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Tag: Weight loss

  • Daily GLP-1 pill could work as well as Ozempic

    Daily GLP-1 pill could work as well as Ozempic

    Rebecca Robbins and Gina Kolata report for the New York Times that a new pill to be taken each day could do as much to lower blood sugar and help with weight loss as Ozempic and Mounjaro, injectable weight-loss medicines. The FDA has not yet approved the pill for sale and is not likely to do so before next year. 

    What’s the value of Eli Lilly’s orforglipron pill?  The pill conceivably could be cheaper than the current GLP-1 drugs because it costs less to manufacture a pill than an injectable drug. And, unlike an injectable, the pill does not need to be refrigerated or injected. The market for a GLP-1 pill is significant because many people do not want to inject themselves.

    Lilly reports that, in a clinical trial, two-thirds of the 559 people who took the pill saw their blood sugar levels fall to the normal range. Lilly further reports that people who took the highest pill dose lost an average of 16 pounds. 

    But, it’s not yet clear whether the clinical trial data supports Lilly’s claims about the efficacy of its new pill. Side effects, such as diarrhea and nausea could be worse than claimed, and benefits could be smaller than claimed. Independent experts are not expected to analyze Lily’s data until June.

    Axios reports that Lilly’s Zepbound, an injectable GLP-1 drug, delivered a greater amount of weight loss over 18 weeks for people without diabetes than people who took the pill. People had between  15.3 percent and  36.2 percent weight loss,, according to the data.

    Today, one in eight Americans have taken a GLP-1. But, about four in ten Americans are obese. So, there’s a huge market for GLP-1 drugs. 

    N.B.: Medicare currently only covers weight-loss medicines for people with diabetes and heart disease. It does not cover these medicines for people who simply want to lose weight.

    Here’s more from Just Care:

  • Proposed Medicare Advantage rule aims to limit bad insurer behavior

    Proposed Medicare Advantage rule aims to limit bad insurer behavior

    Last week, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, proposed a new rule intended to limit some of the many insurance company bad acts, reports Rebecca Pifer for HealthcareDive. Unfortunately, Medicare Advantage plans all too frequently inappropriately delay and deny people’s care notwithstanding CMS rules. To protect MA enrollees, the government should penalize insurers who violate their obligations severely enough to deter bad acts; without strict penalties, more rules are unlikely to be of much help.

    The CMS proposed rule strives to address five of the biggest concerns with Medicare Advantage. The Trump administration will have the power to decide which, if any, of these proposals will be finalized.

    • Insurers’ use of artificial intelligence to deny care without consideration of patient needs. The rule is designed to make transparent to MA enrollees their insurers’ coverage policies. Insurers sometimes use artificial intelligence to engage in across-the-board denials of care, even when care is urgently needed. The  MA insurers use AI particularly to deny care for people with costly and complex conditions, such as people with cancer and people needing rehabilitation services. New CMS data reveals that more than 80 percent of denials are overturned on appeal, but only four percent of people appeal. The proposed rule also would require insurers to notify enrollees about their appeal rights.
    • Insurers’ publication of inaccurate provider directories that misrepresent which physicians and hospitals are in network. The rule strives to ensure that the provider directories do not mislead enrollees as they are wont to do.
    • Insurers’ misleading marketing. The rule strives to protect enrollees from misleading marketing.
    • Insurers’ coverage of supplemental benefits. The rule aims to ensure that enrollees are fully aware of these benefits and their limitations.
    • Insurers’ reporting of how much money they spend on patient care rather than administration and profits. Insurers are legally required to spend at least 85 percent of the money they are paid to cover enrollees on patient care. But, many appear to find ways to spend a lot less.

    In addition, if finalized, the proposed rule would for the first time require Medicare to cover weight-loss drugs for people who are obese, even if they don’t have other health conditions.

    Here’s more from Just Care:

  • Stay healthy: Eat more nuts

    Stay healthy: Eat more nuts

    Nuts are a wonderful source of vitamins and minerals. They also offer other health benefits, reports Daryl Austin for National Geographic.

