Some states say they can’t afford Ozempic and other weight-loss drugs

Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients they can’t take Wegovy, but she’s gotten used to it.

About a quarter of the people she sees at her small clinic in Wyoming County would benefit from the weight-loss drugs, which also include Ozempic, Zepbound and Mounjaro, she says. The medication helped some of them lose 15 to 20 percent of their weight. But most people in the area it serves don’t have insurance to cover the cost, and virtually no one can afford prices of $1,000 to $1,400 a month.

“Even my wealthiest patients can’t afford it,” Dr. Bailey said. She then mentioned what many doctors in West Virginia — one of the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We have separated the haves from the have-nots. »

Such disparities were widened in March when the West Virginia Public Employees Insurance Agency, which pays most of the prescription drug costs for more than 75,000 teachers, city workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.

Some private insurers help pay for medications to treat obesity, but most Medicaid programs only do so to manage diabetes. Medicare covers Wegovy and Zepbound only when prescribed for heart problems.

Over the past year, states have tried, amid growing demand, to determine how far to expand coverage for public employees. Connecticut is on the right track spending more than $35 million this year on a limited weight loss coverage initiative. In January, North Carolina announced it would stop paying for weight-loss drugs after paying $100 million for them in 2023, or 10% of its prescription drug spending.

The problem is not limited to public programs. Blue Cross Blue Shield of Michigan, the state’s largest insurer, paid $350 million for the new classes of obesity and diabetes drugs. in 2023, a fifth of its spending on prescription drugs, and earlier this month it announced that it would remove coverage medications from most commercial regimens.

West Virginia’s program for government workers was limited to just over 1,000 people, but at its peak – despite discounts from manufacturers – it cost about $1.3 million a month, according to Brian Cunningham, director of the ‘agency. Mr. Cunningham said that if expanded as planned to include 10,000 people, the program could end up costing $150 million a year, or more than 40 percent of its current spending on prescription drugs, resulting in severe premium increases.

“I’ve stayed up practically nights since I made this decision,” he said. “But I have a fiduciary responsibility, and that’s my No. 1 responsibility.”

For Dr. Bailey, however, and other obesity doctors in the state, the decision was infuriating. She said this showed a lack of understanding that obesity is medically classified as a “

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