For those of you who take Ozempic

[daisylu]

for weight loss, insurers are starting to clamp down on doctors who prescribe it for weight loss. Be prepared to pay $$$$.

The letters from the insurance company arrived in recent weeks, bearing a warning to health care providers who prescribe Ozempic, a diabetes drug that has gained popularity as a weight-loss treatment.



"The Special Investigations Unit has completed a comprehensive review of your prescription and professional claims," said one letter to a Missouri doctor from insurer Anthem Blue Cross Blue Shield. Of the patients for whom the doctor prescribed Ozempic, the review found that more than 60 percent lacked "sufficient evidence" of diabetes, its Food and Drug Administration-approved use. The "education letter" warned that prescribing the drug for other conditions could put patients at risk, saying the insurer would refer "suspected inappropriate or fraudulent activity . . . to the state licensure board, federal and/or state law enforcement."


link

[skeeter]

I for one really hope that doctors will heed this warning and only prescribe it to their patients who actually need it because they are diabetic.

It's about time all the people who have been abusing this EXPENSIVE drug's main purpose and having insurance pay the high cost just so they can lose weight, pay for it out of their own pockets. 

[raeoflyte]

Insurance crackdown when the backlog is almost fixed doesn't surprise me. I do think priority should be on patients it's intended for when there is a shortage, but there's nothing wrong with off label use.

www.beckershospitalreview.com/pharmacy/ozempic-shortage-partially-clears-up.html#:~:text=All%20Wegovy%20solutions%20are%20available,to%20a%20March%2017%20post.

Having had to fight with Insurance companies about getting access to meds my family needs (when theyre only going off of cost to tell me something else will work as well) they're not doing this to protect people with t2d. They're excited to have a loophole to not pay for meds for people.

I'm also strongly opposed to the idea that thin = healthy. But science is showing physiological reasons some people gain/keep weight more than others and realizing that lack of will power isn't the problem. So for a society obsessed with the supposed health benefits of losing weight its counter intuitive to cheer for more barriers for people to actually achieve said weight loss. At least until you go back to our puritan roots and then absolutely shame is the only way to go.

[daisylu]

Jun 13, 2023 7:43:42 GMT -5 skeeter said:

I for one really hope that doctors will heed this warning and only prescribe it to their patients who actually need it because they are diabetic.

It's about time all the people who have been abusing this EXPENSIVE drug's main purpose and having insurance pay the high cost just so they can lose weight, pay for it out of their own pockets. 

I will agree with this, though I could understand if it was being used to combat morbid obesity - not people wanting to lose 10-20 pounds, which is what a lot of celebrities are using it for.

Also from the article:

Ozempic only has regulatory approval for diabetes but it contains the same active compound, semaglutide, as another drug approved for obesity, Wegovy. Because many insurers do not cover weight-loss medications, doctors have ordered Ozempic to treat obesity, a practice known as prescribing "off label" that is common across health care.

There are other meds that doctors can prescribe, but they go with Ozempic because it is covered by most insurers. And you can believe that the insurance companies are going to get those costs back from the consumers, and since they can not get the costs back from individuals they will find other ways such as higher premiums for EVERYONE. So we all end up paying because some people do not want to.

[raeoflyte]

Jun 13, 2023 8:13:58 GMT -5 daisylu said:

Jun 13, 2023 7:43:42 GMT -5 skeeter said:

I for one really hope that doctors will heed this warning and only prescribe it to their patients who actually need it because they are diabetic.

It's about time all the people who have been abusing this EXPENSIVE drug's main purpose and having insurance pay the high cost just so they can lose weight, pay for it out of their own pockets. 

I will agree with this, though I could understand if it was being used to combat morbid obesity - not people wanting to lose 10-20 pounds, which is what a lot of celebrities are using it for.

Also from the article:

Ozempic only has regulatory approval for diabetes but it contains the same active compound, semaglutide, as another drug approved for obesity, Wegovy. Because many insurers do not cover weight-loss medications, doctors have ordered Ozempic to treat obesity, a practice known as prescribing "off label" that is common across health care.

There are other meds that doctors can prescribe, but they go with Ozempic because it is covered by most insurers. And you can believe that the insurance companies are going to get those costs back from the consumers, and since they can not get the costs back from individuals they will find other ways such as higher premiums for EVERYONE. So we all end up paying because some people do not want to.

