Vegovi works. But here’s what happens if you can’t afford to keep taking drugs.

From TikTok influencers talking about it to celebrities worrying about the “Ozempic face,” drugs like Wegovy and Ozempic are touted as weight loss miracles in a slimness-obsessed land.

But drugs are not intended for cosmetic weight loss. Ozempic is approved for diabetes, while Wegovy is for obese people who also have weight-related conditions, such as high blood pressure or high cholesterol, that put them at risk for heart disease. That’s millions of Americans.

And the data shows that the new class of drugs is far more effective than previous anti-obesity drugs. A landmark clinical study published in New England Journal of Medicine in 2021 found that the drug leads to a decrease in body weight by an average of 15%.

Demand has grown so much that the drug’s active ingredient, semaglutide, is listed as “currently in short supply” in the FDA’s database. Its manufacturer, Novo Nordisk, says maintaining supply stability is a priority. The company also markets Ozempic for diabetes, which is a lower dose of semaglutide.

But at a cost of about $1,400 a month—out of pocket when insurance doesn’t cover it—many people can’t afford to take medication for long periods of time. And when people stop taking it, there is often a dramatic weight gain that is difficult to control. In fact, the study found that most people gain most of their weight within a year of stopping the medication.

This is what is happening with Yolanda Hamilton of South Holland, Illinois. Hamilton’s doctor prescribed Vegovi because she had an elevated BMI, high blood pressure, and high blood sugar. She lost 60 pounds and began to feel much better.

“It gave me more energy,” she says, allowing her to exercise and do household chores. Her cravings for sweets decreased and she felt satisfied with small meals. “I was very surprised at how good I felt,” says Hamilton. The drug is administered once a week at home, which Hamilton says is easy to do.

Her Aetna plan covered the drug, but when she changed jobs last fall, her new plan through Blue Cross and Blue Shield of Illinois denied coverage. She now works in a hospital registering patients, which requires her to be seated most of the day. And after a few months off the drug, she again gained 20 pounds.

“I am very upset that the weight is coming back in such a short time,” says Hamilton.

Blue Cross and Blue Shield of Illinois told NPR that benefits offered by employer plans may vary. “Slimming medications such as Wegovy may be covered depending on the member’s insurance plan,” a company spokesperson said. Many other insurance companies also determine coverage based on what employers are willing to cover.

Barriers to life-changing drugs

The weight gain is not a surprise given how the drug works. The active ingredient in Wegovy, semaglutide, is GLP-1, or glucagon-like peptide-1, which mimics the satiety hormone GLP-1 in our body. When we eat, GLP-1 is released from our intestines and sends signals to the centers in our brain that control appetite.

“This hormone tells your brain: I am full, I don’t need to eat anymore,” explains Dr. Robert Kushner of Northwestern University, who treats Yolanda Hamilton. Kushner also serves on Novo Nordisk’s medical advisory board, for which he receives royalties.

“What the pharmaceutical companies have done is take this natural hormone and turn it into a drug,” he explains. So it’s not surprising that when people stop taking the medicine, they start to feel hungrier, he says.

“I crave sweets,” says Hamilton. And her appetite increased. She no longer feels satisfied in small portions. “I lose energy” when the weight comes back, she says.

Kushner’s office is helping Hamilton appeal her insurance denial, but while she waits, she worries that stopping her medication will also affect her blood pressure and blood sugar. “She is at risk of worsening these conditions as she gains weight,” says Kushner.

“If I gain more weight, I will have to take more medication,” says Hamilton. Given her long struggle with weight loss, she finally found what worked.

“We’re seeing a lot of patients experience dramatic weight gain, and it can really be devastating,” says Dr. Carla Robinson, a Charlotte, North Carolina family physician and medical editor for GoodRx, a company that helps people. find the lowest prices for generics and branded drugs. There is no generally accepted version of semaglutide.

“Unfortunately, because this is a new drug, it’s one of those that varies by manufacturer,” says Robinson.

A Novo Nordisk spokesperson notes that the company is offering Wegovy a $500 coupon to lower costs for patients who pay in cash.

But this graph from GoodRX shows that the lowest price of all retailers is $1,304 per month for out-of-pocket people, which is out of reach for most people — even with a coupon.

“I feel like Wegovy is revolutionary,” says Hamilton. But she says she definitely can’t afford to pay for it.

“Some of the people who need it most don’t have access to them,” Robinson says, pointing out that low-income people are disproportionately obese.

“We are talking about a huge health equity issue,” she says. Blacks and Hispanics have higher rates of obesity, according to the CDC.

Since Wegovy was approved by the FDA in 2021, some insurance plans have begun to cover drugs for people who meet clinical prescribing guidelines. According to the FDA, people are eligible if they have a BMI of 27 or higher and also have at least one “weight-related disease” such as hypertension, diabetes, or high cholesterol. Or they have a BMI of 30 or higher, regardless of weight-related illnesses.

But insurance coverage is very uneven. Medicare does not cover Wegovy or other weight loss drugs, and many insurance companies are following Medicare’s lead. Increasingly, there is pressure to change this. As STAT reported last week, the Moffitt Cancer Center in Florida is lobbying for legislation that would allow Medicare to pay for obesity drugs, citing a link between obesity and cancer risk. The NAACP is also registered to lobby for this issue.

In addition, the American Academy of Pediatrics has published new guidance recommending that pediatricians offer weight loss drugs to obese adolescents 12 years of age and older as an adjunct to behavior modification and lifestyle interventions.

Long term unknowns

But the fact that people may need to take Wegovy indefinitely to maintain weight loss raises concerns about long-term use. The most common side effects of the drug are gastrointestinal symptoms. “Nausea, diarrhea, constipation, vomiting in some people, or heartburn,” says Kushner.

He says that by starting at a low dose and increasing it over time, people may be able to better tolerate the drug. Studies are ongoing to evaluate the effect of the drug on the cardiovascular system, which is still positive.

But the drug does have a black box warning because it has caused thyroid tumors in rodent studies. So, Kushner says doctors need to evaluate patients to see if they have a family history of a certain type of thyroid carcinoma or another rare condition called multiple endocrine neoplasia syndrome type 2 (MEN 2). “It will be an individual patient conversation,” says Kushner. Generally, if you don’t have a history of these conditions, “this medication is considered safe,” he says.

If this sounds alarming, it’s a reminder of just how high the stakes are in the fight against obesity. The theoretical risk of thyroid tumors can be worrisome. But doctors point to the risks associated with untreated obesity: cardiovascular disease is the leading cause of death in the US, and obesity and weight-related conditions are top risk factors.

Of course, exercise and diet modification are still the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of U.S. adults have hypertension, and more than 1 in 3 have prediabetes, groups of doctors note an urgent need for more interventions that could be helpful.

“We as a society spend $173 billion on obesity-related medical costs,” says Dr. Markus Schabacker, CEO of ECRI, an independent non-profit group that reviewed data on new weight loss drugs.

He argues that drugs can be part of the destigmatization of obesity, treating it just like any other disease you treat with drugs. “We wouldn’t ask a person with hypertension just to exercise and change their diet and you’ll be fine. No, we give them beta blockers. medications that have proven to be effective,” he says.

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