How to Get Insurers to Pay for Ozempic and Other Weight-Loss Drugs
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What is the main topic discussed in this episode?
Here's your Money Briefing for Wednesday, May 17. I'm J.R. Whelan for The Wall Street Journal. You see the TV commercials almost every day for Ozempic and other drugs that promise to help people lose weight as a way to treat diabetes. They carry a hefty price tag, but up until now, insurers have been reluctant to prescribe them.
In the past, it has sometimes been considered a lifestyle or cosmetic issue. That thinking is definitely evolving in the medical establishment. Physicians often now consider obesity not a lifestyle issue, but really a health issue and a medical condition that needs to be treated.
We'll talk to Wall Street Journal reporter Ana Wilda Matthews about ways to get your health insurer to cover the costs.
What are GLP-1 drugs like Ozempic, Wegovy and Mounjaro and how do they work?
That's after the break.
Ozempic and similar drugs that have hit the market in recent years may be able to promise to help people lose weight, but insurers are often reluctant to cover the cost of drugs that can list as $900 or more per month. WSJ reporter Ana Wilda-Matthews joins us to discuss the best ways to get your health plan to pay for your prescription. So Ana, how do these medications work and who are they geared toward?
Well, Ozempic is in a category of drugs that work by mimicking the effects of a naturally occurring gut hormone. which is called for short GLP-1. GLP-1 drugs contribute to weight loss by suppressing appetite and making you feel full sooner when you eat. Ozempic and Munjaro are both geared toward people with type 2 diabetes. The FDA has approved them for that use. Wegovi is explicitly approved by the FDA for weight loss, for treating obesity. although the labeling on the drug actually indicates that it's not just for a person who maybe wants to lose a few pounds. It's really for people who are in the category, the clinical category of obesity, which means they have a BMI of 30 or more, or they can have a BMI of 27 or more and then also have a related health condition such as high blood pressure.
So these drugs are geared toward people with weight problems for different reasons.
Who are these medications approved for — diabetes patients or people with obesity?
Well, so specifically, Munjaro and Ozempic are approved to treat diabetes. They are not approved to treat obesity. So they are really to help with diabetes, with the blood sugar issues. Wagovi, although it has the identical active ingredient to Ozempic, is explicitly approved for weight loss.
What steps would someone take to start treatment with these medications?
Well, the first thing is obviously to see a doctor. These are prescription medications and people can't just go to the drugstore and pick them up. And it is also true that these medications can have significant side effects. And we are told by the physicians we interviewed for the story, it is important to be under the care of a physician, both when you seek to get the drug and once you're on it. If your doctor does agree that one of these drugs is a good fit for you, that you could benefit, typically then there's a process that you and your doctor will have to go through seeking approval from your insurance company. That's not always the case, but it is increasingly and often the case.
Now on social media and on the TV commercials, the splashy headline is that these drugs can help people lose weight. Why has it been such a challenge for insurers to cover weight loss drugs and programs in the past?
Well, it is true that a lot of employers and a lot of insurance plans don't cover drugs explicitly for weight loss. Some do, but many don't. In the past, it has sometimes been considered, and I will put air quotes around this, a lifestyle or, again, air quotes, cosmetic issue. That thinking is definitely evolving in the medical establishment.
What steps should a patient take to start treatment with these prescription weight-loss drugs?
Physicians often now consider obesity not, again, quote, lifestyle issue, but really a health issue and a medical condition that needs to be treated. But again, in the past, a lot of insurance plans haven't treated weight loss drugs as something that was vital to cover.
Now, if a doctor prescribes the drugs, is that the green light needed for an insurer to cover the cost?
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Chapters
7 chapters
1
What is the main topic discussed in this episode?
0:02–0:46
2
What are GLP-1 drugs like Ozempic, Wegovy and Mounjaro and how do they work?
0:46–2:21
3
Who are these medications approved for — diabetes patients or people with obesity?
2:21–3:56
4
What steps should a patient take to start treatment with these prescription weight-loss drugs?
3:56–5:26
5
Why have insurers historically resisted covering weight-loss drugs and how is that changing?
5:26–6:53
6
What documentation or prior-authorization evidence do insurers typically require to pay for these drugs?
6:53–7:34
7
How might employer coverage, out-of-pocket costs, and patient appeals influence access to these medications?
7:34–8:03
Speakers
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