Wegovy has been called “a major breakthrough” given how well it works to reduce body weight. But the injection drug is extremely expensive, and when people can’t afford to keep taking it, they experience rebound weight gain that is hard to stop.
Katherine Streeter for NPR
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Katherine Streeter for NPR
Wegovy has been called “a major breakthrough” given how well it works to reduce body weight. But the injection drug is extremely expensive, and when people can’t afford to keep taking it, they experience rebound weight gain that is hard to stop.
Katherine Streeter for NPR
From TikTok influencers talking about it to celebrities worrying about “ozempic face,” drugs like Wegovy and Ozempic are being touted as weight-loss wonders in a country obsessed with slimness.
But the drugs are not intended for cosmetic weight loss. Ozempic is approved for diabetes and Wegovy is for obese people who also have weight-related conditions, such as high blood pressure or high cholesterol, that put them at risk for heart disease. That’s millions of Americans.
And there is some evidence that the new class of drugs is much more effective than previous obesity drugs. A groundbreaking clinical study published in The New England Journal of Medicine in 2021 found that the drug led to a 15% reduction in body weight on average.
There has been such an increase in demand that an FDA database lists the medication’s active ingredient, semaglutide, as “currently in short supply.” The manufacturer, Novo Nordisk, says keeping stocks stable is a priority. The company also markets Ozempic for the treatment of diabetes, which is a lower dose of semaglutide.
But at a cost of about $1,400 a month — out of pocket if insurance doesn’t cover it — many people can’t afford to stay on the medication long term. And when people stop taking it, there is often a rebound weight gain that is difficult to control. In fact, one study found that most people regain most of the weight within a year of stopping the drug.
That’s what happens to Yolanda Hamilton from South Holland, Illinois. Hamilton’s doctor prescribed Wegovy because she had an elevated BMI, high blood pressure, and elevated blood sugar. She lost 60 pounds and started to feel much better.
“It gave me more energy,” she says, allowing her to exercise and do household chores. Her sugar cravings diminished and she felt full from smaller meals. “I was very surprised by how good I felt,” says Hamilton. The drug is administered at home once a week, which Hamilton says is easy to do.
Her Aetna insurance plan covered the cost of the medication, but when she changed jobs last fall, her new insurance plan through Blue Cross and Blue Shield of Illinois declined coverage. She now works in a hospital ER registering patients, which requires her to sit for most of the day. And after going off the drug for a few months, she’s gained 20 pounds.
“I’m very frustrated with the weight coming back on in such a short time,” says Hamilton.
Blue Cross and Blue Shield of Illinois told NPR that employer plan benefits can vary. “Weight loss medications such as Wegovy may be covered depending on the member’s benefit plan,” a company spokesperson said. Many other insurance companies also determine coverage based on what employers are willing to cover.
Barriers to a life-changing drug
The rebound weight gain is no surprise given how the medication works. Wegovy’s active ingredient – semaglutide – is a GLP-1, or glucagon-like peptide-1, which mimics the GLP-1 satiety hormone in our body. When we eat, GLP-1 is released from our gut and sends signals to our brain centers that control appetite.
“This hormone tells your brain: I’m full, I don’t need to eat anymore,” explains Northwestern University’s Dr. Robert Kushner, who treats Yolanda Hamilton. Kushner also serves on a Novo Nordisk medical advisory board, for which he receives fees.
“What the pharmaceutical companies have done is take this naturally occurring hormone and restructure it into a drug,” he explains. So it’s no surprise that when people stop taking the drug, they start to feel hungrier, he says.
“I crave sweets,” says Hamilton. And her appetite has increased. She no longer feels satisfied with small meals. “I lose my energy” as the weight comes back on, she says.
Kushner’s office helps Hamilton appeal the insurance denial, but as she waits, she worries that stopping the medication will also affect her blood pressure and blood sugar levels. “She’s at risk of these conditions getting worse if she gains weight again,” says Kushner.
“If I gain more weight, I’ll be on more medication,” says Hamilton. Given her long struggle with weight loss, she had finally found something that worked.
“We see a lot of patients have this rebound weight gain, and it can be really devastating,” says Dr. Karla Robinson, a family physician in Charlotte, NC, and a medical editor at GoodRx, a company that helps people find the lowest prices for generic and branded drugs. There is no generic version of semaglutide.
“Unfortunately, because it’s a new drug, it’s one of the drugs subject to manufacturer pricing,” says Robinson.
A Novo Nordisk representative notes that the company is offering a $500 coupon for Wegovy to reduce costs for patients paying cash.
But this chart from GoodRX shows that the lowest price of all retailers is $1,304 per month for people paying out of pocket, which is out of reach for most people — not even with a coupon.
“I feel Wegovy is revolutionary,” said Hamilton. But she says she absolutely can’t afford it.
“Some people who need it most don’t have access to it,” Robinson says, noting that low-income people are disproportionately affected by obesity.
“We’re talking about a huge health equity problem,” she says. According to the CDC, black and Hispanic adults are more obese.
Since Wegovy was approved by the FDA in 2021, some insurance plans have begun to cover the medication for people who meet clinical prescribing guidelines. According to the FDA, people are eligible if they have a BMI of 27 or higher and also have at least one “weight-related condition” such as hypertension, diabetes or high cholesterol. Or they have a BMI of 30 or higher, regardless of weight-related conditions.
But insurance coverage is very irregular. Medicare doesn’t cover Wegovy or other weight loss drugs, and many insurers are following Medicare’s lead. There is increasing pressure to change this. As STAT reported last week, Florida’s Moffitt Cancer Center is lobbying for legislation that would allow Medicare to pay for obesity drugs, citing the link between obesity and cancer risk. The NAACP is also registered to lobby on this issue.
In addition, the American Academy of Pediatrics has new guidelines recommending that pediatricians offer weight-loss medications to obese adolescents ages 12 and older as an adjunct to behavior modification and lifestyle interventions.
Long-standing unknowns
But the fact that people may need to stay on Wegovy indefinitely to maintain weight loss has raised concerns about long-term use. The most common side effects of the drug are GI symptoms. “Nausea, diarrhea, constipation, vomiting in some people, or heartburn,” says Kushner.
He says starting with a low dose and increasing it over time can help people tolerate the drug better. There is ongoing research to evaluate the effect of the drug on the cardiovascular system, which is positive so far.
But the drug does carry a black box warning because it caused thyroid tumors in rodent studies. So Kushner says doctors should screen patients to find out if they have a family history of a specific kind of thyroid carcinoma, or another rare condition called multiple endocrine neoplasia syndrome type 2 (MEN 2). “This would be an individual patient conversation,” says Kushner. In general, if you have no history of these conditions, “this drug is considered safe,” he says.
If this sounds disturbing, it’s a reminder of how high the stakes are in fighting obesity. The theoretical risk of thyroid tumors can be unnerving. But doctors point to the risks of leaving obesity untreated: heart disease is the leading cause of death in the US, and obesity and weight-related conditions are the leading risk factors.
Of course, exercise and diet modification are still the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of U.S. adults have hypertension, and more than 1 in 3 have pre-diabetes, doctors’ groups cite an urgent need for more interventions that could be helpful. are.
“We, as a society, spend $173 billion on obesity-related healthcare costs,” says Dr. Marcus Schabacker, CEO of ECRI, an independent non-profit organization that has reviewed the evidence of new weight loss drugs.
He argues that the drugs can be part of destigmatizing obesity by treating it like any other disease you treat with drugs. “We wouldn’t ask someone with hypertension to just exercise and change their diet and they’ll be fine. No, we give them beta-blockers. It’s no different here. Exercise and nutrition are important components of tackling obesity, but so are those drugs that have been shown to be effective,’ he says.