- Experts are pushing healthcare providers to consider how new drugs for weight loss can be made more available for anyone who needs it.
- Weight loss drugs, known as GLP-1 drugs, are injectables that have been approved by the FDA and include famous brands such as Ozempic and Wegovy.
- These drugs can be difficult to get as they are in short supply and expensive if not covered by insurance.
Now experts are pushing healthcare providers to consider how new drugs for weight loss can be made more available for anyone who needs it.
In an editorial published in
Obesity in the U.S. has been rising for decades, but not all demographic groups are affected equally.
According to a 2018 study published in
Approximately 50% of non-Hispanic Black, 46% of Hispanic adults, and 41% of non-Hispanic white adults have obesity, according to the
While effective weightloss drugs have become available in recent years, the drug costs for some of these weight loss pills can cost around $1,000 per month if they are not covered by insurance.
This among other obstacles means that not everyone who qualifies for these medications has access to them.
Some are for diabetes and others are for obesity and weight loss.
Both Ozempic and Wegovy the same active ingredient — semaglutide.
“They all work for weight tools, but at different potencies. Some are for diabetes and some are for obesity,” said Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital.
One reason that the drugs have been difficult for patients to access to access is due to supply and demand. In 2023, there was a surge in the number of prescriptions for Wegovy and Ozempic.
“There are two main barriers to these weight loss medications — the supply chain and cost,” said Sarah McBane, PharmD, Associate Dean of Pharmacy Education, UC Irvine Department of Clinical Pharmacy Practice. “The demand for Wegovy, and later on Ozempic, was not really anticipated by the manufacturer, which led to some of the shortages we heard about in early 2023. This seems to be resolving [however] the cost of these medications remains a substantial barrier for many people, and insurance coverage of these medications may vary.”
Another reason a person may be unable to get the drug is related to whether or not insurance will cover the cost of the drug.
An ‘appropriate candidate’ refers to someone who meets the FDA criteria for these drugs. Both sets of drugs, whether used for diabetes or obesity, work for weight loss, but the
After the pandemic, however, the number of prescriptions for weight loss drugs went up, including among people who may not be FDA-qualified for the prescription. This means it may not be covered by insurance
Healthcare providers are at the mercy of the supply chain and have very little control over the cost of medications.
“If it were up to me, everyone who is an appropriate candidate for something like semaglutide would have access. But I’m against pharmacy benefit managers, insurance companies, and people paying out of pocket. I feel pretty powerless ensuring those who are appropriate candidates have access to the medication,” said Sood.
Sood said may people who gained a moderate amount of weight during the pandemic may be interested in these drugs but will not qualify to have them covered by insurance.
“A very common scenario is someone with a BMI of 21 who gained 20 pounds in the pandemic, and now their BMI is 24 or 25 and they don’t like what they weigh,” said Sood. “They are seeking these medications. I don’t blame them because after two years of being at a higher weight, their hormones have changed to keep them there. They do great on these medications, but technically they don’t meet the criteria.”
Sood said the shortage of the drugs also puts pressure on healthcare providers to ensure that only people who meet FDA criteria get access to the drug for now.
“The one small onus on prescribers is to prioritize prescribing people who meet the FDA criteria first and foremost, and to try to be moderate in use in people who do not meet the criteria so that we can contribute to managing the overall supply. We are at the mercy of pricing and insurance coverage, as well as supply coverage and manufacturing issues,” said Sood.
“Manufacturers have the ability to improve AOM (antiobesity medications) access and promote equity by reducing prices to ranges within common societal willingness-to-pay thresholds,” wrote the authors.
They go on to say that manufacturers also have a responsibility to ensure that there is enough of a supply, so as to match the demand.
Healthcare payers like Medicaid often opt to exclude weight loss drugs from their coverage. The editorial calls on policy changes to allow coverage of antiobesity medications.
“Private payers and Medicaid programs should consider patient-centered frameworks for AOM coverage and formulary placement decisions that account for downstream AOM benefits associated with the prevention of obesity-related comorbidities.”
Physicians and prescribers of the medication also have a responsibility to ensure treatment recommendations align with patient preferences and financial situations, according to the authors.
Physicians can use benefit tools that report out-of-pocket costs and insurance coverage restrictions for proposed treatments, and they can adapt their recommendations based on what patients can afford.
Finally, the editorial authors say that more clinical trials are needed to generate evidence on the long-term effects of anti-obesity medications on comorbidities and mortality outcomes.
Observational studies need to look at the long-term effects of anti-obesity medications, as well as evaluate the equity in anti-obesity medication use across race, ethnicity, and socioeconomic status. Research also has to be done on the cost effectiveness so as to inform payer coverage decisions.
The main takeaway from the editorial is that while newer anti-obesity medications, like Ozempic, are promising, it’s the disparity in access that creates the inequities in obesity across different demographics, and it’s the responsibility of decision-makers to correct that.
What can patients do who want access to these drugs, but are having difficulty? The first step is to discuss with your pharmacists or doctor to determine if these medications are the right choice, and if you are FDA-qualified.
“If cost is a significant barrier, people can visit the manufacturers’ websites to look for savings programs. In addition, some local areas might offer additional prescription assistance through charitable organizations,” said McBane.
Additionally, experts point out that these new drugs are not the only weight loss medications that can be considered.
“[People] should not underestimate the power of slow and consistent lifestyle change,” added Sood. “There are other medications for overweight and obesity that have been around for years that obesity specialists have been prescribing. Ozempic is not the first weight-loss medication. We’ve been prescribing others since at least 2008.”