A few years ago West Virginia which has the highest obesity rate in the country A small pilot project has been started. It is extraordinary to quietly impact the lives of hundreds of people. It began covering diet pills for government employees. Although other insurance companies A lot of people are hesitant about things. They are considered expensive.vanity” narcotics
The program was a success based on health measures. Patients lost up to 120 pounds and their cholesterol decreased. Pre-diabetes disease decreased and reduce blood pressure medication When the news began to spread More patients also want to participate. A school nurse told me that her weight loss inspired at least six other teachers and staff to join the pilot project as well.
And then everything suddenly ended. in march The state’s Public Employees Insurance Agency (PEIA) decided it could no longer bear the hefty costs of Wegovy and Zepbound (these diet pills are sometimes better known by the brand names Ozempic and Mounjaro, respectively, which are How to Sell Diabetes Drugs) Over the next several months, PEIA patients began to run out of medicine. They rationed their remaining supplies. By extending the weekly injection to 10 days, two weeks, or three weeks. They consider the hybrid version a counterfeit. One woman started Sharing Ozempic of her diabetic mother People who can no longer take the drug feel the “food noise”, thoughts about eating that diet pills constantly suppress. Come back with a vengeance And they gained weight.
West Virginia’s pilot project is just a microcosm of the dilemma posed by a new diet drug that is at once effective and shockingly expensive. Patients, doctors and insurance companies are stuck. A difficult situation to resolve Since the program ended, Laura Davisson, director of medical weight management at West Virginia University, told me, “There’s a lot of hopelessness that we see in our practice.” Her center is one of no. How many people are in the state pilot program? which is always small It had about 1,000 patients registered at its peak. This is only a fraction of the number of more patients. 200,000 West Virginians who relied on PEIA (about two in five people in West Virginia are obese), and since then these 1,000 patients have been an unwitting subject in an experiment about what happens when Patients receive life-changing drugs Just to make the medicine disappear
Megan Pigott is what everyone loves. It’s also called Wegovy’s great responder; She lost 120 pounds, more than a third of her body weight, after starting the drug in 2022. Before that, she had been counting calories since elementary school. She has tried SlimFast shakes, cabbage soup and green chili diets that have made her suffer. and an older obesity drug called liraglutide. Nothing worked better than Wegovy, which WVU prescribed for her as part of a weight management plan that included dieting and exercise. This medicine is intended to be taken indefinitely. First, to help patients lose weight. Then off the medication, Pigott tells me, Wegovy finally gave her hope.
After PEIA cut its coverage, she left Wegovy in July. Half of the weight she had lost had returned. She is now considering generic liraglutide. Even though the drug had previously caused vomiting and diarrhea (Wegovy can also cause these side effects, Pigott found them to be more severe), in order to purchase a cheaper, less effective drug, She plans to drive an hour and a half to the nearest Rite Aid. This will use a coupon that reduces the price to $245 per month. Wegovy’s out-of-pocket price, which is more than double the price even with the manufacturer’s coupon, is no problem. “I felt like a drug addict,” Pigott told me, having taken the drug to lose that much weight. Like the other PEIA patients I interviewed, she was willing to try it. She found that dealing with her obesity alleviated what was making her body so sick.
When Cassie Hornbeck Maxwell started Wegovy, she was diagnosed with pre-diabetes. sleep apnea and polycystic ovary syndrome This is a hormonal abnormality that can cause irregular periods. All of which are related to obesity. “I gave up on myself,” she told me. “I gave up on my health.” With Wegovy, her health problems gradually faded. disappear little by little Her blood sugar dropped. She doesn’t need the CPAP machine to sleep and her periods are back to normal. Her experience matches the growing clinical and anecdotal evidence that weight loss drugs can alleviate these associated symptoms.
Hilaria Ireland Swisher cuts blood pressure medication in half She told me that she cried when she first started using Zepbound, that she was so overwhelmed by the lifelong diet, starvation, dieting, and weight gain. It was a drug that might finally put an end to her health problems. Obesity made her daily life difficult. She used to be unable to breathe when she climbed the stairs. And her feet ached for days after going shopping with friends. But weight loss from pills creates a virtuous cycle. She can move without pain. As a result, she is more active and maintains healthy habits. Now she goes to the gym twice a week.
This is why patients in PEIA do not want to lose access to their medicines. Whatever the drug’s negative effects—long-term side effects are still unknown—patients don’t want to go back. The pilot program has been a rollercoaster for patients, said Bisher Mustafa, a weight management expert at Marshall Health, one of the centers in PEIA’s pilot program. Davisson at WVU encourages PEIA to treat at least some of the patients in the pilot program on the drug. She argued that kicking them off Wegovy and Zepbound now would reverse the progress that had already been made: “All the money you put into You have to leave it behind.”