    Nuts help make strong bones. Some experts claim that nuts also reduce your risk of cancer. And, eating nuts can reduce your risk of diabetes because nuts help manage your blood sugar.

    There’s also evidence that eating just one ounce of nuts each day reduces your risk of heart disease by 21 percent. Nuts can lower blood pressure, sharpen your mind, lower your cholesterol and help you live longer.

    More good news—Even though nuts are high in calories, so long as you don’t eat large quantities, they should not lead you to gain weight . They could even help you lose weight.

    How can nuts lead to weight loss? Nuts contain a lot of fat, protein and fiber, which can sate you, so you don’t feel hungry. And walnuts and almonds don’t have as many calories as you think. Some of their calories leave your body in stool.

    Which nuts are best to eat? All nuts are different. Almonds are very good for you because they have a lot of fiber, calcium, phosphorus and vitamin E; they also help to reduce your bad cholesterol.  Pistachios also offer a lot of health benefits, including vitamin B6 and B1, all nine amino acids, potassium and lutein, which help with brain function and stave off cognitive decline. Of note, they are not as caloric as other nuts.

    Brazil nuts, peanuts and walnuts are also especially good for you. Walnuts are good for improving heart health and brain health and providing omega-3 fatty acids.

    Go for the mixed nuts for a wide range of health benefits!

    Here’s more from Just Care:

  • Are weight-loss drugs cost effective?

    Are weight-loss drugs cost effective?

    Millions of Americans now take weight-loss drugs, some as a treatment for diabetes but, increasingly, simply to lose weight.  A new study funded by the Blue Cross Blue Shield Association suggests that these drugs might not be cost effective, reports Joshua Cohen for Forbes. Nearly six in ten people stop taking them before they lose significant weight.

    People who take weight-loss drugs—GLP1s—can improve their health, particularly if they eat well and exercise. The drugs can help reduce the risk of heart attacks. They can also help people with chronic kidney disease and non-alcoholic fatty liver disease.

    Some believe GLP1s also can benefit people with sleep apnea and people with joint issues. As of now, Medicare only covers these drugs for people with diabetes and a small group of overweight people at risk for serious heart events.

    To be effective, people must continue to take these drugs, if not for the rest of their lives, for a prolonged period. People who go off them before they have shown clinical benefit tend to regain the weight they lost.

    People with diabetes are less likely to stop taking these medicines, Still, 58 percent of people who start taking them stop before they’ve experienced any real benefit. And three in ten people don’t renew their prescriptions after taking them for just one month.

    Only 32 percent of people who start on a weight-loss drug appear to continue taking them after a year. About one in three working people do not have health insurance coverage for these drugs if they don’t have diabetes. These drugs cost so much that businesses who cover them will drive up insurance costs significantly.

    So, insurers don’t cover these drugs because of their cost, which is insanely high. Moreover, most people don’t continue on them long enough to benefit their health. And, their benefits for those who stay on them appear to be marginal.

    Even people who take weight-loss drugs on an ongoing basis appear to lower their risk of heart failure by just 1.5 percent, according to one recent study. Put differently, one in 67 people on these drugs avoid a serious heart event and virtually none avoid death any more so than people who don’t take these drugs.

    Bottom line, it’s still too early to make a compelling case that insurers should cover weight-loss drugs for people who are not diabetics. At least for now, the data suggest that the costs might outweigh the benefits.

    Here’s more from Just Care:

  • Diet soda: Bad for your health and your weight

    Diet soda: Bad for your health and your weight

    According to the experts, diet soda is bad for your health and your weight, Peri Ormont Blumberg reports for Time Magazine. Notwithstanding, many Americans live on diet sodas. By so doing, they often mistakenly think they are keeping their weight down and promoting good health.

    According to recent research, however, diet drinks lead to all kinds of diseases, including cancer, mood disorders, fatty liver development and diabetes. There’s only observational studies to support these findings, which means the researchers can’t link cause and effect for sure. But, there’s mountains of long-term studies showing a correlation between drinking diet soda and poor health outcomes.

