As a bariatric medicine specialist in Norman, Oklahoma, Dr. Laure DeMattia understands the struggles faced by her patients in their quest to lose weight. She heads a clinic where numerous individuals grapple with obesity, and she believes that newly developed medications like Ozempic and Wegovy could provide significant help if only they were affordable.
Over the years, says Dr. DeMattia, her patients have implemented different approaches in a bid to control their weight. From popular diets like Weight Watchers and Nutrisystem to strategies involving high-protein, low-carb regimes, these individuals have often modified their lifestyles drastically. However, what many have not tried are monthly injections of semaglutide or tirzepatide. Despite the potential these drugs offer, their high cost and the complexity of insurance coverage creates barriers that can be prohibitive.
Dr. DeMattia voices particular concern for her patients from Medicare and Medicaid populations, which lack access to these essential anti-obesity medications. Obesity continues to be a persistent and serious health issue, with nearly half of the U.S adult population struggling under its ramifications. Unaddressed, obesity can lead to potentially life-threatening conditions, including heart disease, diabetes, or cancer.
The disparity in access to such drugs is accentuated by geographic and racial factors. Semaglutide, a key ingredient in Ozempic and Wegovy, is primarily accessible to white populations. Indeed, a 2023 analysis showed 85% of semaglutide national prescriptions were attributed to white patients. Disconcertingly, only 12% were dispensed to Black adults, a demographic with notably higher instances of obesity and diabetes.
After its approval for the treatment of diabetes seven years ago, medications like semaglutide and tirzepatide have been hailed as revolutionary. Despite the endorsements, coverage for these drugs is minimal, with PurpleLab analysis showing only 1% of the U.S population with insurance receiving semaglutide prescription coverage in 2023.
The expensive nature of these drugs presents a formidable barrier to those who need them most. Health insurance companies are often reluctant to cover the around $1,000 monthly cost of such injections, throwing formidable hurdles in the path of effective obesity management.
Further cementing the unequal accessibility, other medications such as Eli Lilly’s Zepbound or Mounjaro (tirzepatide for diabetes) were not included in the data. Oklahoma, which has an adult obesity rate of 40% (third highest in the U.S), does not feature even among the top 25 states for semaglutide prescriptions.
As individual stories reveal, the struggle to access these medical breakthroughs often feels insurmountable. Liz Shumate, for instance, even with her insurance policy from her place of work, can’t afford the $1,000 monthly prescription. Susan Beam, who suffers from excess weight related conditions like high blood pressure and rheumatoid arthritis, has her hopes dashed as Medicare doesn’t cover her needed weight loss medications.
While health care professionals, too, feel the burden of inaccessible care, with doctors like Dr. Ryan Morgan describing it as “weight-based discrimination,” the question remains: Will Medicare ever cover weight loss drugs? This prohibition, coupled with the perceived view of obesity as a cosmetic issue, inhibits accessibility further.
With FDA’s recent approval to include heart attack and stroke reduction as potential benefits of Wegovy, greater coverage from insurers could potentially be on the horizon. However, with prohibitive pricing for such medication and a lack of competition rendering access difficult, equality in obesity treatment still seems a remote possibility.
