CHARLOTTESVILLE, VA (CVILLE RIGHT NOW) – Two UVA Health physicians who work with diabetes and obesity patients are celebrating what will be better access to weight loss drugs.
The Centers for Medicare & Medicaid Services plan to reduce costs of Wegovy and Zepbound for Medicare/Medicaid patients this spring.
Self-pay prices for the drugs, depending on discounts, can run between $200-$400 a month. It’s unclear what the new prices will be, but the doctors believe it will become more affordable as insurance companies negotiate to cover the medications.
“Often as Medicare and Medicaid go often will the commercial payers follow,” said Dr. Jennifer Kirby, a UVA Health diabetes medicine specialist, on a reporter conference call. “I think this is going to open the door for negotiations for lower costs and I think our employer-based insurance companies are finally going to come on-board and covering these medicines.”
Dr. Kirby and UVA Health Obesity Medicine Director, Dr. Cate Varney, believe there’s a bit of stigma around these drugs.
Initially approved for Type-2 diabetes treatment, the drug five years ago was approved by the FDA for obesity treatment.
“I think there’s this misunderstanding that patients with obesity don’t have willpower,” Dr. Varney said. “It’s not about willpower, appetite and how much food we take in are all hormonally and neurochemically-driven, and just like ‘some people got it, and some people don’t’.”
Dr. Varney said these medications correct the hormonal signals going to the brain saying they’re full or satisfied, and they’re able to make the lifestyle changes.
One of the issues in access only seven state Medicaid programs cover anti-obesity medications.
And furthermore, requirements can be extremely stiff.
Dr. Varney points out the FDA approves Wegovy and Zepbound use for those with BMI of 27.
However, Virginia’s Medicaid coverage requires a minimum BMI of 37.
She also notes employer coverage plans vary greatly.
Usually large employer plans, which is greater than 1,000 employees, have obesity medication coverage while medium-to-small employers don’t.
Even the large employer coverages come with patient burdens and restrictions.
Drs. Kirby and Varney hope the CMS decision will open some of these coverage options up for patients.
