The Philadelphia -Mara Nissley has a rare disorder, so the brain swells like a tumor. Body weight loss can help to treat a state called a similar waste brain. Last year, her doctor recommended that her doctor would start a popular weight loss drug to alleviate weak headaches and vision problems.
In just a few months, Nissley lost 20 pounds and suspended headaches and vision.
But now, she’s approaching the drug that she recognizes that she changes her life. The Philadelphia region and health insurance companies across the country Lowing or limiting the scope of application of some drugs In this new type of drug, known as GLP-1 agent. This includes the brand name and zepbound of drugs taken by Wegovy and Nissley.
Local residents, such as Nissley, who have lost their coverage for the last few months, say they are worried about losing their health improvements without being convinced of how to deal with drugs.
The GLP-1 agent was originally developed. It mimics the effect of GLP-1 hormone that treats diabetes and regulates blood sugar levels. The Food and Drug Administration has approved various drugs in other brand names to treat various states, including obesity, cardiovascular disease and sleep apnea.
Most insurance changes are used for drugs used for weight loss. Ozempic, a particularly well -known drug of this class, has been approved by FDA to treat diabetes and prevent complications of heart failure and kidney disease. For this purpose, the label is often prescribed, but the approval for weight loss is not approved. Other drugs such as Wegovy and Zepbound have been specially approved to encourage weight loss.
However, a huge cost -dosage of up to $ 1,400, Much higher than other countries’ costs We urged some US insurers to strengthen their requirements for application. Some have accused the increase in prescriptions for drugs in which the entire customer -based premium rises.
Doctors and patients who have succeeded in GLP-1 agents can block access to drugs that can prevent serious conditions such as diabetes and heart disease by limiting the scope of application.
Nissley, a 33 -year -old of Francisville, said he had never considered taking weight loss drugs before it helped to treat his condition.
“My primary care doctor and I are scrambling. If you leave Wegovy, you can gain weight. Wegovy can lower blood pressure. As blood pressure rises, the pressure in the brain can increase. So it’s not helpful to take it out. ”Nissley said.
Nissley and other Philadelphian patients, who have lost their insurance coverage for GLP-1 drugs, also said they have no time to save new insurance plans or ensure their own expenses because they have not been sufficient warnings before the coverage is lowered.
UTIBE ESSIEN, a doctor and assistant professor at the University of California, Los Angeles, said, “This is a personal problem for people.” I don’t know about you but usually does not store $ 10,000 for the drugs that need to be guaranteed. “
‘I see who will blink first’
The reason for the high price of drugs such as Wegovy and Ozempic is complicated. The relative lack of market competition, monopoly patents and the US Byzantine drug price pricing system can all contribute to high prices.
As GLP-1 prescriptions rise with the potential of the drug, there is a limitation of insurance companies for insurance.
Highmark, a major insurer in the Philadelphia region, has deployed more strict prescription requirements. Last summer, Pennsylvania’s GLP-1 drugs for summer Pennsylvania’s long-term benefits were restricted, causing the patient to take consistently and uninviable supply of drugs without demand.
In January, Independence Blue Cross, the largest insurance company in this area I stopped the cover of the weight loss drug When citing high costs and prescribed only by weight loss. (The decision does not apply to GLP-1 agents prescribed to treat other FDA approval conditions.)
The company encouraged people who lost their insurance benefits to use other IBX benefits that support doctors about their choices and support weight loss such as behavioral health and nutrition, repayment of gymnasium and obesity surgery.
Pennsylvania is one of the many states that the Medicaid Plan is a number of states that restrict drug insurance for those who rely on government health insurance for low -income families and disabled people. This month, the state health authorities told legislators that the GLP-1 agent report could add $ 1 billion in new costs to Medicide expenditures this year. WESA reported.
Some people can pay in their pockets, but the most vulnerable patients who need GLP-1 agents will not be able to afford it without insurance. People with lower income are also in A There is a high risk of state such as obesity and diabetes There is less access to healthy foods and physical activity opportunities.
“This is an innovative moment of science, but we will be wider because people approaching these drugs are not the same as those who have the highest risk of obesity and diabetes.”
Many patients with David Sarwer GLP-1 drug Temple University’s Obesity Research and Education Center I have already tried weight loss method. He was frustrated to see the difficulty of approaching the drug now.
Sarwer, director of the center, said, “The clinical therapeutic community says every week wants more approach to the drug. Every week we are watching another story about this.” And insurance companies and pharmaceutical companies look at each other and see who will blink first. “
Inform the patient about changes in the application range
Some patients said IBX rarely warned about reducing their insurance applications.
Rich Venezia, the 35 -year -old of the Center City, lost 20 pounds in three months after the Zepbound started in the fall.
He said he was notified of IBX’s decisions at the end of December. It’s too late to change to a new plan dealing with drugs.
“I have studied a lot of things that are most meaningful to me in part,” he said. “I was inherently robbed of a decision that could be made as a personal consumer.”
Last fall, Nissley was fired at her work and found a new plan in early December. Pennie, Health Insurance Market Place. She asked the medical service navigator whether IBX would deal with Wegovy. Pennie refused to mention the exchange.
Less than a month later, Nissley said he had received a letter from Yves that her insurance would not deal with Wegovy. Similar waste cerebri is not one of the conditions approved by the FDA for the treatment of GLP-1 agents. Because weight loss can cure brain disorders, the doctor prescribes WEGOVY for weight loss.
A spokesman for IBX said that if the additional purpose of personal medicines is not confirmed in the form of insurance, the company usually says there will be no way to know it. The doctor can submit a guarantee request again, the spokesman said.
The company told the group insurance plan, IBX doctor and insurance broker in the network for changes in the application range in August. IBX informed the health care navigator about the decision in October and sent a letter to patients with individual plans from November.
Nitsley and Venice have not announced the plan change by the end of this year because the IBX report on the medicine began after September 4, 2024, so the cut -off date to inform the members early this year was not informed.
Nissley still said she is trying to find out how she will pay for Wegovy. It takes $ 650 without insurance coverage. She is considering a low formalization of about $ 350 to $ 400.
She said she had a lot of stress to explore the situation.
“I have to be an unemployed and have a budget, ‘at least my health is managed. You can get the necessary drugs and focus on search searches,” she said. “And now I spend all of this energy about this problem.”
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