I hate this argument. The cost of a drug doesn't determine its efficacy. I think it works here because fundamentally we think fat people are lazy, just need to work harder, get some will power, medical assistance losing weight is cheating etc. But apply it to other medical situations and the bs isnt so easily hidden.

Every other year we have to fight the insurance company not to change ds insulin. Just because they sign a contract with a new distributor is no reason to make children change medications that have life long complications.

We paid full price out of pocket for migraine meds for years! because the ones covered didn't do jack shit.

It's bs the insurance companies have more control than doctors and pharmacists in patient care.

[wvugurl26]

That's some pretty language in the Blue Cross letter but it doesn't mean squat. Physicians can prescribe off label all they want. The manufacturer is limited to advertising for on label, approved uses. And some insurance companies use approved labeling for coverage determinations. It means nothing in terms of limiting a physician's prescribing. The only time I've seen that argument gain traction is with TIRF drugs aka high power fentanyl. That's a deadly drug class. Ozempic is not.

I agree that those who have diabetes should absolutely have priority in times of a drug shortage.

The pharmacy benefit managers (PBMs) are who jack things in up in terms of pricing and coverage. I take a daily asthma inhaler. There's been a generic available for a few years. My insurer offers no coverage for the generic. I have to remind the physician to write for the brand because the software defaults to generic.

My insurer does not cover the generic because the PBM has negotiated a big fat rebate with the brand manufacturer to only put that on the formulary and deny coverage for the generic. Brand is $500/ month if you pay cash. Asthma drugs are covered for me at $0 copay.

A Google search shows the generic can be had for $128 cash using a Good rx coupon.

[pulmonarymd]

We need to be careful with this. Many drugs are prescribed and effective for off label uses. Drugs are approved, then they are shown to be effective for another condition, condition. The manufacturer has little incentive to apply to the FDA for these additional indications. Yet medications such as prednisone and aspirin, for example, are used for things that are off label. People are going to be hurt. And as pointed out, physicians are allowed to prescribe any approved medication for any reason, so unless what a physician is doing is so far out there, the medical board will be reluctant to sanction them. The only power an insurance company has is in relation to payment. They can refuse to pay for these medications without proof of diabetes. They have preauthorization requirements for many of the newer asthma medications, and do deny payment at times. So they could do it for Ozempic. They always say they aren't practicing medicine when they deny medications and  tests, so they should stay in their lane.

[Bonny]

Jun 13, 2023 9:12:23 GMT -5 pulmonarymd said:

We need to be careful with this. Many drugs are prescribed and effective for off label uses. Drugs are approved, then they are shown to be effective for another condition, condition. The manufacturer has little incentive to apply to the FDA for these additional indications. Yet medications such as prednisone and aspirin, for example, are used for things that are off label. People are going to be hurt. And as pointed out, physicians are allowed to prescribe any approved medication for any reason, so unless what a physician is doing is so far out there, the medical board will be reluctant to sanction them. The only power an insurance company has is in relation to payment. They can refuse to pay for these medications without proof of diabetes. They have preauthorization requirements for many of the newer asthma medications, and do deny payment at times. So they could do it for Ozempic. They always say they aren't practicing medicine when they deny medications and  tests, so they should stay in their lane.

And it seems counter-intuitive to me that when people who are obese, for whatever reason, shouldn't have access to drugs that could help them from becoming diabetic. That's a long-term disease that has lots of consequences.

Fat shaming isn't helpful.

[pulmonarymd]

Jun 13, 2023 9:57:31 GMT -5 Bonny said:

Jun 13, 2023 9:12:23 GMT -5 pulmonarymd said:

We need to be careful with this. Many drugs are prescribed and effective for off label uses. Drugs are approved, then they are shown to be effective for another condition, condition. The manufacturer has little incentive to apply to the FDA for these additional indications. Yet medications such as prednisone and aspirin, for example, are used for things that are off label. People are going to be hurt. And as pointed out, physicians are allowed to prescribe any approved medication for any reason, so unless what a physician is doing is so far out there, the medical board will be reluctant to sanction them. The only power an insurance company has is in relation to payment. They can refuse to pay for these medications without proof of diabetes. They have preauthorization requirements for many of the newer asthma medications, and do deny payment at times. So they could do it for Ozempic. They always say they aren't practicing medicine when they deny medications and  tests, so they should stay in their lane.

