By Gregory S. Pokrywka, MD, FACP, FNLA, FASPC, NCMP
A few of my patients are kids. Others are over age 90. But nearly all are overweight or obese.
As a clinical lipidologist – a cholesterol expert – practicing in preventive cardiology, I’ve learned to expect this connection between lipids like cholesterol and triglycerides, pre- and outright diabetes and body weight.
For weight loss, I advise old-fashioned nutrition and lifestyle modifications, and use a skilled clinical dietitian, before prescribing medication. I also follow new data on popular approaches like intermittent fasting and the ketogenic diet. However, some people simply need more help losing weight. Rather than suggest patients try existing older medications with limited weight loss effects, I’d like to prescribe semaglutide for weight loss.
A low dose of semaglutide has been used to treat diabetes for some time. But researchers recently found that at a higher dose, the same medication can help people sustain significant weight loss, 10-20% of their body weight. This volume of loss is on par with bariatric surgery – without the risks of an operation. The dual benefit was a landmark discovery, leading to recent FDA-approval of the medication for obesity.
Despite this benefit, I’ve yet to find a health insurance plan – government or commercial – willing to cover semaglutide for weight loss.
I’m used to jumping through insurance company hoops like prior authorization to get my patients the medications they need. But that’s not even an option when I prescribe semaglutide for weight loss. Insurers exclude it outright. This forces patients to pay the entire cost out of pocket, which few people can afford.
Insurers’ stubbornness is a travesty at a time when upward of 70% of Americans are overweight or obese. Being overweight is associated with higher rates of metabolic disease like diabetes and polycystic ovary syndrome. It increases the risk of heart disease, Alzheimer’s and some cancers.
Carrying excess weight also wears out joints, which will lead to a surge in knee and hip surgeries in the future. All of these problems – and their associated treatment and societal costs – could be reduced if we help patients maintain a healthy weight.
The potential of semaglutide for weight loss is enormous. It’s the medical breakthrough we’ve been needing for years. Now, we need to break through the insurance barriers that are keeping millions of Americans from accessing this life-changing medication.
Gregory S. Pokrywka, MD, FACP, FNLA, FASPC, NCMP, is a National Lipid Association Lipid Specialist and a member of the Alliance for Patient Access.
Breakthrough, an IfPA blog series, offers health care providers a voice in the ever-growing conversation about innovation and value.