Biotech
Tuesday, October 17th, 2023 1:57 pm EDT
Key Points
- Increasing Off-Label Use for Weight Loss: Ozempic, Wegovy, and other drugs containing the active ingredient semaglutide, initially intended for treating diabetes, have gained popularity for off-label weight loss. Semaglutide has demonstrated the ability to help individuals lose an average of around 15 percent of their body weight.
- Issues of Equity and Affordability: The availability and cost of these drugs have raised significant questions about equity and affordability. Most private insurance providers and federal health programs, including Medicare, do not cover weight-loss drugs. The out-of-pocket cost for Ozempic, Wegovy, and similar medications can exceed $1,000 per month, limiting access to many.
- Potential Health Benefits and Clinical Trials: Recent clinical trial findings suggest that semaglutide may offer more than just weight loss; it may reduce the risk of heart disease and strokes. In August, Novo Nordisk announced these findings, prompting pressure on insurance providers to cover these drugs. A bipartisan group of lawmakers has also reintroduced a bill to allow Medicare coverage of weight-loss medications, although progress has been slow. The hope is that Medicare coverage could increase access to these drugs, primarily for older adults. However, concerns remain about how insurance providers may restrict access, leaving certain groups behind, and equity issues surrounding access to these medications for those who need them most.
This article discusses the increasing use of medications like Ozempic and Wegovy, originally developed to treat type 2 diabetes, for off-label purposes such as weight loss. These drugs contain the active ingredient semaglutide and have been shown to help people lose significant amounts of weight. New clinical trial findings indicate that semaglutide can also reduce the risk of heart disease and stroke. However, these drugs are expensive, with costs exceeding $1,000 per month, and most insurance providers, including Medicare, do not cover them.
The high prices and limited insurance coverage raise questions about equity and affordability. Many individuals express interest in using these drugs for weight loss but are deterred by the lack of insurance coverage. Efforts are underway to change this situation, with lawmakers introducing a bill to reauthorize Medicare coverage of weight-loss medications. Clinical trial findings may further influence insurance providers to cover these drugs, putting them within reach for many people who cannot otherwise afford them.
While these medications have shown promise for weight loss, they come with potential side effects, including nausea, fatigue, and digestive system paralysis, which can be more severe in older adults. Researchers are concerned about how these side effects may affect seniors who try the drugs.
The cost-effectiveness of covering these weight-loss drugs is a complex issue, as they can lead to long-term health benefits, such as a reduction in cardiovascular events. Critics argue that covering these expensive medications may divert funding away from other medical treatments. Equity concerns also arise, as these drugs could potentially be accessible mainly to wealthier individuals.
In addition, the article points out that racial and ethnic disparities exist in access to obesity treatment. Medicare coverage of these drugs could help reduce such disparities. However, the current pattern of access to these medications suggests that wealthy, predominantly white individuals are more likely to benefit, leaving others behind.
Supply constraints, particularly for Novo Nordisk’s drugs, raise concerns about equitable access. Shortages of these medications could further exacerbate the situation, making it essential to consider equity at every step, from diagnosis to treatment and prevention.
Overall, the availability and affordability of weight-loss medications like Ozempic and Wegovy present complex issues surrounding equity and healthcare access. Changes in insurance coverage and cost-control measures may influence the accessibility of these medications to a wider population.
For the full original article on CNBC, please click here: https://www.scientificamerican.com/article/should-insurance-cover-wegovy-ozempic-and-other-new-weight-loss-drugs/