And it seems counter-intuitive to me that when people who are obese, for whatever reason, shouldn't have access to drugs that could help them from becoming diabetic. That's a long-term disease that has lots of consequences.

Fat shaming isn't helpful.

I think this has taken off too fast, IMHO. The use of Ozempic for weight loss needs to be studied, as the short and long term effects need to be determined, in addition to the long term side effects, and the long term effectiveness. For example, does the drug need to be taken indefinitely to maintain the weight loss, or is the weight loss durable after it has been stopped. Prior experience would suggest that the weight loss would return if the drug is stopped, as it does with other interventions. It is a complicated issue, and has significant implications for the cost of insurance, since the drug is expensive. 

This situation, like all others in medicine, comes down to cost vs benefit. Those 2 effects are unknown with this drug in regards to its use for weight lose. Further studies are needed. Unfortunately, the issues surrounding obesity are so emotional and difficult, these studies maynot been down as well as these need to be done, similar to the mess we saw surrounding Covid. In addition, some people will not accept any answer that is contrary to their beliefs, as we have seen with Ivermectin.

[bean29]

Who says the insurance is even paying for much if any of the prescription's cost.  My insurance technically covers prescriptions.  I have found that most of the time it is cheaper to pay cash than to fill under the insurance.  If I pay cash it does not count towards my deductible.  Prescription coverage does not really kick in until my $3,000 (individual) or $6,000 family deductible is met.  My insurance covers both DH and I, so we essentially each have our own deductible.  I did not hit deductible last year and probably won't this year either although we will probably come close to $6,000-we did last year too.

[The Walk of the Penguin Mich]

Jun 13, 2023 10:48:16 GMT -5 bean29 said:

Who says the insurance is even paying for much if any of the prescription's cost.  My insurance technically covers prescriptions.  I have found that most of the time it is cheaper to pay cash than to fill under the insurance.  If I pay cash it does not count towards my deductible.  Prescription coverage does not really kick in until my $3,000 (individual) or $6,000 family deductible is met.  My insurance covers both DH and I, so we essentially each have our own deductible.  I did not hit deductible last year and probably won't this year either although we will probably come close to $6,000-we did last year too.

I take a drug like this too.  When my SIL was still practicing in Canada, she’d rewrite my prescription for me and a year supply would cost me $300 vs $300/mo.  She retired, so can no longer do this.  

Amazon now has a pharmacy, and without insurance it’s $41/mo.  When I get back, I am planning on looking into this.  

[The Walk of the Penguin Mich]

Jun 13, 2023 10:12:09 GMT -5 pulmonarymd said:

Jun 13, 2023 9:57:31 GMT -5 Bonny said:

And it seems counter-intuitive to me that when people who are obese, for whatever reason, shouldn't have access to drugs that could help them from becoming diabetic. That's a long-term disease that has lots of consequences.

Fat shaming isn't helpful.

I think this has taken off too fast, IMHO. The use of Ozempic for weight loss needs to be studied, as the short and long term effects need to be determined, in addition to the long term side effects, and the long term effectiveness. For example, does the drug need to be taken indefinitely to maintain the weight loss, or is the weight loss durable after it has been stopped. Prior experience would suggest that the weight loss would return if the drug is stopped, as it does with other interventions. It is a complicated issue, and has significant implications for the cost of insurance, since the drug is expensive. 

This situation, like all others in medicine, comes down to cost vs benefit. Those 2 effects are unknown with this drug in regards to its use for weight lose. Further studies are needed. Unfortunately, the issues surrounding obesity are so emotional and difficult, these studies maynot been down as well as these need to be done, similar to the mess we saw surrounding Covid. In addition, some people will not accept any answer that is contrary to their beliefs, as we have seen with Ivermectin.

Didn’t Phen-Fen as a weight loss do the same thing until later they found out it caused heart damage?

As I remember things, when a drug is released by the FDA after testing to the public, the testing isn’t really complete.  The final test is to look at side effects when prescribed in large populations where they are more likely to be seen.  That involves hundreds of thousands of prescriptions over around 5 or so years?  This was how the heart damage was found, and when Bextra, Voixx and a few other NSAIDs were pulled off the market.
I used Bextra, it was phenomenally effective and was most annoyed when it got yanked. 