However, across the country, other insurance companies Faced with the same costs as PEIA, it was largely unaffected by the argument that Obesity drug coverage will ultimately save you money. By preventing obesity-related conditions such as diabetes and, eventually, heart attack. North Carolina also reduced coverage for state employees. earlier this yearand private insurance received Also cut out the patient.– Wegovy and Zepbound are still new enough that cost savings are hard to come by. handful of education And simulations suggest that future health savings will continue to be dwarfed by the cost of drugs. At least at the current price. Simulation For example, Novo Nordisk, Wegovy’s manufacturer, found savings of $85 million over five years for 100,000 patients, but Wegovy’s current list price over that same period would be as high as $8 billion. This makes a big difference even if the insurance company doesn’t pay the full price.
In West Virginia, PEIA said it was struggling with costs: A pilot program for 1,000 patients was running about $15 million in annual revenue at its peak. Expanding to 10,000 patients would cost $150 million per year, or 40 percent of the agency’s total prescription drug budget. “I have been up at night most of the time since I made this decision,” said Brian Cunningham, director of the agency. said in June– “But I have a fiduciary responsibility. And that is my number” 1 Responsibility” (PEIA did not respond atlantic oceanQuestions about ending the pilot program) Closing the pilot program puts West Virginia in line with other states: Most never covered diet pills for state employees in the first place. only approximately One in four Americanswith any type of insurance There is coverage for these drugs, according to Obesity Coverage Nexus.
For West Virginians who received brief coverage then lose reporting Talking about this number can feel quite abstract compared to the dramatic changes they feel in their bodies every day. For insurance companies Avoidable heart attacks are probably just a number on a spreadsheet. But for the patient This is their life. Some have written to PEIA and state lawmakers to plead their case. Angela Young, a retired state employee, (which is not part of the pilot but lost coverage when she took the PEIA exam after the divorce) told me as bluntly as possible. She felt the extra weight on the knee she replaced. She battled breathing difficulties and heart problems. “I guess,” she said, “this is going to kill me eventually.”
PEIA patients tell me that even after taking obesity medication for only a short period of time, It can change their lives beyond the physical. “When you are overweight, It’s like you can’t see,” Lori Osborne said. “It’s like you’re smaller than a person,” Randy Bourne, a school nurse with six co-workers in the pilot project, told me. They are always aware of the humiliation. willful ignorance Subtle and not-so-subtle insults But losing weight opened their eyes to how society treats fat people. Maxwell felt that she had lost part of her identity when she was initially considered “fat.” Ultimately, losing weight allowed her to be seen as who she was—as Cassie— But will regaining the weight erase her identity again?
The drug also made Maxwell rethink how she thought about herself and obesity. Like many, she had long viewed obesity as a problem of self-discipline and motivation. On Wegovy and then Zepbound, the sensation of food noise disappeared along with changes in brain chemistry. causing her to view it as a medical condition Obesity is more complicated than the hormonal imbalances mimicked by these drugs. But doctors generally consider it a chronic disease. Now Maxwell saw that too.
For her and other patients That makes PEIA’s decision even more irrational. “It is like giving cancer medicine to a cancer patient. or diabetics on insulin,” Swisher said of obesity drugs. Many say these classifications feel like another instance of discrimination. Historically, insurance companies have been reluctant to pay for obesity treatment. It stems from the belief that obesity is a personal failure.-Medicare is still prohibited by law from covering weight loss drugs. The Biden administration recently propose rules to avoid such laws But the Trump administration must approve it.
In the fall, PEIA offers Increase insurance premiums next year– It also refers to High price of GLP-1 drugClasses featuring Wegovy and Zepbound were a key reason, but PEIA has canceled its pilot program on obesity drugs. Future costs will come from the supply of prescribed drugs for diabetes. (The pilot project was so small that about 86 percent of the money PEIA spent on GLP-1 drugs went on to treat diabetes. However, about two or three times as many people in West Virginia are obese. more than diabetes, so this pilot project was expanded (The program would significantly increase the costs of obesity.) The agency is not proposing to eliminate diabetes coverage.
When Pigott started Wegovy, she was pre-diabetic. “One of the reasons I took the pills was to protect myself from getting diabetes,” she says, and it worked: Her blood sugar levels dropped. Now her premiums are increasing. and She still can’t take the medicine. Except that she would eventually develop diabetes. “It doesn’t make any sense,” she said, asking for help. She must become more seriously ill first.
