Novo-Nordisk, the maker of the medicine Dr. Apovian prescribed, and patient advocacy groups have been aggressively lobbying insurers to pay for weight-loss drugs. They also have been lobbying Congress to pass a bill that has languished through 3 administrations that would require Medicare to pay for the drugs.
But for now, the status quo has not budged.
…But even if a patient’s insurer will cover weight loss drugs, most doctors do not suggest the drugs and most patients do not ask for them, as they fail to realize there are good treatment options, said Dr. Scott Kahan, an obesity medicine specialist in Washington, D.C. And, he added, even if doctors and patients know there are F.D.A. approved drugs, many think they are “unsafe or not well studied and that everyone regains their weight.”…“The perception is, ‘If you are heavy, pull yourself up from your bootstraps and try harder’”, Dr. Kahan said.
…Novo Nordisk sells 2 weight loss drugs that are of the same class in 2 doses—liraglutide as Saxenda, and semaglutide at a higher and more effective dose as Wegovy. The list price—the suggested retail price—for both is about $1,350 a month. That means the same drug costs 51% more if it is used to treat obesity than if it is used for diabetes.
But as an obesity drug, it is hard to get. Not only do most US insurers decline to pay for Saxenda or Wegovy because they are weight-loss drugs, but Wegovy supplies are so limited that the company has asked doctors not to start new patients on it.
Eli Lilly has a similar and seemingly more powerful weight-loss drug, tirzepatide, which it hopes to get approved for people with obesity. It was recently approved to treat diabetes under the name Mounjaro. As a diabetes drug, its retail price is $974 a month.
Douglas Langa, an executive vice president at Novo Nordisk, said the Wegovy supply problem was caused by a manufacturing issue that should be resolved later this year. He also said that diabetes and obesity were “separate categories, separate marketplaces” to explain the difference in price between the companies’ 2 drugs that were based on the same medicine, semaglutide. He said Wegovy’s price “reflects efficacy and clinical value in this area of unmet need.”
Dr. Stanford was appalled. “It’s unbelievable”, she said, adding that it was a gross inequity to charge people more for the same drug because of their obesity. She finds herself in an untenable situation: getting excited when her patients with obesity also have diabetes because their insurers pay for the drug. Dr. Apovian says she too finds herself rejoicing when patients have high blood sugar levels—and that was what ultimately resolved Ms. Cohen’s problem. Her insurance company would cover Ozempic [semaglutide], but it would not cover Saxenda [liraglutide]. So she started taking Ozempic, with a $70 a month copay.
Ms. Cohen—who measured at 5 feet tall and weighed 192 pounds when she saw Dr. Apovian—had a dramatic response to Ozempic. She has lost 54 pounds and now weighs 138 pounds. Her waist size, which was 46 inches, is now 33 inches. She has more energy and her joints do not hurt. “It has absolutely changed my life”, Ms. Cohen said.