Joanna Bailey, a family physician 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 she sees at her small clinic in Wyoming County would benefit from the weight-loss drugs known as GLP-1, which also include Ozempic, Zepbound and Mounjaro, she says. The medication helped some of them lose 15 to 20 percent of their weight. But most people in the area it serves don’t have insurance to cover the cost, 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. She then mentioned what many doctors in West Virginia — one of the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We have separated the haves from the have-nots. »
Such disparities widened in March when the West Virginia Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal employees 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 tried, amid growing demand, to determine how far to expand coverage for public employees. Connecticut is on track to spend more than $35 million this year on a limited weight loss coverage initiative. In January, North Carolina announced it would stop paying for weight-loss drugs after paying $100 million for them in 2023, or 10% of its prescription drug spending.
The problem is not limited to public programs. Blue Cross Blue Shield of Michigan, the state’s largest insurer, paid $350 million for weight-loss drugs in 2023, a fifth of its prescription drug spending, and announced earlier this month that it would remove drug coverage from most commercial plans.
West Virginia’s program for government workers was limited to just over 1,000 people, but at its peak – despite discounts from manufacturers – it cost about $1.3 million a month, according to Brian Cunningham, director of the ‘agency. Mr. Cunningham said that if expanded as planned to include 10,000 people, the program could end up costing $150 million a year, or more than 40 percent of its current spending on prescription drugs, resulting in severe premium increases.
“I’ve stayed up practically nights since I made this 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. She said it showed a lack of understanding that obesity is medically classified as a “complex disease”, along with depression and diabetes.
Laura Davisson, director of the weight management program at the West Virginia University Health System, found that in her clinic, patients taking anti-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 pushed in recent months to maintain the Public Employees Insurance Agency’s pilot program and expand coverage more broadly. for weight loss drugs, but has not made much progress.
“Almost everyone is the same,” she says. “They say, ‘I’d love to treat obesity.’ I would like to help people. It’s just too expensive. But we cannot not treat cancer because it costs too much. Why can we do this 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 pounds. His blood pressure dropped, as did his blood sugar. When she learned of the program’s cancellation, she was disheartened.
“I’ll be honest,” she said. “I can’t afford it out of pocket. This is simply not feasible.
Her doctor warned her against regaining weight and reviewed her options before her medication coverage ended in July. They were thin. “She said, ‘Look, I don’t want you to be diabetic, but if you are, you qualify for this drug,'” Dr. Morgan said. “It’s mind-boggling. They would rather you get sicker while taking this medicine.
In some ways, doctors, patients, health advocacy groups and pharmaceutical companies are pitting themselves 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 promote their products as ways to change, as Novo Nordisk puts it, “the way the world perceives, prevents and treats obesity.” And in recent years, they have succeeded, to some extent.
But although Novo Nordisk and Eli Lilly offer coupons to patients with commercial insurance and give deep discounts to employers and government programs that cover the drugs, Mr. Cunningham said the cost remains staggering to the health system and for most patients in West Virginia. and that claims of social justice might ring hollow from two companies that together are valued at more than $1 trillion.
Levi Hall, a pharmacist at Rhonda’s Pineville Pharmacy in Wyoming County, often turns away patients who come to him with drug prescriptions, due to supply shortages or exorbitant prices. “It’s like that Geico commercial, where the guy has a dollar bill tied to a string and he keeps pulling it out when you get close to him,” Mr. Hall said. “You just can’t get it.”
Mr. Cunningham said he also worries about possible long-term side effects of the drugs that are not yet known, and he 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 prescribed painkiller overdoses in America. It began in the mid-1990s, when Purdue Pharma marketed OxyContin to areas with high disability rates to treat a silent “pain epidemic.”
“The drugmakers told a story and were very effective in creating a coalition of caring nonprofits and putting pressure on doctors to prescribe this product,” Mr. Cunningham said, referring to the anti-obesity medications.
Mollie Cecil, an obesity doctor in Lewis County, West Virginia, acknowledged this skepticism and said her patients sometimes express their own distrust of big pharmaceutical companies. But she argued that drugs like Ozempic and Wegovy are categorically different from prescription opioids like OxyContin: They have been on the market for nearly two decades, are highly effective and are not addictive. And she added: “Obesity is not a silent epidemic. This is a very real epidemic.
She continued: “So I’m wondering if anyone has a problem with anti-obesity drugs in a way that they don’t with other illnesses. Why are they questioning best practices and guidelines for obesity due to industry involvement, but not questioning other areas of medicine with the same involvement?
Especially in West Virginia, Dr. Cecil said — where healthy foods can be expensive and difficult to obtain and eating habits are passed down from generation to generation, often leading to higher risks of obesity, diabetes, steatosis hepatic and stroke – there is an urgent need. for medicines.
“These are really effective treatments and they can make a difference in the lives of people here,” she said. “But they might as well have never been created.”