[pulmonarymd]

Jun 13, 2023 11:10:58 GMT -5 The Walk of the Penguin Mich said:

Jun 13, 2023 10:12:09 GMT -5 pulmonarymd said:

I think this has taken off too fast, IMHO. The use of Ozempic for weight loss needs to be studied, as the short and long term effects need to be determined, in addition to the long term side effects, and the long term effectiveness. For example, does the drug need to be taken indefinitely to maintain the weight loss, or is the weight loss durable after it has been stopped. Prior experience would suggest that the weight loss would return if the drug is stopped, as it does with other interventions. It is a complicated issue, and has significant implications for the cost of insurance, since the drug is expensive. 

This situation, like all others in medicine, comes down to cost vs benefit. Those 2 effects are unknown with this drug in regards to its use for weight lose. Further studies are needed. Unfortunately, the issues surrounding obesity are so emotional and difficult, these studies maynot been down as well as these need to be done, similar to the mess we saw surrounding Covid. In addition, some people will not accept any answer that is contrary to their beliefs, as we have seen with Ivermectin.

Didn’t Phen-Fen as a weight loss do the same thing until later they found out it caused heart damage?

As I remember things, when a drug is released by the FDA after testing to the public, the testing isn’t really complete.  The final test is to look at side effects when prescribed in large populations where they are more likely to be seen.  That involves hundreds of thousands of prescriptions over around 5 or so years?  This was how the heart damage was found, and when Bextra, Voixx and a few other NSAIDs were pulled off the market.
I used Bextra, it was phenomenally effective and was most annoyed when it got yanked. 

Most weight loss drugs have been associated with pulmonary hypertension, but that may have been a class effect.

Most drugs are tested on a few thousands, or occasionally 10 thousand before approval. So a serious 1 in 100,000 side effect may not be seen until it is in wide use. It is why being conservative with drugs if there are otherwise accepted options for treatment is wise.

[The Walk of the Penguin Mich]

Jun 13, 2023 11:30:06 GMT -5 pulmonarymd said:

Jun 13, 2023 11:10:58 GMT -5 The Walk of the Penguin Mich said:

Didn’t Phen-Fen as a weight loss do the same thing until later they found out it caused heart damage?

As I remember things, when a drug is released by the FDA after testing to the public, the testing isn’t really complete.  The final test is to look at side effects when prescribed in large populations where they are more likely to be seen.  That involves hundreds of thousands of prescriptions over around 5 or so years?  This was how the heart damage was found, and when Bextra, Voixx and a few other NSAIDs were pulled off the market.
I used Bextra, it was phenomenally effective and was most annoyed when it got yanked. 

Most weight loss drugs have been associated with pulmonary hypertension, but that may have been a class effect.

Most drugs are tested on a few thousands, or occasionally 10 thousand before approval. So a serious 1 in 100,000 side effect may not be seen until it is in wide use. It is why being conservative with drugs if there are otherwise accepted options for treatment is wise.

Yep.  I was always kind of surprised that they stopped there in the testing.  But it does make sense.  Trying to do a study on a population that large has got to be a nightmare.

[pulmonarymd]

Jun 13, 2023 11:34:46 GMT -5 The Walk of the Penguin Mich said:

Jun 13, 2023 11:30:06 GMT -5 pulmonarymd said:

Most weight loss drugs have been associated with pulmonary hypertension, but that may have been a class effect.

Most drugs are tested on a few thousands, or occasionally 10 thousand before approval. So a serious 1 in 100,000 side effect may not be seen until it is in wide use. It is why being conservative with drugs if there are otherwise accepted options for treatment is wise.

Yep.  I was always kind of surprised that they stopped there in the testing.  But it does make sense.  Trying to do a study on a population that large has got to be a nightmare.

Many factors go into it. Cost to the company, make it to difficult to get it to market, and they will not spend the money. If a drug works, there is harm to those who would benefit by delaying it. More alternatives is better for patients. So, you try to benefit risk and benefit on a population level.

