Weight Loss Drugs' Trickle Down Effect - Insurer Restrictions Create Access Challenges For Diabetes Patients

There is growing concern among some type 2 diabetes patients over challenges in obtaining reimbursement for medications like Novo Nordisk A/S's NVO Ozempic amid stricter health plan management by U.S. insurers. 

According to reports from various patients, restrictions imposed by insurers are making it harder for doctors to prescribe these medications, particularly for weight loss purposes.

In a sample group of 24 diabetes patients contacted via Reddit, 13 reported encountering recent difficulties with their health plans covering medications like Ozempic or Eli Lilly And Co's LLY Mounjaro.

One patient highlighted her challenges with Blue Cross Blue Shield, which mandated trying two alternative drugs before approving Mounjaro, despite her doctor's prescription of Ozempic in March. 

This led to adverse side effects for Beddow, who was later switched to Lilly's Trulicity without successful blood sugar level control.

Also Read: JNJ CEO Signals No Rush Into Weight-Loss Drug Realm, Emphasizes Different Priorities.

The impact of insurer interventions on prescriptions for these high-priced medications, valued at over $1,000 per month, has been substantial. 

Insurers' emphasis on prior authorization for GLP-1 drugs for diabetes is attributed to increased off-label weight loss usage.

Some patients expressed frustrations with delays caused by prior authorization, extending to weeks or months before starting new medications. 

Citing a J.P. Morgan survey, Reuters noted that a significant percentage of large employer-based health plans require prior authorization for GLP-1s, hinting at a mounting challenge for diabetes patients.

Despite a recent increase in Ozempic prescriptions, a subsequent drop has been recorded, raising concerns among doctors and patients anticipating changes in coverage terms by January. 

Disclaimer: This content was partially produced with the help of AI tools and was reviewed and published by Benzinga editors.