Patients Lack Consistent Coverage for Weight-Loss Drugs
Coverage Varies Depending on Who Pays the Bill
Paul Mack dropped about 70 pounds after he started taking Wegovy. The Redwood City, California, resident said food noise — constant thoughts of eating — faded, and he was able to have a heart procedure. The treatment was covered by California’s Medicaid program, Medi-Cal. Then the 50-year-old security guard got a raise. He no longer qualified for Medi-Cal and lost coverage of the drug for several months starting last summer. He regained two pants sizes. “I couldn’t control the eating,” he said. “All the noise came back.”
Cost and Uncertain Payoff Loom as Concerns Payer Concerns
Treatment prices that can top hundreds of dollars monthly even after discounts make it hard for many people to afford these drugs on their own. That can make the life-changing weight loss that patients seek dependent on the coverage they have and how long it lasts.
Patchy Coverage Complicates Treatment Plans
Dr. Amy Rothberg says the lack of consistent coverage leaves her conflicted about writing prescriptions because she’s not sure how long patients will be able to take the drug. “We know from the studies that people go off these medications, they regain their weight,” she said. “I don’t want to do harm.”
Uncertainty for Medicare Recipients
The lack of Medicare coverage remains a concern as well, especially for people who retire and move to the government-funded program from employer-sponsored coverage. “Patients come to us terrified about switching to Medicare and losing coverage,” said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and cofounder of the obesity treatment company FlyteHealth. “We start talking about backup plans a year before they transition.”
Will Coverage Ever Become Consistent?
There’s no clear path toward widespread coverage of these drugs for obesity, even as polls show Americans favor having Medicaid and Medicare cover the costs. Leaders at Zepbound maker Eli Lilly have seen coverage grow steadily for their drug, and they’re optimistic that will continue.
Additional Options in the Pipeline
Drugmakers are currently testing several additional obesity treatments. Such potential competition could reduce prices and prompt more coverage.
Conclusion
The lack of consistent coverage for weight-loss drugs, such as Wegovy and Zepbound, can make it difficult for patients to access these life-changing treatments. As the demand for these drugs continues to grow, it is essential to address the patchy coverage and uncertainty surrounding their availability.
FAQs
* What is the current state of coverage for weight-loss drugs?
+ Coverage varies depending on who pays the bill, with some employers and insurers covering the drugs while others do not.
* Why is there a lack of consistency in coverage?
+ The lack of consistency in coverage is due to the patchy coverage of these drugs, with some employers and insurers covering the drugs while others do not.
* What are the challenges for patients with weight-loss drug coverage?
+ Patients who have weight-loss drug coverage may face challenges in maintaining their coverage, as their employer or insurer may change their coverage or stop covering the drug.
* What is the impact of the lack of consistent coverage on patients?
+ The lack of consistent coverage can have a significant impact on patients, making it difficult for them to access these life-changing treatments and potentially leading to weight regain.
* What is being done to address the lack of consistent coverage?
+ Efforts are being made to address the lack of consistent coverage, including proposals for Medicare and Medicaid coverage and the development of additional obesity treatments.