[Tiny]

Jun 13, 2023 9:57:31 GMT -5 Bonny said:

Jun 13, 2023 9:12:23 GMT -5 pulmonarymd said:

We need to be careful with this. Many drugs are prescribed and effective for off label uses. Drugs are approved, then they are shown to be effective for another condition, condition. The manufacturer has little incentive to apply to the FDA for these additional indications. Yet medications such as prednisone and aspirin, for example, are used for things that are off label. People are going to be hurt. And as pointed out, physicians are allowed to prescribe any approved medication for any reason, so unless what a physician is doing is so far out there, the medical board will be reluctant to sanction them. The only power an insurance company has is in relation to payment. They can refuse to pay for these medications without proof of diabetes. They have preauthorization requirements for many of the newer asthma medications, and do deny payment at times. So they could do it for Ozempic. They always say they aren't practicing medicine when they deny medications and  tests, so they should stay in their lane.

And it seems counter-intuitive to me that when people who are obese, for whatever reason, shouldn't have access to drugs that could help them from becoming diabetic. That's a long-term disease that has lots of consequences.

Fat shaming isn't helpful.

IDK. The thing about weight loss isn't a "lose it once and then you are done and won't gain weight back". I can easily count 10 people I know in real life who have been constantly cycling thru weight loss and gain for the last 40 years. Some of them loose 40 or 50 pounds (after months and months of "dieting and excercising") and then woohoo! they can now eat anything they want and they no longer need to excercise... and then months later they've put back on 50 or 60 pounds and the cycle starts again. over and over an over. And each time they cycle they gain a little more and loose a little less. Now losing 10% of their body weight is a lot of weight and isn't enough to get them to a "healthy" body weight or size.

My point is - if someone takes this drug - does it mean they have to take it for the rest of their life to maintain their weight loss? Or once they go off it will they have the skills/habits/mindset to keep the weight off? Or will this drug become a "go to" thing so they can loose 20 or 30 pounds before the "wedding", the "cruise", the "holidays", "swim suit season" and then gain the weight back so they can take the drug again to prep for the next "event" they need to be thinner for??


That's the thing with being overweight or obese - sure there's a lot of emotional boost/feel good from the initial starting out weight loss of 10% or 15% of your body weight - but it takes live long continued work to keep losing and to keep it off.

If the drug is intended to be something you take for the rest of your life then just disregard everything I said.


Just as a snarky aside - I know quite a few diabetics who take various drugs who didn't change their eating habits - one couple both take a pill to control their blood sugar but they are both happy to crow about how they still buy the big "barrel containers" of icecream (they bought a chest freezer to hold it) and have ice cream sundays (made just like when they were in highschool/college) when ever they want. And they are unconcerned about loosing weight even though they have to be at the high end of obese or into the extremely obese category.

Changing one's eating habits (diet, amount consumed) isn't easy. There's emotional, physical (your brain doesn't tell you when you've had enough), psychological (clean plate issues from childhood, peer pressure to have another beverage/more food or shame when you eat something everyone else is NOT having, you get the idea.)

Weightloss and keeping it off isn't as simple as taking a pill every day.

[daisylu]

Jun 13, 2023 10:48:16 GMT -5 bean29 said:

Who says the insurance is even paying for much if any of the prescription's cost.  My insurance technically covers prescriptions.  I have found that most of the time it is cheaper to pay cash than to fill under the insurance.  If I pay cash it does not count towards my deductible.  Prescription coverage does not really kick in until my $3,000 (individual) or $6,000 family deductible is met.  My insurance covers both DH and I, so we essentially each have our own deductible.  I did not hit deductible last year and probably won't this year either although we will probably come close to $6,000-we did last year too.

Good RX shows Ozempic prices starting at $915.It would not take long to meet deductible at that price.

[daisylu]

Jun 13, 2023 8:38:12 GMT -5 raeoflyte said:

Jun 13, 2023 8:13:58 GMT -5 daisylu said:

I will agree with this, though I could understand if it was being used to combat morbid obesity - not people wanting to lose 10-20 pounds, which is what a lot of celebrities are using it for.

Also from the article:



There are other meds that doctors can prescribe, but they go with Ozempic because it is covered by most insurers. And you can believe that the insurance companies are going to get those costs back from the consumers, and since they can not get the costs back from individuals they will find other ways such as higher premiums for EVERYONE. So we all end up paying because some people do not want to.

I hate this argument. The cost of a drug doesn't determine its efficacy. I think it works here because fundamentally we think fat people are lazy, just need to work harder, get some will power, medical assistance losing weight is cheating etc. But apply it to other medical situations and the bs isnt so easily hidden.

