Ozempic for Weight Loss: Costs, Insurance Coverage, and Financial Risks

A woman walking across a bridge. Share on Pinterest
Many insurance companies do not cover the cost of newer weight loss medications. Getty Images
  • A novel category of diabetes medication has demonstrated efficacy in assisting individuals in rapidly shedding pounds.
  • Several insurance policies do not include these medications for the treatment of obesity, which renders them excessively costly.
  • Some individuals are compelled to modify their weight management strategies because of the expenses involved.
  • It’s common knowledge that obesity is an ongoing public health issue in the United States, but the magnitude of the problem might be surprising to find.

    In an interview with Healthline, Dr. Atif Iqbal, FACS, FASMBS, a certified general surgeon and medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, described it as extremely regrettable.

    Iqbal remarked, “These figures are astonishing. It is estimated that 50% of the United States’ population will be overweight by 2035. The prevalence of obesity has consistently grown. We are at the top, with the United States taking the lead globally in terms of obesity.”

    Despite the continuous increase in obesity rates over the years, we are now facing fresh challenges that we are just beginning to address.

    Iqbal stated, “The burden of healthcare industry has increased by trillions of dollars. Due to people losing their jobs, engaging in low physical activity, and relying on home food ordering, there has been a significant increase in obesity, which was already at the top of the charts. What a tough two-and-a-half years the pandemic has been for us.”

    Obesity is not just a solitary condition, but rather it can sound ridiculously high, like an exorbitant amount of dollars. It may require additional medical assistance and interventions, as it can increase the risk of many other complications.

    Iqbal stated, “You seriously have to take obesity very seriously. It leads to many other health issues, including some cancers, heart disease, acid reflux, back pain, high lipids, high cholesterol, sleep apnea, high blood pressure, diabetes, and many other health problems. Obesity is the root cause of all these diseases.”

    Is it an exclusion or an exception? It appears that the ability to prevent severe illness is capable of managing the treatment of severe diseases and urgent life-threatening situations, yet numerous insurance policies do not cover it.

    Patel stated, “We are still against discriminating patients with obesity. Therefore, we may not provide coverage for obesity care, but we might say that we will cover all medical care for this individual. Insurance plans sometimes have exclusions that completely exclude certain benefits.”

    It’s not only private insurance plans that do not cover these more recent weight loss medications, either.

    Patel stated, “We don’t know how long it’s going to be, but eventually Medicare’s plan will cover these drugs. Medicaid and Medicare do not cover any weight loss drugs. However, there are still a few commercial insurance plans that exclude obesity care.”

    This results in certain awkward discussions at the physician’s clinic.

    Patel stated that they will soon retire, but they have an insurance commercial and they may walk in to see me first at 64 or 63 years old. Actually, I have had these discussions with my patients when they are about to close Medicare.

    She added, “The reason we usually change our plan is because the metabolic changes needed to maintain weight loss do not occur within a year or two. If they are not using these types of drugs, we cannot continue them in the long term and we need to have a lengthy discussion about it.”

    Finding an alternative treatment that differs from your doctor’s recommended plan solely because of its cost can be difficult to accept. So, what is the exact cost of these medications?

    Patel stated, “If you’re paying more than $1,000 per month and you have to take that medication forever, the cost difference is approximately a couple hundred dollars. It depends on whether you’re taking semaglutide or tirzepatide, but they cost about $1,400 per month.”

    In recent years, a new class of diabetes medication has been found to be exceptionally effective in promoting weight loss and reversing obesity, in order to control and manage it.

    Dr. Rutuja Patel, an obesity medicine specialist at Northwestern Medicine Central DuPage Hospital near Chicago, expressed, “Although we currently possess an extensive range of treatment approaches for the significant obesity epidemic, our progress in this field over the past five years has been remarkable, yet we must acknowledge that we are still grappling with this issue.”

    Patel explained to Healthline precisely how this novel category of weight reduction medication functions.

    Introducing Patel, “clarified,” “it helps in the secretion of insulin post-meals, and the third thing it does is delay gastric emptying. This means that food sits longer in the stomach, making us feel full. One of its multiple functions is to communicate with the brain, informing it about our food intake response. GLP-1 is a hormone secreted by our gut.”

    Patel added, “When we treat patients with semaglutide, a GLP-1 agonist, they tend to lose weight without having to struggle too much with hunger. Additionally, the effect of this hormone is diminished in patients with diabetes and obesity.”

    Semaglutide serves as the generic term for the weight loss drug Wegovy. Additionally, it is marketed under the name Ozempic, which is utilized for diabetes management.

    “The diabetes medication and the obesity medication are the same, but the dosages vary slightly,” stated Patel.

    Tirzepatide, a drug similar to Mounjaro, is currently used to treat diabetes under the name Mounjaro. However, it is expected to be reviewed by the FDA later this year for its use in treating obesity.

    “These are all weekly injections, regardless of whether they’re being used to treat obesity or diabetes,” stated Patel.

    When it comes to insurance coverage, there is a caveat: even though there are currently many effective medications available for combating obesity, it may seem like a logical combination at first, but there are certain drawbacks to consider.

    “The quality of coverage is improving, but it is still far from reaching the desired level,” stated Patel.

    So, what is the issue?

    Some people who cannot afford these medications can also receive assistance from certain payment plans offered by doctors and even without insurance.

    Iqbal stated, “However, the decision ultimately lies with the patient. If they are unable to afford it, there is a possibility of financing. We do inform patients about the price for self-payment–which is determined by the pharmaceutical company, not us–and they have the autonomy to purchase it on their own.”

    However, for the majority of individuals, that is not a practical choice.

    There are other classes of medications that can be used to treat obesity, but they are likely to be part of the same insurance exclusions that Semaglutide coverage can prevent.

    Iqbal stated that they provide support for the mentally ill patient and help with some weight loss, but the efficacy is not as good. We have cheaper medications that can be taken orally, unlike Wegovy, which contains semaglutide and is not available for family use.

    It appears that medication is only a part of the solution for controlling obesity, where those who are able to acquire more financial wealth are still able to get better results than those who are left with a system that does not.

    Iqbal explained, “You should expect to regain weight after discontinuing the medication. It is important to engage in lifestyle changes and exercise. All of these are tools. Any type of weight loss attempt, including dietary programs, surgery, or medicine.”

    The dangers do resurface, just like the excess pounds if you remain within that range only for as long as it is beneficial for your overall well-being. Overweight and obesity are the thresholds that need to be surpassed in order to achieve weight loss.

    Iqbal stated, ‘Previously we addressed all these significant health concerns, and once weight is regained, you find yourself once again at your elevated starting level of risk. However, in general, it has certain adverse impacts, modifying and readjusting, alternating, your metabolism.’