Healthline

Ozempic Coverage May be Less Likely If You Have This Type of Insurance

By Shawn Radcliffe,

2 days ago

https://img.particlenews.com/image.php?url=46vZ1q_0ux9vBkQ00 — New research highlights which types of health insurance plans are paying for the majority of prescriptions for GLP-1 drugs like Ozempic and Wegovy in the United States. Natalia Lebedinskaia/Getty Images
This article originally appeared on Healthline

The majority of prescriptions in the United States for GLP-1 drug semaglutide were paid with commercial insurance.
Semaglutide is the active ingredient in anti-diabetes drugs Ozempic and Rybelsus, and the weight loss drug Wegovy.
Smaller numbers of people paid for GLP-1 prescriptions with Medicaid and Medicare, and even fewer by cash.

A new study shows that commercial health insurance paid for the majority of prescriptions in the United States for the anti-diabetes drugs Ozempic and Rybelsus and the anti-obesity drug Wegovy . This trend was especially true for Wegovy.

In contrast, much smaller numbers of prescriptions for these drugs were filled using Medicare Part D or Medicaid, with a tiny fraction of people paying with cash.

“Despite the disproportionate burden of obesity in Medicaid and Medicare Part D populations and recent increases in public spending on weight-loss medications, most Wegovy fills were for the commercially insured,” wrote study author Dima M. Qato, PharmD, MPH, PhD , director for the Program on Medicines and Public Health at the USC School of Pharmacy, and her colleagues.

The study was published August 2 in JAMA Health Forum .

Commercial insurance is most commonly used to cover GLP-1 prescriptions

In the study, researchers examined data from IQVIA’s National Prescription Audit PayerTrak. This system covers 92% of prescriptions filled and dispensed at retail pharmacies in the United States.

They looked specifically at prescriptions for semaglutide. This drug is the active ingredient in anti-diabetes medications Ozempic and Rybelsus, and anti-obesity drug Wegovy.

They also examined the type of payment used for the prescriptions — commercial health insurance, Medicaid, Medicare Part D, or cash.

Researchers found that between January 2021 and December 2023, the number of prescriptions filled for semaglutide increased by over 442% (from 471 ,876 to 2, 555 ,308). Of these, over 70% were for Ozempic.

During this period, semaglutide prescriptions increased for all types of payment. However, most of the prescriptions were filled using commercial insurance, particularly for Wegovy.

In 2023, commercial insurance accounted for 61.4% of prescriptions filled for Ozempic, 89.5% of Wegovy prescriptions, and 58.1% of Rybelsus prescriptions.

In contrast, Medicare Part D accounted for only 28.5% of prescriptions filled for Ozempic, 32.9% of Rybelsus prescriptions, and 1.2% of Wegovy prescriptions.

Medicaid accounted for less than 10% of prescriptions filled for all three drug brands in 2023.

A small number of people paid cash for Ozempic and Rybelsus, less than 1% of all prescriptions each.

A larger percentage paid cash for Wegovy — 12.7% of prescriptions in 2021, 2.6% in 2022 and 1.2% in 2023.

This trend may represent increased insurance coverage of this medication over time.

What the new study reveals about GLP-1 medication coverage trends

Robert Klitzman, MD , professor of psychiatry and director of the Master of Science in Bioethics program at Columbia University, said that the results of the new study are important, but they don’t give us the whole picture. Specifically, why these prescription trends are happening.

For example, are people with Medicare and Medicaid less comfortable asking their doctor to prescribe one of these drugs for weight loss? And how many people stop taking the drug after a few months, and does it vary by the type of insurance?

“There’s room for more research here to find out why there are differences in the number of people on Medicare, Medicaid, and private insurance taking these medications,” said Klitzman.

However, he pointed out that in 2022, 54.5% of Americans had commercial insurance, 18.8% had Medicaid and 18.7% had Medicare, according to the US Census .

“So the distribution of prescriptions found in the JAMA Health Forum article is not as alarming as one might initially think,” Klitzman, author of Doctor, Will You Pray for Me?: Medicine, Chaplains, and Healing the Whole Person , told Healthline.

Also, he said the fact that patients on Medicare are more likely than others to be on Ozempic or Rybelsus is not surprising “since these people are older and hence more likely to have heart disease or stroke, which would make them eligible for these medications.”

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A glimpse into how the U.S. is tackling the obesity epidemic

Overall, Klitzman thinks this study only provides a glimpse into how well the United States is handling the obesity epidemic.

More than two in five American adults are living with obesity, according to the Centers for Disease Control and Prevention. Rates are higher among Black adults and adults with lower levels of education.

