Health insurance, new diabetic drugs and the future of weight loss

October 27, 2023

In the U.S., weight-loss drugs have received renewed attention thanks to recent medical advancements. Frequently, Ozempic, Wegovy and Mounjaro are included in this conversation—even though not all of them are marketed as weight-loss drugs.

For example, Ozempic notes on its about page that,  “While not for weight loss, Ozempic may help you lose some weight.” Ozempic (semaglutide), is prescribed as a drug for adults with Type 2 diabetes to improve blood sugar and cardiovascular health.

Mounjaro (tirzepatide) has similar marketing: “Mounjaro is an injectable prescription medicine that is used along with diet and exercise to improve blood sugar (glucose) in adults with Type 2 diabetes mellitus.” It too states that it is not a weight-loss drug.

On the other hand, Wegovy (also semaglutide) explicitly markets itself as weight-loss drug. On its website it states, “Wegovy is the first and only prescription weight-management medicine taken once weekly.”

Regardless of their intended usage, these drugs are purchased out-of-pocket to help facilitate weight loss. Currently, most insurers don’t cover drugs that are used for weight loss.

According to Scientific American, “Semaglutide has been shown to help people lose an average of about 15% of their weight … New findings suggest they also have the potential to lower the risk of heart disease and stroke.”

Scientific American continues, “Semaglutide imitates a hormone called glucagon-like peptide-1 (GLP-1), which prompts the body to produce more insulin and makes a person feel satiated.”

Weight-loss drugs and insurance

There are numerous barriers for these drugs receiving broader acceptance in the insurance marketplace.

Cost is a major factor. Scientific American cites a study from the New England Journal of Medicine that shows, “with modest uptake of the medications, the annual cost of brand-name semaglutide weight-loss drugs to Medicare could be $13.6 billion to $26.8 billion.”

“For reference,” Scientific American states, “Total annual spending for Medicare Part D, the program that helps beneficiaries pay for self-administered prescription drugs, is about $98 billion.”

There are legal barriers too. In 2003, Medicare banned coverage for weight-loss drugs due to safety concerns at the time over the combination of fenfluramine and phentermine, which—according to Scientific Journal—has been “associated with life-threatening hypertension and heart valve issues.”

Further, in older adults over 65, some side effects from semaglutide have been documented. These include “nausea, fatigue, lightheadedness, decreased muscle mass and, in rare cases, chronic paralysis of the digestive system.”

However, in conjunction with the weight-loss benefits, “related GLP-1 medications have been used to treat diabetes for nearly two decades, which has assuaged some physicians’ fears of large-scale safety issues.”

Next steps

Wegovy and these diabetic drugs used off-label have the potential to assist millions of Americans in achieving their weight-loss goals.

Their future in the American insurance industry is yet to be decided, but whatever comes of them will have massive ripple effects for those who use them.

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Matt McDonough is PIA Northeast's writer, editor and content curator. Matt joined PIA Northeast in September 2023. Before that, he had been an editor for the online entertainment magazine Collider from 2021-23 as a copy editor for its lists section. Matt entered the world of journalism at his alma mater, SUNY New Paltz, writing and reporting for the college's student run newspaper, The New Paltz Oracle. He graduated from SUNY New Paltz with a Bachelor of Arts in English and a minor in Creative Writing in 2020.

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