JustCare

Tag: Wegovy

  • Will the Trump administration support Medicare coverage of Ozempic?

    Will the Trump administration support Medicare coverage of Ozempic?

    Among his final acts as President of the United States, Joe Biden proposed Medicare coverage of Ozempic for obese individuals. It will be up to the Trump administration to decide whether to finalize this proposal or kill it. What would RFK Jr. do about Medicare coverage of Ozempic if he is confirmed as head of the US Department of Health and Human Services posits Jonathan Cohn for The Huffington Post?

    Cohn explains that Medicare coverage of Ozempic would be consequential for millions of people. It would deliver potentially significant benefits to them. At the same time, it could cost the Medicare program a tremendous amount of money.

    Ozempic is a glucagen-like peptide or GLP-1 agonist because it works just like a hormone in our bodies that reduces our blood sugar and desire to eat. GLP-1’s have delivered health benefits since the early 2000’s. They became popular when they could be taken once a week. They are also sometimes referred to as semaglutide.

    Semaglutide–marketed in some cases as Ozempic or Wegovy–treats diabetes, heart disease as well as weight loss. But, it is quite costly, with prices as high as $1,000 a month.

    Today, Medicare only covers semaglutide for people with diabetes and heart disease. By law Medicare covers medically reasonable and necessary treatments for health conditions, with a few exceptions, including weight-loss. The Biden administration is now arguing that when people are found to be obese, it threatens their health, and a semaglutide affords them medically reasonable and necessary treatment.

    If the Trump administration finalizes coverage of semaglutide, the price tag is projected to be around $40 billion over ten years. More than ten percent of the 65 million people with Medicare are obese. But, if the Trump administration does not repeal Biden’s Inflation Reduction Act, which allows for Medicare drug price negotiation, the federal government would have the power to pay a lower price for the drug beginning in 2027.

    RFK Jr. has said that he opposes coverage of semaglutide. He argues that obesity stems from malnutrition. We should be spending taxpayer dollars on healthy meals for Americans, not using it to boost Pharma profits.

    To be clear, the evidence shows that people are obese for a number of reasons, and many of those reasons have nothing to do with healthy eating.

    Here’s more from Just Care:

  • Are weight-loss drugs a modern-day miracle?

    Are weight-loss drugs a modern-day miracle?

    Pretty much everywhere I turn, there’s a new story about the benefits of weight-loss drugs beyond helping people lose weight. It’s still early days, and many weight-loss drugs are extremely expensive. But, if you believe the stories, weight-loss drugs can treat heart conditions, can reduce overall health care spending and, can even treat depression and dementia, reports Simar Bajaj for the New Scientist.

    For now, Medicare covers weight-loss drugs mainly for people with diabetes. They are super expensive, driving up insurance premiums considerably, and there’s a lot we still don’t know about them. Still, what’s coming out about their benefits seems nothing short of a miracle.

    Some former alcoholics and drug addicts appear to lose their desire for alcohol and drugs when they take a semaglutide, a weight-loss drug, such as Wegovy and Ozempic. Their depression and anxiety fade away. So, can their addiction.

    Today about six million Americans take a weight-loss drug or GLP-1 medicine. Before long, it is projected that five times that number–30 million–Americans will be on a semaglutide. These drugs enable people to drop between 15 to 20 percent of their body weight.

    Back in February, Epic, which keeps Americans’ medical records, determined that people who took a GLP-1 were considerably less likely to suffer from depression and anxiety than others.  An earlier study arrived at similar findings. 

    Time will tell before we know for sure whether weight-loss drugs deliver all these findings. For now, it seems that the findings make sense. People who are overweight are more prone to depression. If they lose weight after taking a GLP-1, it’s more than likely that it will benefit them mentally as well as physically. For most of us, it feels good to lose weight.

    Some scientists believe there’s more to the story. GLP-1s are produced in the brain as well as the gut. So when you take a GLP-1 drug, you could be benefiting your brain directly, improving cognitive functions and emotional control. Indeed, in a small study of people who did not lose weight from a GLP-1, the researchers still saw improvements to their moods, and they experienced fewer depressive symptoms.

    GLP-1s have been found to increase blood flow in the brain as well as to keep nerve cells from dying as quickly as they otherwise do. They bring more glucose to the brain. As a result, the brain can function better. For these reasons, in small studies, GLP-1s have also been found to be responsible for less brain shrinkage in people with Alzheimer’s and to slow the progression of the disease.