    • Type 2 diabetes strongly linked to consumption of diet soda: Many researchers find this connection. Here’s a recent study of 106,000 people.
    • Diet soda strongly linked to obesity. This meta-analysis of 11 studies found a significant association between artificially sweetened soda consumption and obesity.
    • Diet soda linked to heart conditions: People who drink more than two quarts of diet soda a week have a 20 percent higher likelihood of poor heart health, including heart attacks, heart disease and stroke. Here’s a recent study.
    • Diet soda linked to cancer. Here’s a meta-analysis. Other research has found potential links from diet soda to cancers including colon, uterine, kidney, and pancreatic, though it’s not clear whether obesity or diet soda is causing the cancer.

    No one can pinpoint why the link between diet soda and poor heart health. It could be most pronounced in people who don’t exercise, smoke, drink alcohol, and otherwise don’t take care of themselves.

    Diet soda is linked to cancer: The World Health Organization believes that aspartame, a key ingredient in some diet sodas, could be  carcinogenic. Some research has shown links between diet soda and colon, pancreatic, and kidney cancer. But, the World Health Organization somehow also found that it’s safe for people who weigh around 150 pounds to drink eight cans of diet soda with aspartame a day!!!! You wonder whether it is being sincere or is worried about a lawsuit from the diet soda manufacturers.

    Diet soda is linked to weight gain: Some researchers suggest that, because diet soda tends to be sweeter than sugar, it could change the way people experience tastes. As a result, it could make people feel hungrier, causing them to consume more calories and to gain weight. People should not think that drinking diet soda helps with weight loss.

    Should you drink diet soda? No. It is far better to drink water than diet soda. And, if you need your soda to be sweet, drink soda water with a bit of honey or juice in it. That said, some researchers believe that if you must drink prepackaged soda, diet soda could be preferable to sugary soda and alcohol for your health and your teeth. We know how harmful sugar can be; but, for some reason, we are not as clear about the harms of artificial sweeteners.

    Tricks to limit your diet soda intake:

    • Take a sip and pour the rest down the drain.
    • Think of it like candy, not like an alternative to water when you sit down to a meal.
    • Drink seltzer water with some fruit juice or honey added.

    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.

    Here’s more from Just Care:

  • Could weight-loss drugs ultimately reduce health care spending?

    Could weight-loss drugs ultimately reduce health care spending?

    Bruce Japsen reports for Forbes that weight-loss drugs are costing employers $324 per worker each year. These costs will only increase as more workers take these prescription drugs, if the government does not step in to rein in drug prices. They will also drive up Medicare costs a lot if Medicare decides to cover drugs for weight loss. (Medicare covers weight-loss drugs for people with diabetes.) Ideally, weight-loss drugs will reduce the prevalence of diabetes, heart disease and other costly conditions, driving down overall health care spending.

    Right now, Wegovy, Rybelsus and Saxenda as well as Ozempic are responsible for ever higher insurance premiums, deductibles and copays. Their costs likely will keep going up, as more people take them and their manufacturers raise prices. When will our government step in to negotiate prescription drug prices for everyone or, at the very least, open our borders to prescription drugs from verified pharmacies abroad, which are significantly cheaper than in the US and have been shown to be safe.

    In 2021, weight-loss drugs contributed to $96 of insurance costs for each worker. In two years, health insurance costs for these weight-loss drugs are projected to rise to $500 per worker.

    Competition from new weight-loss drugs should contain costs some. And, indeed, Gina Kolata reports for the New York Times that more weight-loss drugs are coming to market. Eli Lilly’s Zepbound, tirzepatide, is the latest to receive FDA approval. But, even if these drugs bring down prices a little, these new drugs are sure to drive up demand. Obesity is rampant in the US, affecting 100 million adults.

