New meds like Ozempic are fueling a weight-loss frenzy – and a gold rush – The Washington Post

“The Special Investigations Unit has completed a comprehensive review of your prescription and professional claims,” said one letter to a Missouri doctor from insurer Anthem Blue Cross Blue Shield. Of the patients for whom the doctor prescribed Ozempic, the review found that more than 60 percent lacked “sufficient evidence” of diabetes, its Food and Drug Administration-approved use. The “education letter” warned that prescribing the drug for other conditions could put patients at risk, saying the insurer would refer “suspected inappropriate or fraudulent activity … to the state licensure board, federal and/or state law enforcement.”

“There’s really no difference between semaglutide as Wegovy and semaglutide as Ozempic,” said Angela Fitch, president of the Obesity Medicine Association and co-founder of weight-focused start-up knownwell. She has seen a handful of Anthem’s letters and considers them unwarranted, saying “these clinicians aren’t committing any kind of fraud.”

Elevance Health, which operates Anthem plans, said the letters went to fewer than 150 providers. The insurer said that in most cases it won’t cover Ozempic unless a patient is diagnosed with diabetes and has tried another medication to manage it, but physicians can still prescribe it. “Nationwide shortages have occurred due to the large uptick in off-label prescribing,” the letters state, and patients with diabetes “often cannot find the medication in stock.”

America’s Health Insurance Plans, a trade group, has noted concerns about side-effects and cost of GLPs. “The evidence is still evolving related to how these medications may impact complications related to obesity such as heart disease and diabetes,” said David Allen, a spokesperson.

There may be no buzzier medication on the market than GLPs. They are being popularized by celebrities, going viral on social media and transforming the lives of people who’ve tried everything over decades to lose weight. They are also generating windfalls for pharmaceutical firms big and small, shaking up the fortunes of some conventional weight-loss companies and creating growth for companies that manufacture parts needed to inject the medication.

New prescriptions for Ozempic and Wegovy, made by Novo Nordisk, have surged by 140 percent and 297 percent, respectively, as of a year ago, according to a research note from Cowen analysts. With list prices more than $900 a month, GLPs are far more expensive than older weight-loss drugs, and some insurers are requiring patients to clear more hurdles before covering them, according to several doctors who treat patients for obesity.

GLPs that have been approved by the Food and Drug Administration have quickly become engines of cash for their developers. Eli Lilly brought in $568.5 million of revenue in the first three months of 2023 from Mounjaro, its new diabetes drug. Novo Nordisk, a Danish company, reported the equivalent of about $3.5 billion in sales from Ozempic and Wegovy combined over the same period.

Developing a drug that can meaningfully and safely help people shed pounds has been a “holy grail” for the pharmaceutical industry for decades, analysts say. The new drugs are man-made versions of Glucagon-like peptide 1, a hormone naturally produced by the body that helps regulate blood-sugar levels, make food pass more slowly through the stomach and suppress appetite. The treatment has evolved from drugs that had been injected daily to once a week, and drugmakers are developing a pill version.

Part of the excitement for these new drugs is the potential for broader health benefits — and the cost savings that could flow from them. Matthew Gilbert, an endocrinologist at University of Vermont Medical Center, said GLP drugs are so effective at managing diabetes that he’s able to cut back on prescribing insulin to patients.

Yet the benefits of GLP drugs can vanish when patients stop taking them, which could mean patients take them for a lifetime. Gilbert said he is not concerned about the long-term safety, but the prospect of lifelong use raises a question no one can yet answer. “Are these drugs going to be safe for someone to take for 30 years?” he said.

Gary Foster, chief scientific officer of WeightWatchers, said in a statement that GLPs are a breakthrough, but emphasized the need to pair them with a behavioral program. That, he said, “is the foundation for healthier patterns of eating and activity as well as a better quality of life.”

“It was not TRS’ intent to provide coverage for weight loss and anti-obesity drugs,” the letter states, adding that doing so “would require TRS to factor the costs of such medications into the premiums charged to all employees” in its plan.

“The ‘eat less, move more’ approach is really not very effective for the average person who is looking for meaningful, sustained weight loss,” said Jaime Almandoz, medical director of the UT Southwestern Medical Center in Dallas.

Taher Modarressi, a doctor at Hamilton Cardiology Associates in New Jersey, hasn’t experienced such a tightening of requirements but sees a looming collision. It is the physician’s job to do what is medically right for the patient, including prescribing GLP drugs to treat obesity, he said. Still, “we would face overwhelmingly prohibitive systemic costs” if such medications were prescribed to everyone who qualifies.

This content was originally published here.

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