Some of the wealthiest companies in the United States are health insurers. Their CEOs and higher executives often make tens of millions of dollars a year and have “golden parachutes” when they leave. For doctors and patients, it is an entirely different story. From the patient standpoint, their health insurance company is NOT on their “favorite people” list: Denial of services, delayed payments, protracted waiting times on the phone trying to get help: Frustration after frustration. From the physician vantage point, every bit as much frustration: fighting them for approvals for needed procedures/tests for their patients, fighting delayed/reduced claims’ payments, etc etc.
However, the government does have the right to monitor these companies and implement laws that sort of force those companies into taking actions that ultimately will help people. Here is something new that will be enforced on the insurance companies soon: Having to pay for one (or several) of the new GLP agonists to help overweight/obese people lose weight.
Ozempic and Mounjaro were FDA-approved for diabetes treatment but weight loss was noted to be am interesting “side effects”. Those medications slow the transit time of food from the stomach into the small intestines after a meal, thereby keeping the stomach dilated longer after a meal. This, in turn, leads to chemical signals that make a person feel “full” for longer periods of time.
Many doctors (including me) started writing these medications for weight loss but most of the insurance companies would deny paying for these, stating that “the person needs to have diabetes” to be eligible. Out of pocket with no insurance coverage, patients would be facing a $1000 a month cost unless they opted for a compounded version.
A study was just released covering almost 18000 patients without diabetes that Wegovy (same GLP-1 agonist under a different name than Ozempic) produced a marked decrease in heart attacks in overweight/obese people taking this medication for weight control. The roughly 17,500-person Select study tested Wegovy in people with obesity and heart disease but who did not have diabetes. Weekly injections of Wegovy slashed the overall risk of heart attack, stroke and death from cardiovascular causes by 20%, according to detailed results from the trial presented Saturday at the American Heart Association Scientific Sessions and simultaneously published in the New England Journal of Medicine.
Now, 17,500 people is not a small study. With this powerful data, how can it be possible that insurers will be allowed to continue to deny covering this medication for their overweight/obese patients?
Well, this will not happen immediately as the longer they fight and delay forced implementation, the longer they keep your premiums in their pockets. BUT, I definitely see this happening at some point pretty soon. A caveat: There is no “Magic” weight loss medication/shot or pill. We all must commit to behavioral changes.
Here is a very funny video I found about the GLPs…Enjoy!