Newer GLP-1 drugs have been shown to be very effective at helping people lose weight and keep the weight off — as long as they keep taking the medication — but Klitzman thinks this is only part of the solution.

“You certainly want to have a good treatment [such as GLP-1s] available to everyone,” he said, “but I wouldn’t want people to think, ‘all we need is for everyone to take a medication and we’ll all be treated.’”

Eating healthy, staying physically active and learning to deal with stress can also help people lose weight, while offering other benefits.

“Exercise helps you not just lose weight, but it helps with your cognitive thinking and it helps with your heart,” said Klitzman.

However, Lydia C. Alexander, MD , president of the Obesity Medicine Association and chief medical officer of Enara Health, cautions against thinking that people should skip the GLP-1 drugs and only try to lose weight with diet and exercise, something that fuels the stigma surrounding obesity.

People with obesity sometimes get judged for “not taking good care of themselves” or “not trying as hard as they can to maintain a healthy weight ,” she told Healthline.

“This thinking is very common, even among primary care physicians,” she added.

While nutrition, physical activity and lifestyle changes are essential to treating obesity, “obesity is a disease,” Alexander said, “and just like any other disease, a medication may also be needed.”

“Because obesity is a metabolic dysfunction, where the body is no longer getting the correct signals to maintain a healthy weight,” she said.

GLP-1 coverage varies across healthcare plans

One limitation of the new study is researchers did not have information on why people were prescribed semaglutide, which may have affected prescription rates.

Ozempic was initially approved for the treatment of type 2 diabetes , and later to reduce the risk of serious heart problems in adults with cardiovascular disease who living with overweight or obesity.

This drug is also sometimes prescribed off-label to help people lose weight, something that was especially common before Wegovy was approved in June 2021 by the Food and Drug Administration as an anti-obesity drug.

The extent of coverage for semaglutide and other GLP-1 medications depends upon the type of health insurance — and the condition it is prescribed to treat.

“Medicare Part D will cover GLP-1 medications when they are used to treat type 2 diabetes or people with pre-existing cardiovascular disease who need to lose weight,” said Alexander.

But “there’s an actual clause that prohibits treating obesity [alone] as part of Medicare,” she said. As a result, the Medicare population does not have GLP-1s readily available to them for all uses.

With Medicaid, GLP-1 coverage varies from state to state since these are state-run programs.

“For example, in Arizona, it’s relatively more difficult to have Medicaid cover anti-obesity medications,” said Alexander, “but in California, these drugs are included as part of Medicaid coverage, and many times without prior authorization needed.”

Among commercial insurance plans, coverage also varies.

However, a recent survey found that one-third of employer health plans said they are covering GLP-1 drugs for both diabete s and weight loss. This is an increase from around one-quarter in 2023.

In addition, over half of employer health plans cover GLP-1 drugs only as a treatment for type 2 diabetes, the report from the International Foundation of Employee Benefit Plans found.

However, of employers with GLP-1 coverage only for diabetes, almost one-fifth said they are considering offering the drugs for weight loss.

How to find out if your insurance covers GLP-1 drugs like Ozempic

To find out if your health insurance plan covers GLP-1s for weight loss, check the plan’s formulary and summary of benefits and coverage (SBC). This information should be available on your insurance company’s website.

Ro, a direct-to-patient healthcare company, also recently launched the GLP-1 Insurance Coverage Checker , a free tool to help people find out if their insurance covers treatment with GLP-1 medications.

The company said in a news release that nearly half of its patients have coverage for GLP-1s for weight loss, and most have coverage for more than one medication.

In addition, about two-thirds of patients with coverage paid less than $100 per month, the company said. However, most companies require people to get prior authorization before accessing the drugs.

The list price for Wegovy is almost $1,350 for a month’s supply. This is the amount people without insurance coverage would pay before any discounts or rebates. Drugmaker Novo Nordisk also offers a savings card that allows people to pay cash for a one-month supply for $650.

Takeaway

Researchers found that between 2021 and 2023, the majority of prescriptions in the United States for anti-diabetes drugs Ozempic and Rybelsus, as well as the anti-obesity drug Wegovy, were paid with commercial health insurance. The trend was especially strong for Wegovy.

Smaller numbers of people paid for prescriptions with Medicare or Medicaid, which may reflect fewer Americans having these health plans. However, Medicare does not offer coverage for Wegovy, and Medicaid coverage of GLP-1 drugs varies across states.

The study provides a glimpse into how well the country is tackling the obesity epidemic, but experts say more information is needed. For example, why are there differences in prescription rates across insurance, and how many people are prescribed these drugs solely for weight loss?