Every other year we have to fight the insurance company not to change ds insulin. Just because they sign a contract with a new distributor is no reason to make children change medications that have life long complications.

We paid full price out of pocket for migraine meds for years! because the ones covered didn't do jack shit.

It's bs the insurance companies have more control than doctors and pharmacists in patient care.

I fought for years with DS's ADHD medication. Every year that would try to get us to go with a different med. Usually some information provided from the doctor and it was covered. I know it is a PITA.

ETA - If it continues to be prescribed for weight loss, which everyone knows is not covered by health insurance, I fear that it will become an issue where people who need it for T2D will have to start jumping those hoops to get it approved.

[raeoflyte]

Jun 13, 2023 12:22:29 GMT -5 Tiny said:

Jun 13, 2023 9:57:31 GMT -5 Bonny said:

And it seems counter-intuitive to me that when people who are obese, for whatever reason, shouldn't have access to drugs that could help them from becoming diabetic. That's a long-term disease that has lots of consequences.

Fat shaming isn't helpful.

IDK. The thing about weight loss isn't a "lose it once and then you are done and won't gain weight back". I can easily count 10 people I know in real life who have been constantly cycling thru weight loss and gain for the last 40 years. Some of them loose 40 or 50 pounds (after months and months of "dieting and excercising") and then woohoo! they can now eat anything they want and they no longer need to excercise... and then months later they've put back on 50 or 60 pounds and the cycle starts again. over and over an over. And each time they cycle they gain a little more and loose a little less. Now losing 10% of their body weight is a lot of weight and isn't enough to get them to a "healthy" body weight or size.

My point is - if someone takes this drug - does it mean they have to take it for the rest of their life to maintain their weight loss? Or once they go off it will they have the skills/habits/mindset to keep the weight off? Or will this drug become a "go to" thing so they can loose 20 or 30 pounds before the "wedding", the "cruise", the "holidays", "swim suit season" and then gain the weight back so they can take the drug again to prep for the next "event" they need to be thinner for??


That's the thing with being overweight or obese - sure there's a lot of emotional boost/feel good from the initial starting out weight loss of 10% or 15% of your body weight - but it takes live long continued work to keep losing and to keep it off.

If the drug is intended to be something you take for the rest of your life then just disregard everything I said.


Just as a snarky aside - I know quite a few diabetics who take various drugs who didn't change their eating habits - one couple both take a pill to control their blood sugar but they are both happy to crow about how they still buy the big "barrel containers" of icecream (they bought a chest freezer to hold it) and have ice cream sundays (made just like when they were in highschool/college) when ever they want. And they are unconcerned about loosing weight even though they have to be at the high end of obese or into the extremely obese category.

Changing one's eating habits (diet, amount consumed) isn't easy. There's emotional, physical (your brain doesn't tell you when you've had enough), psychological (clean plate issues from childhood, peer pressure to have another beverage/more food or shame when you eat something everyone else is NOT having, you get the idea.)

Weightloss and keeping it off isn't as simple as taking a pill every day.

As I understand it, the thinking now is that most medications for weight loss would be taken for life or at least medically managed for life.

Eta - for your last sentence - I think weight loss meds are more like anti-depressants. The pill doesn't make you lose weight, but if you can get on a medication that counters the issues stopping you from losing or maintaining weight, then the life style changes have a much better chance of actually working.

[raeoflyte]

Jun 13, 2023 12:26:29 GMT -5 daisylu said:

Jun 13, 2023 8:38:12 GMT -5 raeoflyte said:

I hate this argument. The cost of a drug doesn't determine its efficacy. I think it works here because fundamentally we think fat people are lazy, just need to work harder, get some will power, medical assistance losing weight is cheating etc. But apply it to other medical situations and the bs isnt so easily hidden.

Every other year we have to fight the insurance company not to change ds insulin. Just because they sign a contract with a new distributor is no reason to make children change medications that have life long complications.

We paid full price out of pocket for migraine meds for years! because the ones covered didn't do jack shit.

It's bs the insurance companies have more control than doctors and pharmacists in patient care.

I fought for years with DS's ADHD medication. Every year that would try to get us to go with a different med. Usually some information provided from the doctor and it was covered. I know it is a PITA.

ETA - If it continues to be prescribed for weight loss, which everyone knows is not covered by health insurance, I fear that it will become an issue where people who need it for T2D will have to start jumping those hoops to get it approved.

That's a reason not to support insurance controlling that decision. There's no concern about pulling viagra because of its off label use (that made the company infinitely more money than its intended purpose).

Eta - more insurance companies are covering weight loss meds. I'm sure they prefer the combo drugs that are available in generics but I believe the ozempic type drugs work differently than the standards meds.

[Pink Cashmere]

Jun 13, 2023 13:13:24 GMT -5 raeoflyte said:

Jun 13, 2023 12:22:29 GMT -5 Tiny said:

IDK. The thing about weight loss isn't a "lose it once and then you are done and won't gain weight back". I can easily count 10 people I know in real life who have been constantly cycling thru weight loss and gain for the last 40 years. Some of them loose 40 or 50 pounds (after months and months of "dieting and excercising") and then woohoo! they can now eat anything they want and they no longer need to excercise... and then months later they've put back on 50 or 60 pounds and the cycle starts again. over and over an over. And each time they cycle they gain a little more and loose a little less. Now losing 10% of their body weight is a lot of weight and isn't enough to get them to a "healthy" body weight or size.

My point is - if someone takes this drug - does it mean they have to take it for the rest of their life to maintain their weight loss? Or once they go off it will they have the skills/habits/mindset to keep the weight off? Or will this drug become a "go to" thing so they can loose 20 or 30 pounds before the "wedding", the "cruise", the "holidays", "swim suit season" and then gain the weight back so they can take the drug again to prep for the next "event" they need to be thinner for??


That's the thing with being overweight or obese - sure there's a lot of emotional boost/feel good from the initial starting out weight loss of 10% or 15% of your body weight - but it takes live long continued work to keep losing and to keep it off.

If the drug is intended to be something you take for the rest of your life then just disregard everything I said.


Just as a snarky aside - I know quite a few diabetics who take various drugs who didn't change their eating habits - one couple both take a pill to control their blood sugar but they are both happy to crow about how they still buy the big "barrel containers" of icecream (they bought a chest freezer to hold it) and have ice cream sundays (made just like when they were in highschool/college) when ever they want. And they are unconcerned about loosing weight even though they have to be at the high end of obese or into the extremely obese category.

Changing one's eating habits (diet, amount consumed) isn't easy. There's emotional, physical (your brain doesn't tell you when you've had enough), psychological (clean plate issues from childhood, peer pressure to have another beverage/more food or shame when you eat something everyone else is NOT having, you get the idea.)

Weightloss and keeping it off isn't as simple as taking a pill every day.

As I understand it, the thinking now is that most medications for weight loss would be taken for life or at least medically managed for life.

Eta - for your last sentence - I think weight loss meds are more like anti-depressants. The pill doesn't make you lose weight, but if you can get on a medication that counters the issues stopping you from losing or maintaining weight, then the life style changes have a much better chance of actually working.

Given my current situation, this makes sense to me in a way it probably would not have before. I’ve been slowly gaining weight over the last several years, but over the last 4 years the pace accelerated. I gained over 20lbs after Mister and I moved here, at my heaviest, it was more like 25-30lbs. I started to really, really dislike how I look in my clothes from the beginning.

As some of you know, I’ve had some terrible digestive issues since last year, I didn’t realize I’d started losing weight until I noticed I’d lost 10-12lbs about a month ago. Within 3 weeks after that, I lost another 12, as of last week.

Even though that is not the ideal way to lose weight, now that I have, I am more motivated to at least keep that weight off, and try to lose more. I have no choice but to be more mindful of what I’m eating while I try to sort out my gut issues, so in my mind, I might as well use that as an opportunity to also improve my diet and address some of my bad habits for better health and weight loss. So imo, there is a psychological factor that comes into play as far as increased motivation, once you’ve started losing weight. Or maybe I’m just weird lol.

[finnime]

In the 2 1/2 years since DH started using Ozempic for type 2 diabetes he's lost about 30 lbs. and almost as soon as he started, stopped needing and using insulin. So I'm in favor of the drug. During the shortage he went for 2 months without any which was very worrisome.

I think that its use for weight loss alone is fine for those who are obese. That is a definite dangerous condition that is life-threatening. Assuming no shortage Ozempic should be available for any medical use IMNSHO.

