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

Joanna Bailey, a family doctor 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 he sees at his small clinic in Wyoming County would benefit from the weight-loss drugs known as GLP-1, which also include Ozempic, Zepbound and Mounjaro, he says. The drugs helped some of them lose 15 to 20 percent of their weight. But most people in the area where she operates don't have insurance that covers the costs, 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. He then mentioned something that many doctors in West Virginia – among the poorest states in the country, with the highest prevalence of obesity, at 41% – say: “We have separated the haves and have-nots.”

Those disparities deepened in March, when the Public Employees Insurance Agency of West Virginia, which pays most of the cost of prescription drugs 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 drugs to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.

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

The problem doesn't just affect public programs. Blue Cross Blue Shield of Michigan, the state's largest insurer, paid $350 million for GLP-1 drugs in 2023, a fifth of its prescription drug spending, and announced earlier this month that would have removed drug coverage from most commercial plans.

West Virginia's program for public employees was limited to just over 1,000 people, but at its peak — despite manufacturer rebates — it cost about $1.3 million a month, according to Brian Cunningham, the agency's director. Cunningham said that if it were expanded as planned to include 10,000 people, the program could end up costing $150 million a year, more than 40% of current spending on prescription drugs, resulting in steep premium increases.

“I've been up at night pretty much since I made the 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. He said this demonstrates a lack of understanding that obesity is medically classified as a “complex disease”, in the same category as depression and diabetes.

Laura Davisson, director of the weight management program at West Virginia University Health System, found that in her clinic, patients taking obesity medications lost 15 percent more weight than those who relied solely on diet and exercise. Local lawmakers have jurisdiction over drug coverage in state programs like Medicaid, and Dr. Davisson has lobbied in recent months to maintain the Public Employees Insurance Agency pilot program and expand coverage more broadly for weight-loss drugs, but he hasn't made much progress.

“Pretty much everyone is the same,” he said. “They say, 'I'd like to cure obesity. I would like to help people. It's just too expensive.” But you can't not treat cancer because it costs too much. Why can you do that with obesity?”

Christina Morgan, a political science professor at West Virginia University, started taking Zepbound in December as part of the state's obesity drug pilot program. By March she had lost 30 kilos. Her blood pressure dropped, as did her blood sugar level. When she learned of the program's cancellation, she was disheartened.

“I'll be honest,” she said. “I can't afford it out of my own pocket. It's simply not feasible.”

Her doctor warned her to gain weight back and weighed her options before coverage for her medications ended in July. They were thin. “She said, 'Listen, I don't want you to be diabetic, but if you are, you're entitled to this medicine,'” Dr. Morgan said. “It's disconcerting. They would rather you become sicker to take this medicine.

In some respects, doctors, patients, health advocacy groups and pharmaceutical companies are aligned against employers and government health insurance programs in the battle for access to weight-loss drugs.

Novo Nordisk, which sells Ozempic and Wegovy, and Eli Lilly, which sells Zepbound and Mounjaro, are major donors to America's largest obesity advocacy groups and are well represented at medical conferences. Most manufacturers mention weight stigma on their websites and present their products as a way to change, as Novo Nordisk puts it, “the way the world views, prevents and treats obesity.” And in recent years, to some extent, they have succeeded in doing so.

Although Novo Nordisk and Eli Lilly promote coupons for patients with commercial insurance and give large discounts to employers and government programs that cover the drugs, Cunningham said the cost is still staggering to the health care system and to most patients in West Virginia and that claims of social justice might ring hollow from two companies that, combined, are worth more than $1 trillion. But so far the issue has had no political resonance: Top elected officials in the state have remained largely silent.

Levi Hall, a pharmacist at Rhonda's Pineville Pharmacy in Wyoming County, often turns away patients who come to him with prescription medications due to shortages or exorbitant prices. “It's like that Geico commercial, where the guy has a dollar bill hanging by a string and he keeps pulling it away when you get close,” Mr. Hall said. “You just can't understand it.”

Cunningham said he is also concerned about possible long-term side effects of the drugs that are not yet known, and noted that West Virginia has good reason not to trust big pharmaceutical companies. The state was at the center of the nation's opioid epidemic, with the highest rate of opioid and prescription painkiller overdoses in America. It all started in the mid-1990s, when Purdue Pharma marketed OxyContin in areas with high rates of disability to treat a silent “epidemic of pain.”

“The drug makers told a story and were very effective in creating a coalition of charitable nonprofits and pressuring doctors to prescribe them,” Cunningham said, referring to obesity drugs.

Mollie Cecil, an obesity doctor in Lewis County, Virginia, acknowledged that skepticism and said her patients sometimes expressed their distrust of big pharmaceutical companies. But she argued that drugs like Ozempic and Wegovy were categorically different from prescription opioids like OxyContin: They have been on the market for nearly two decades, are highly effective and non-addictive. And she added: “Obesity is not a silent epidemic. It's a very real epidemic.”

He continued: “So I would wonder if anyone has problems with anti-obesity drugs in a way that they don't have with other disease states. Why do they question best practices and guidelines on obesity because of industry involvement, but not question other areas of medicine with the same involvement?”

Especially in West Virginia, Dr. Cecil said — where healthy food can be expensive and difficult to obtain and eating habits are passed down from generation to generation, often leading to increased risks of obesity, diabetes, fatty liver disease and stroke — there is a desperate need for drugs.

“These are really effective treatments and can make a difference in people's lives here,” he said. “But they might as well never have been created.”

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