    Again, these are early days. The good news is that these weight-loss drugs seem to have myriad benefits. And, for now, they also appear to come with few risks. But, if we know anything, it’s that what’s good for your health today might be found to come with serious side effects tomorrow.

    Here’s more from Just Care:

  • Will FDA approval of Wegovy to treat heart conditions mean more people with Medicare can fill a weight-loss prescription?

    Will FDA approval of Wegovy to treat heart conditions mean more people with Medicare can fill a weight-loss prescription?

    The FDA recently approved Wegovy, a weight-loss drug, to treat overweight people with heart conditions. Will that mean that more people with Medicare will get their weight-loss drugs covered? Maya Goldman reports for Axios on what the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, as well as the insurers offering Medicare Part D prescription drug coverage, are considering.

    At the moment, CMS has not decided whether Medicare will cover Wegovy as a treatment for overweight people with heart conditions. To date, Medicare has not covered any weight-loss drugs simply for the purpose of helping people lose weight. But, Medicare does cover weight-loss drugs as a treatment for people with diabetes.

    Medicare, by law, covers only treatments for medically reasonable and necessary services. CMS does not consider treatment for weight loss as reasonable and necessary. Treatment for a heart condition, much like treatment for diabetes, is very different.

    About 40 percent of people with Medicare have heart conditions. That’s more than 24 million people. And, likely a sizeable number of them are overweight. So, Medicare might end up covering Wegovy for them.

    Of note: Wegovy costs about $1,200 a month. Covering it for even four million more people will likely cause Medicare spending to balloon. Fortunately, people with Medicare should not see their costs balloon. Beginning in 2025, people’s annual out-of-pocket costs for covered prescription drugs will be capped at $2,000.

    For now, insurers offering Medicare Part D prescription drug coverage are waiting for CMS to rule on the conditions under which Medicare will cover Wegovy. Part D insurers could, of course, decide to cover Wegovy without waiting for CMS, but that would cost them a bundle. Their Medicare payments for this year are already set.

    Here’s more from Just Care:

  • Weight-loss drugs are a hot commodity and hard to get

    Weight-loss drugs are a hot commodity and hard to get

    Weight loss drugs are a hot commodity. They can be hard to come by. Getting them can try your patience and your pocketbook. Reed Abelson and Rebecca Robbins offer six reasons why it is so hard for people to get weight-loss drugs in the New York Times.

    1. A lot of people want these drugs. Already nearly four million people are taking weight-loss drugs. Between TikTok and advertisements, more and more people are wanting to take weight-loss drugs.

    2. Production of these drugs is slow. Few factories can manufacture the latest weight-loss drugs. And, they come in five or more strengths. Eli Lilly also needs to make enough of its pens used to inject Zepbound.

    3. Insurance often won’t cover these drugs, making them unaffordable to most. Medicare will only cover these drugs for people with diabetes. It does not cover weight-loss drugs for obesity. However, Medicare covers nutrition and weight-loss counseling.

    Medicaid does not either. The insurers consider them “lifestyle” drugs, rather than medically necessary drugs. As. result about 40 percent of employers also do not offer this coverage to their workers.

    These are injectable drugs that can cost as much as $16,000 a year. With discounts or coupons from Eli Lilly, people can get Zepbound, one of the weight-loss drugs, for $550 a month, if they have insurance. They can get a coupon from Novo Nordisk for Wegovy, another weight-loss drug, and pay $1,000 a month instead of $1,500 a month.

    4. People can’t find these drugs at their pharmacies. While these drugs are often not in stock at pharmacies, they will order them when requested. The drugs cost too much money, literally tens of thousands of dollars for a pharmacy to stock.

    5. Pharmacies sometimes claim that these drugs provide them no profit. In fact, some say that they lose money on weight-loss drugs because the insurers do not reimburse them adequately for the drugs. The insurers’ pharmacy benefit managers or PBMs reimburse the pharmacies below cost in some cases. This seems like a way for the insurers to avoid covering weight-loss drugs.

    6. Most insurers create hurdles in order to cover weight-loss drugs. People need their doctors to verify they qualify for coverage. In some cases, before the insurer will cover these drugs, enrollees must take a six-month nutrition and exercise program. Some insurers require people to try other less expensive drugs before they will cover these drugs.

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