Right now DH has lost so much weight that he's deliberately trying to gain some back. He is developing a gaunt look. I do not think it's coincidental that his CKD has stablized since he's been on Ozempic, either. Still not on dialysis although he has been stage 5 for almost 3 years.

I am opposed to PBMs practicing medicine, and opposed to our current system of insurance companies controlling access to medical treatments. 

[jerseygirl]

Yes insurance companies and PBM have way too much power and do seem to verge on practicing medicine
Both patients and physicians are impacted by this. Both financially and wasting time and resources

[susana1954]

Jun 13, 2023 8:55:04 GMT -5 wvugurl26 said:

That's some pretty language in the Blue Cross letter but it doesn't mean squat. Physicians can prescribe off label all they want. The manufacturer is limited to advertising for on label, approved uses. And some insurance companies use approved labeling for coverage determinations. It means nothing in terms of limiting a physician's prescribing. The only time I've seen that argument gain traction is with TIRF drugs aka high power fentanyl. That's a deadly drug class. Ozempic is not.

Yes, the insurance company told me exactly that when they refused to cover a glaucoma drop.  The doctor can prescribe what he/she thinks best.  The insurance company just determines what it will pay for.  They accept no responsibility if I choose not to do as the doctor suggests just because it isn't covered.

Lol.

[pulmonarymd]

Jun 14, 2023 12:32:43 GMT -5 susana1954 said:

Jun 13, 2023 8:55:04 GMT -5 wvugurl26 said:

That's some pretty language in the Blue Cross letter but it doesn't mean squat. Physicians can prescribe off label all they want. The manufacturer is limited to advertising for on label, approved uses. And some insurance companies use approved labeling for coverage determinations. It means nothing in terms of limiting a physician's prescribing. The only time I've seen that argument gain traction is with TIRF drugs aka high power fentanyl. That's a deadly drug class. Ozempic is not.

Yes, the insurance company told me exactly that when they refused to cover a glaucoma drop.  The doctor can prescribe what he/she thinks best.  The insurance company just determines what it will pay for.  They accept no responsibility if I choose not to do as the doctor suggests just because it isn't covered.

Lol.

Exactly. They are just making a coverage decision. It has nothing to do with whether it is "medically necessary".

What they refuse to acknowledge is that it does impact treatment. Patient's go without, they question their doctor's medical judgment, treatment gets delayed because of the need to appeal, etc. But, sure, they are not practicing medicine/s

[scgal]

Jun 13, 2023 12:23:15 GMT -5 daisylu said:

Jun 13, 2023 10:48:16 GMT -5 bean29 said:

Who says the insurance is even paying for much if any of the prescription's cost.  My insurance technically covers prescriptions.  I have found that most of the time it is cheaper to pay cash than to fill under the insurance.  If I pay cash it does not count towards my deductible.  Prescription coverage does not really kick in until my $3,000 (individual) or $6,000 family deductible is met.  My insurance covers both DH and I, so we essentially each have our own deductible.  I did not hit deductible last year and probably won't this year either although we will probably come close to $6,000-we did last year too.

Good RX shows Ozempic prices starting at $915.It would not take long to meet deductible at that price.

I take ozempic. It is expensive over $900 for the pen where i'm at. I do have excellent ins. I pay $70 premium mo thru work once I hit the 3k ded everything is 100% covered. The only problem I have with ozempic so far is 2x I was unable to get it. It was in short supply the reason was that they couldn't keep up with the weight loss sister drug. That really pissed me off. 

[Ava]

My doctor prescribed me Ozempic.
I took it for a month. Then I went back to the doctor. I expressed my concerns.
It makes me nervous that I have to inject myself and deal with needles. Worried about an infection, injury, etc.i watched videos on YouTube on how to apply it but not sure i was doing it right.
Then I travel internationally. Next trip is for 6 weeks. Getting there takes approx. 24 hours. Concerned about a drug that needs to be refrigerated. It's very difficult to transport for that long.
Then it says to discard after 6 weeks which means I have to take two pens and hope I never run into a power outage while I'm there in summer.

Plan to move back to Uruguay in a few years, where they don't offer Ozempic so not sure if I want to take it now

My doctor put me back on Metformin.

I'm debating whether I should switch to Ozempic or stay with Metformin.

I didn't get any side effects with Ozempic during the 4 weeks I took it. But I was on the lowest dose