    Time will tell the extent to which these new weight-loss drugs affect the overall cost of health care in the US. Zepbound’s initial list price for a four-week dose is $1,060, somewhat less than the price of Wegovy, which is $1,349. But, these drugs are expected to drive down people’s weight by as much as 20 percent, helping to reduce their risk of diabetes, heart disease and other chronic conditions people develop as a result of being overweight. We can only hope that the cost of these drugs will be offset by savings from a reduction in the prevalence of some costly chronic conditions.

    Here’s more from Just Care:

  • The cost of weight-loss drugs is driving up our insurance premiums

    The cost of weight-loss drugs is driving up our insurance premiums

    Gina Kolata reports for The New York Times that the cost of weight-loss drugs is not what it seems. People must take them throughout their lives, and weight-loss drugs have list prices of as much as $1,300 every four weeks. Ozempic, Wegovy and drugs like them could literally mean a huge increase in people’s health insurance premiums.

    One epidemiologist projects that if prices for these weight-loss drugs are not controlled, they could increase health care spending by 50 percent! What’s interesting is that it is not only the drug manufacturers that are raking in the profits from these drugs. The health insurance companies and pharmacy benefit managers are profiting wildly from them as well.

    The weight-loss drug manufacturers pump up the list price of the drug so that they can then give a major rebate to the pharmacy benefit managers and insurers as a financial incentive to promote and cover them. The insurers and PBMs pocket these rebates or most of the rebates rather than pass them along to consumers.

    Net prices for the weight-loss drugs are, according to the conservative American Enterprise Institute, AEI, much less than the list prices. The AEI believes that the net price for Ozempic is just $300, $650 less than its list price. Similarly, AEI believes the net price for Wegovy is $700 or $650 less than its list price.

    The weight-loss drugs are unaffordable to many Americans because they cannot afford the copays even with insurance, they have no health insurance, or their insurance does not cover them. Medicare does not cover weight-loss drugs for weight-loss. However, it does cover the drugs for people with diabetes. Medicaid rarely covers the drugs.

    Novo Nordisk, a Danish company, expects to generate $11 billion in revenue this year from Ozempic and another $4 billion from Wegovy. Some might argue that the price for these drugs is fair because treating obesity, with its risk of diabetes, kidney failure, heart attacks and strokes, can be very expensive. No other wealthy country pays prices anywhere near as high as Americans.

    Here’s more from Just Care:

  • Poll shows that weight-loss drugs are extremely popular among adults in US, at least in theory

    Poll shows that weight-loss drugs are extremely popular among adults in US, at least in theory

    A new Kaiser Family Foundation (KFF) poll shows that about half the US adult population is receptive to the idea of taking “a safe and effective prescription weight loss drug.” It’s not surprising; so many adults are trying to lose weight, But, the most effective drugs now on the market are extremely costly, and Medicare, as well as many corporate health insurers, will not cover them for weight loss.

    Though a large portion of Americans are overweight, only a very small portion of them have taken a drug to help lose weight as of now. The drugs are expensive. They often are not covered by insurance and require injections, They might need to be taken for the rest of your life to keep weight off. And, they are not FDA-approved for weight loss.

    The KFF poll finds that once people learn that the weight-loss drugs currently available are administered through regular injections, many fewer are interested in taking them.  The percentage of people interested in taking one of these drugs also drops if their insurance does not cover them and if the Food and Drug Administration does not approve them for weight loss. Interest also declines when people learn that weight-loss drugs must be taken in perpetuity if people want to avoid regaining weight.

    Increasingly, insurers are finding ways not to cover these drugs for weight loss. They can cost as much as $28,000 a year. So, these drugs could drive up people’s insurance premiums significantly if covered for everyone wanting to lose weight. Insurers tend to cover these drugs for people with disabilities.

    To contain spending, some insurers are not approving these new weight-loss drugs unless people take less costly drugs first. Some insurers are requiring prior authorization and asking for people’s diagnosis and body mass index.

    If insurers expand their coverage of weight-loss drugs, insurance premiums for everyone are sure to go up. But, a large portion of the population does not seem to care, according to the Kaiser Family Foundation poll.

    NB: If you’re thinking about losing weight, read this. Being mildly overweight in older age has its benefits!

    Here’s more from Just Care: