A few years ago, West Virginia, which has the highest obesity rate in the nation, quietly launched a small and unusual pilot program that could end up killing hundreds of people. It began covering obesity drugs for state employees, even though many other insurance companies balked at the inclusion. They thought it was expensive.”vanity”Drugs.
From a health measure point of view, the program was a success. The patient lost 120 pounds, his cholesterol decreased, his prediabetes disappeared, and his blood pressure medication was reduced. As word started to spread, more patients wanted to participate. One school nurse said her weight loss inspired at least six other teachers and staff members to join the pilot program.
Then everything came to an abrupt end. In March, the state’s Public Employees Insurance Agency (PEIA) determined it could no longer bear the devastating costs of Wegovy and Zepbound. (This is why these obesity drugs, sometimes known by the brand names Ozempic and Munjaro, respectively, are sold as diabetes drugs.) In the months that followed, PEIA patients found themselves running out of drugs. I started doing it. They rationed remaining supplies and extended weekly injections to 10 days, two weeks, and even three weeks. They considered a composite version of the mimic. started by a woman share Ozempic for diabetic mothers. People who were no longer able to access the medication felt the “food noise” — the constant thoughts about eating that had been suppressed by obesity drugs — coming back with a vengeance. And they gained the weight back.
West Virginia’s pilot program is a microcosm of the dilemma posed by new obesity drugs that are both effective and shockingly expensive. Patients, doctors, and insurance companies alike are in a situation out of control. Since the program ended, Laura Davison, director of medical weight management at West Virginia University, told me: “We see a lot of desperate situations in our practice.” Her center was one of a few in the state’s pilot program and has always been small. At its peak, about 1,000 patients were enrolled, a fraction of the many more. 200,000 West Virginians People who rely on PEIA. (About 2 out of 5 people in West Virginia are obese.) And then those 1,000 patients are given a life-changing drug and what happens if they end up taking it. I became the subject of an experiment about
Megan Pigott is a super responder at Wegovy. After starting the drug in 2022, she lost 120 pounds, more than a third of her body weight. Before that, I had been counting calories since I was in elementary school. She tried SlimFast shakes, a cabbage and pepper soup diet with disastrous results, and an old obesity drug called liraglutide. Nothing worked as well as Wegovy, which WVU prescribed to her as part of a weight management plan that also included diet and exercise. This drug is intended to be taken indefinitely, first to help patients lose weight, and then to continue losing weight. Piggott said Wigobee finally gave her hope.
She ran out of Wegovy in July after PEIA cut coverage. Half of the weight she lost has already returned. She is now considering a generic version of liraglutide, even though it caused vomiting and diarrhea when she took it previously. (Wegoby can also cause these side effects, but Piggott personally found the side effects to be mild.) To buy even this cheaper and less effective drug, she went to her local Rite Aid. I’m planning on going by car for an hour and a half. Up to $245 per month. The actual selling price of Wigobee, which is more than double even if you use the manufacturer’s coupon, is out of the question. “I felt like a drug seeker,” Piggott told me. I had such a hard time taking medicine to lose weight. She, like other PEIA patients I’ve interviewed, has found that managing her obesity has improved many of the things that were negatively impacting her body, so she’s willing to give it a try.
When Kathy Hornbeck Maxwell started Wegovy, she had already been diagnosed with prediabetes, sleep apnea, and polycystic ovary syndrome (a hormonal disorder that can cause irregular periods). All of these are associated with obesity. “I had given up on myself,” she told me. “I had given up on my health.” With Wegovy, her health problems disappeared one by one. My blood sugar levels have gone down, I no longer need a CPAP machine to sleep, and my periods are more regular. Her experience is consistent with a growing body of anecdotal and clinical evidence that obesity drugs can reduce these associated symptoms.
Hilaria Ireland Swisher cut her blood pressure medication in half. She told me that when she first started Zepbound, she cried. After a lifetime of dieting, dieting, dieting, and just trying to put the weight back on, it was a shock to finally get the medication that might end her health problems. Obesity has made her daily life difficult. She would often be out of breath when climbing stairs, and her legs would hurt for days after going outlet shopping with friends. But drug-induced weight loss started a virtuous cycle. She can move without pain, allowing her to be more active and maintain healthier habits. Now she goes to the gym twice a week.
This is why PEIA patients don’t want to lose access to their medicines. Whatever the downsides of the drug, the long-term side effects are still unknown, but patients don’t want to go back. Visher Mustafa, a weight management expert at Marshall Health, one of the centers in the PEIA pilot program, said the pilot program has been a bit of a roller coaster for patients. WVU Professor Davidson has been pushing PEIA to at least keep patients enrolled in drug treatment trial programs. Getting rid of Wegovy and Zepbound now, she argues, would reverse progress made. “All the money you put in now will be thrown away.”
But across the United States, other insurers facing the same costs as PEIA have found that covering obesity drugs can help prevent obesity-related diseases such as diabetes and heart attacks in the future, and ultimately is largely unmoved by claims that it will save money. North Carolina has also cut off insurance coverage for state employees. early this yearprivate insurance is cut out the patient too. Because Wegovy and Zepbound are still new, hard evidence of cost savings is difficult to obtain. a a handful research However, simulations suggest that future medical cost savings will still appear small compared to the cost of the drug, at least at current prices. a simulation For example, Novo Nordisk, the manufacturer of Wegovy, saw savings of $85 million over five years for 100,000 patients. However, Wegovy’s current list price over the same period is $8 billion, a significant difference even if the insurance company did not pay the full amount.
In West Virginia, PEIA says it is struggling with costs. At its peak, the 1,000-patient trial program cost about $15 million a year. Expanding to 10,000 patients would require $150 million annually, or 40 percent of the agency’s total prescription drug budget. “Ever since we made the decision, we’ve been sleeping pretty much every night,” said Brian Cunningham, the agency’s director. said in june. “But I have a fiduciary responsibility and that is my first responsibility.” (PEIA did not respond) atlantic oceanQuestions regarding the end of the pilot program. ) Closing the pilot program will put West Virginia in line with other states. In the first place, most states do not cover obesity treatment drugs for state employees. just about one-fourth of AmericansAccording to Obesity Coverage Nexus, any type of insurance policy will cover these drugs.
For West Virginians who briefly gained coverage and then lost it, the numbers may seem pretty abstract compared to the changes they intuitively feel in their own bodies every day. For an insurance company, whether or not a heart attack was averted may be a number on a spreadsheet, but for a patient, it’s their life. Some have complained by writing letters to PEIA and state legislators. Angela Young, a former state employee who wasn’t part of the pilot but lost her coverage when she signed up for PEIA after her divorce, said it to me most bluntly: She feels extra weight on her replaced knee. She suffers from shortness of breath and heart problems. “I think this is ultimately going to kill me,” she said.
PEIA patients have told me that even a short period of time on obesity drugs has changed their lives in ways that go beyond the physical. “When you’re overweight, you feel invisible,” says Rory Osborne. “You seem subhuman,” Randy Vaughn, a school nurse who is participating in the pilot program with six colleagues, told me. They’ve always been aware of fat shaming, deliberate neglect, subtle or not-so-subtle disdain, but losing weight has changed society’s treatment of obese people. My eyes were opened to how different it was. Maxwell felt that he lost part of his identity when he was first seen as a “fat person”. Losing weight finally allows her to be seen as herself, Cassie, but will gaining weight back mean part of her identity will disappear again?
The drug also made Maxwell rethink the way she thinks about herself and obesity. Like many people, she had long thought that obesity was a problem of self-control and motivation. While using Wegovy and then Zepbound, she felt the food sounds go away as she tweaked her brain chemistry, and she began to think of it as a medical condition. Although obesity is more complex than the simple hormonal imbalance mimicked by these drugs, doctors now generally consider obesity to be a chronic disease. Maxwell now thinks so too.
For her and other patients, that makes PEIA’s decision all the more unfair. “It’s the same as giving a cancer patient a chemotherapy drug or giving a diabetic patient insulin,” Swisher said of obesity drugs. Many said they felt like putting them in a separate category was another example of discrimination. Historically, insurance companies have been reluctant to cover obesity drugs. Born from the belief that obesity is a personal flaw. Medicare is still prohibited by law from covering medications for weight loss. recent Biden administration proposed a rule To circumvent this law, the Trump administration would need to approve it.
In the fall, PEIA proposed. Raise next year’s insurance premiums. Further cited is Expensive GLP-1 drugsmainly because of the classes that include Wegovy and Zepbound. However, PEIA had already halted its testing program for obesity drugs. Future costs will fund drugs prescribed for diabetes. (This pilot program was so small that about 86 percent of the money PEIA was spending on GLP-1 drugs was still going toward treating diabetes.) The pilot program needs to be scaled up, as two to three times as many people are obese.) The program would make obesity much more costly. ) The agency did not propose eliminating diabetes insurance.
When Piggott started Wegovy, she was prediabetic. “One of the reasons I took this drug was to prevent me from getting diabetes,” she said. And it worked, lowering her blood sugar levels. Her insurance premiums are going up now. and She can’t get the drug yet — unless, of course, she eventually develops diabetes. “That doesn’t make sense,” she said. Before you can seek help, your illness must first get worse.
