Weight Loss With Wegovy or Ozempic: Insurance Frustrates Patients

When people with obesity can’t lose weight, suffering a host of health consequences as a result, a new generation of drugs can help, obesity experts say.

Wegovy is a treatment for chronic weight management that patients inject under their skin once a week. In studies, those who took the drug for 16 months lost an average of 12% of their body weight compared to those who received a placebo.

It’s in a class of drugs called GLP-1 receptor agonists and works by mimicking a natural hormone the body releases when a person eats food.

This hormone, called glucagon-like peptide-1, targets areas of the brain that regulate appetite and food intake. Researchers believe its action in the brain helps people feel satiated earlier, so they eat less than they usually would.

But one year after the U.S. Food and Drug Administration approved Wegovy, there have been a couple of snags.

“Unprecedented” demand for the anti-obesity therapy and issues at the manufacturing site have led to a shortage of the drug, said Novo Nordisk, the pharmaceutical giant that makes Wegovy. The company has asked doctors not to start new patients on the treatment for now.

But even when that issue clears up, many patients who want to take Wegovy will find it out of reach financially because health insurance often doesn’t cover anti-obesity drugs.

Wegovy has a list price of $1,349 per package, which contains four injector pens. Each pen contains a single dose of the drug, which should be injected once a week, according to the prescribing information, so the package lasts a month.

‘Obesity is not a choice’

Adriana Kelly, a 25-year-old social worker, knows all about the dilemma. She considered Wegovy her last option before resorting to bariatric surgery. Standing 5 feet, 2 inches tall, her weight reached 280 pounds last year. Kelly loves to dance, but her heavy frame put a painful strain on her knees and back, leading to injuries.

“I just kept gaining weight. I couldn’t lose it no matter what I did. I could eat salads for months, still couldn’t lose it,” Kelly, who lives in Branford, Connecticut, told TODAY. “It was a constant struggle.”

So her physician, Dr. Ania Jastreboff, prescribed Wegovy. But Kelly said her health insurance refused to cover it — a scenario that Jastreboff sees over and over again, to her frustration.

“Unfortunately, many insurance companies do not cover anti-obesity medications and that is extremely difficult for our patients. It’s extremely difficult for us. It’s a barrier that we really have to work to overcome,” said Jastreboff, director of weight management and obesity prevention at the Yale Stress Center in New Haven, Connecticut. She serves on the scientific advisory board for Novo Nordisk.

“Obesity is not a choice. It is a disease. There’s clear physiology that that leads to obesity, (but) there’s a bias that it’s not treated as a disease.”

TODAY contacted five of the country’s biggest health insurance companies and America’s Health Insurance Plans, the industry’s trade association, about coverage of Wegovy and other anti-obesity medications. Only one commented: Health Care Service Corporation said the medication is eligible for coverage under its pharmacy benefits, depending on a member’s plan.

Dr. Beverly Tchang, an endocrinologist and obesity medicine physician at NewYork-Presbyterian/Weill Cornell Medicine, said she has seen “a tremendous amount of interest” in the drug from patients and “pretty good” insurance coverage of it.

Insurance companies that refuse to cover the drug usually still believe obesity is a cosmetic problem, she noted.

“Some are still kind of in the Dark Ages in thinking that everyone should just do lifestyle, diet and exercise and think that’s going to work. We know from many, many long term studies that does not work and it’s not sustainable,” Tchang said.

“Most of the world recognizes now that (obesity) truly is a health issue — a medical problem.”

Obesity, which affects 42% of U.S. adults, results from the dysregulation of how much fat our body wants to carry — a setpoint determined by our brain, Jastreboff noted. The goal of anti-obesity medications is to reset that setpoint so that the body wants to carry less weight, specifically less fat.

When doctors can treat obesity, they can also treat or prevent many other weight-related conditions, including high blood pressure, diabetes and heart disease, she said. There are 13 types of cancer shown to be related to obesity, she added: “Our patients have suffered enough.”

Doctors turn to off-label use

Still, doctors like Jastreboff have used a unique workaround when it comes to Wegovy, the brand name for semaglutide. It’s the same molecule as Ozempic — a type 2 diabetes treatment also made by Novo Nordisk. The injector pens are slightly different and come in different doses, but the medication inside is identical.

If semaglutide in the…