CEDAR RAPIDS, Iowa — Struggles with obesity are a longstanding issue for millions of Americans and thousands of Iowans, but recent advancements in medication, specifically GLP-1 receptor agonists such as Ozempic, Wegovy, and Mounjaro, are transforming how the condition is managed. These drugs have shown promise not only in promoting significant weight loss for many, but also in improving overall health. However, issues surrounding affordability, insurance coverage, and access present hurdles that could determine their long-term impact.
A game-changer in obesity treatment
Initially developed for type 2 diabetes, GLP-1 receptor agonists work by mimicking hormones in the gut to regulate blood sugar levels and appetite. Dr. Morgan Herring, a clinical associate professor at the University of Iowa College of Pharmacy, described how these drugs function: “As you eat, your body releases these hormones. GLP-1 tells the pancreas, ‘Hey, you need to put out insulin if that’s needed,’ or it can give feedback to the liver to store extra glucose. Beyond that, it slows the emptying of the stomach, so you feel full faster and for longer. Patients often report that the ‘food noise’ in their heads disappears.”
The results, according to Herring, are unprecedented. “It’s just blown the rest of them out of the water,” she said. “We’re seeing 22% weight loss in some of these, which is just insane to think about that you can lose that much weight, where the other ones were like, excited if it’s five.”
Dr. Rita Glaze-Rowe, President of Transformative Healthcare Markets at Real Chemistry, highlighted the societal and psychological benefits: “We’re seeing self-proclaimed GLP-1 influencers and GLP-1 advocates. More people are becoming engaged. More people are seeing that it is real. People are actually losing weight and ‘I can see the visible difference,’” she said. “If I’m losing weight, I’m moving better, I’m feeling better, and all of the aesthetic values that go along with that as well, because we can’t discount those mental health aspects.”
In Iowa, where 47.6% of the population is classified as obese, the demand for GLP-1 medications continues to grow. A Real Chemistry study ranked Iowa ninth in the nation for the usage of these drugs, with 1.5% of patients in the state using them.
Insurance and affordability: The biggest roadblocks
Despite their effectiveness, GLP-1 medications come with a steep price tag. Without insurance, these drugs cost could cost up to $1,400 per month, and even with coverage, out-of-pocket expenses can exceed $400.
Many insurers are pulling back coverage, citing high costs and concerns about off-label use for weight loss.
Dr. Glaze-Rowe pointed out the financial pressures insurers face: “Employers and insurers are seeing double-digit increases in pharmacy spend and pulling back coverage.”
Herring described the devastating impact insurance denial can have on patients. “We have patients with BMIs over 60, which is four or five hundred pounds, and we can’t get these drugs approved. It’s very depressing,” she said. “We have to wait for them to get sicker to treat it, which is really unfortunate.”
Eligibility restrictions further complicate access. “For weight loss, they’re very specific about BMI cutoffs,” Herring explained. “Even for patients with pre-diabetes, insurers often won’t cover the drug unless their condition worsens. The hoops we have to jump through are frustrating.”
Recognizing the growing demand and inequities, the Biden administration has proposed a $35 billion initiative over 10 years to expand Medicare and Medicaid coverage for obesity drugs. This includes legislation like the Treat and Reduce Obesity Act, aimed at increasing accessibility for lower-income patients.
“Right now, there’s more and more active legislation at both state and federal levels,” Dr. Glaze-Rowe said. “If passed, these laws could help millions of Americans access these life-changing treatments.”
Herring, however, expressed skepticism about the feasibility of such funding. “I feel like $35 billion is maybe underestimating how much it would cost,” she said. “Knowing how many middle-class people are on it right now, it makes me very surprised that it would only cost that much. I would hate for us to bankrupt Medicare because of these drugs.”
Structural and systemic inequities
The high cost and limited coverage of GLP-1 medications underscore broader inequities in healthcare. According to the Real Chemistry study, lower-income individuals are more likely to be obese, yet higher-income patients are the primary users of these medications due to their ability to pay out of pocket.
“Patients in low-income areas often don’t have access to healthy foods,” Herring said. “Even if they do, it’s so expensive—especially in Iowa during the winter. Many are on food stamps, which often run out by the end of the month. It’s things out of their control.”
The stigma surrounding obesity exacerbates these challenges. “There’s this idea that people with obesity do this to themselves or don’t want to work,” Herring said. “But that’s just not true. Everyone is working so hard just to get through the day-to-day.”
For those unable to afford GLP-1 medications, compounded versions from specialty pharmacies offer a lower-cost alternative. However, these options are not FDA-approved and come with risks. Herring recommends working with clinicians to explore other medications or non-drug interventions.
For patients unable to afford GLP-1 medications like Ozempic, several assistance programs are available:
Novo Nordisk Patient Assistance Program (PAP): Novo Nordisk offers medications at no cost to eligible individuals through their patient assistance program. Patients can apply by visiting the NovoCare website or by calling 1-866-310-7549.
HealthWell Foundation Copay Program: This foundation provides financial assistance to underinsured patients, helping with copayments for medications. More information is available on the HealthWell Foundation website.
Patient Advocate Foundation (PAF) Co-Pay Relief Program: In partnership with the American Diabetes Association, PAF offers financial aid to eligible patients for copays, deductibles, and coinsurance related to diabetes treatment. Details can be found on the Patient Advocate Foundation website.
Manufacturer Savings Cards: Some pharmaceutical companies provide savings cards that can significantly reduce out-of-pocket costs for medications such as Ozempic. Eligibility criteria apply, and information is available on the Ozempic website.
Patients are encouraged to consult with healthcare providers to explore these options and determine the most suitable financial assistance programs for their needs.
It is also important to note GLP-1 drugs can have serious side effects and as many as one in five people naturally won’t respond to the drugs and won’t lose weight in the process. You should always work with your doctor before starting any weight loss plan.
