ‘we’ll cover all of this person’s medical care, but we won’t cover obesity care.’ So, we are still discriminating against patients with obesity,” said Patel.

It’s not just private insurance plans that don’t cover these newer weight loss drugs, either.

“Obesity care is still a plan exclusion in quite a few commercial insurance plans. Medicare and Medicaid do not cover any weight loss drugs. Medicare’s plan is to eventually cover these drugs, but we don’t know how long that’s going to be,” said Patel.

This leads to some uncomfortable conversations at the doctor’s office.

“I’ve actually had these discussions with my patients when they’re close to Medicare. They may first walk in to see me at 63 or 64 years old, and they have commercial insurance, but they’re going to retire soon,” said Patel.

“I have a long discussion with them about not using these types of drugs if they can’t continue taking them long term. One or two years is not enough time to make those metabolic changes that we need to keep that weight off. Usually, we change our plan because of that,” she added.

Having to find an alternative treatment that’s different than your doctor’s recommended plan strictly due to the cost can be a tough pill to swallow. So how much do these medications cost, exactly?

“They are about $1,400 a month, depending on whether it’s tirzepatide or semaglutide — I think the cost difference is about a couple hundred. If you’re paying more than $1,000 per month and you have to take that drug forever, we’re not doing that out of pocket,” said Patel.

Some people can afford these drugs on their own without insurance, and some doctors also offer payment plans that can help a small percentage of others.

“We do tell patients the self-paid price — that’s set by the drug company, not us — and they can independently buy it. If they can’t afford it, there is an option of financing. But that’s totally up to the patient,” said Iqbal.

But for most people, that isn’t a realistic option.

There are other classes of medications that can be used to treat obesity, but they will likely be part of the same insurance exclusions that prevent coverage of semaglutide.

“We have cheaper medications — not in the semaglutide family — that can be taken by mouth. They are not as good Wegovy. They do provide some support for the patient mentally and help with some weight loss, but the efficacy is less,” said Iqbal.

That still leaves a system where those with more financial wealth are able to get better care than those who do not. But the medication, it seems, is only part of the solution for controlling obesity.

“Any type of weight loss attempt — medicine, surgery, dietary programs — these are all tools. It’s important to be involved. Be engaged in exercising and in lifestyle changes. Otherwise, you should expect to regain the weight after the medication is discontinued,” Iqbal explained.

Losing weight to get below the thresholds for obesity and overweight is good for your long-term health, but only for as long as you stay in that range. If the weight comes back, so do the risks.

“Your metabolism going back and forth, adjusting and recalibrating, has some negative effects, but overall, after weight is regained, you end up back again at your increased baseline risk for all these big health issues we discussed earlier,” said Iqbal.