Recent advances in diabetes and obesity medications are proving essential in saving lives; however, a revealing study conducted by researchers at the Yale School of Public Health and the University of Florida indicates a concerning trend: individuals with the greatest need for these injectable treatments are often the ones least likely to receive them.
The medication semaglutide, marketed under the brand names Ozempic and Wegovy, is primarily promoted as a treatment for type 2 diabetes but has also gained recognition for its effectiveness in weight management.
Semaglutide, alongside tirzepatide—available in the weight-loss drug Zepbound as well as the diabetes treatment Mounjaro—belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists.
These innovative drugs are designed to assist in decreasing blood sugar levels, effectively managing type 2 diabetes while simultaneously promoting weight loss. Ozempic has received official approval for diabetes treatment yet is frequently prescribed off-label for weight loss, while Zepbound has been specifically approved for obesity treatment.
However, the exorbitant cost of these medications, often exceeding $1,000 per month without insurance coverage, significantly limits access for many, highlighted by Professor Alison Galvani of the Yale School of Public Health.
Medicare, a crucial insurance program catering to older adults, currently excludes coverage for these medications when used for weight loss, and similar limitations exist within Connecticut’s Medicaid program. In a recent article published in “Proceedings of the National Academy of Sciences,” Galvani and her collaborators pointed out that private insurance plans frequently impose steep deductibles and co-pays, further complicating access to these vital treatments.
“Currently, about 8,000 deaths are being averted [because of the GLP-1 medications],” Galvani said. “However, if access were expanded to all who are eligible, more than 42,000 lives could be saved each year.”
Alarmingly, individuals from certain racial backgrounds and those residing in rural areas face even greater barriers to access these essential treatments.
“And this gap is especially alarming, given the disproportionate burden of diabetes and obesity among economically disadvantaged populations,” she added.
CDC data sounds alarm over obesity
Data released in September 2023 by the Centers for Disease Control and Prevention highlighted a troubling trend, revealing that more than 1 in 3 adults in 23 states are currently living with obesity. Present statistics indicate that at least 1 in 5 adults across each U.S. state is grappling with obesity issues.
“This new data highlight the need for obesity prevention and treatment options, which start with building healthier communities where people of all ages have safe places for physical activity, and where health care and healthy food options are accessible and affordable for all,” emphasized Dr. Karen Hacker from the CDC, in a statement.
According to the CDC, effective obesity treatment often involves a comprehensive approach that includes GLP-1 medications, recently sanctioned by the U.S. Food and Drug Administration, in conjunction with health behavior and lifestyle modifications.
Weight-loss injectables could combat ‘a silent killer’
Obesity was described as a public health crisis by Galvani.
“It acts as a silent killer, increasing inflammation in the body and exacerbating mortality from a multitude of causes, including cardiovascular disease, cancer and type two diabetes,” she highlighted. “It’s even a risk factor for heightened severity of flu and COVID.”
The GLP class of drugs “are a blessing in the field, showing a marked improvement in weight loss and control of A1C [blood-glucose levels],” stated Dr. Varalakshmi Venkatachalam, an associate professor of medicine at UConn and an expert in obesity management.
“I want to prevent diabetes, but even [many] private insurers do not cover weight loss specifically, and patients without diabetes are not getting these drugs,” she mentioned.
Venkatachalam is transitioning to California to spearhead an obesity and lifestyle medicine program within the primary care division at Stanford University School of Medicine.
“These medications should be widely available regardless of insurance status,” she asserted. “There are now studies looking at CKD [chronic kidney disease] improvement as well as [better] cardiac outcomes.”
**Interview with Professor Alison Galvani, Yale School of Public Health**
**Editor:** Thank you for joining us today, Professor Galvani. Your recent study sheds light on a concerning issue regarding access to GLP-1 medications like Ozempic and Wegovy. Can you summarize your findings?
**Professor Galvani:** Absolutely. Our research indicates that while GLP-1 medications are proving vital in managing diabetes and obesity, especially in saving lives, access remains strikingly inequitable. The individuals who would benefit most, those with the greatest health needs, are often the ones least likely to receive these treatments.
**Editor:** That’s alarming. What are some of the specific barriers preventing access to these life-saving drugs?
**Professor Galvani:** The primary barrier is cost. Without insurance coverage, these medications can exceed $1,000 a month, which is prohibitive for many people. Additionally, Medicare excludes coverage for weight management, and Medicaid programs have similar restrictions. Private insurance often includes high deductibles and copays, which further complicates access.
**Editor:** You mentioned in your study that approximately 8,000 deaths are currently being averted due to the use of GLP-1 medications. What could happen if access to these medications were expanded?
**Professor Galvani:** If we could broaden access to everyone who qualifies for these treatments, we estimate that more than 42,000 lives could ultimately be saved each year. This expansion is especially critical given the disproportionate impact of diabetes and obesity on economically disadvantaged populations.
**Editor:** It’s very concerning to hear that certain racial groups and rural populations face even greater barriers. Can you elaborate on this?
**Professor Galvani:** Yes, the disparities in access to healthcare are stark. Data shows that those from specific racial backgrounds and those living in rural areas experience greater challenges in obtaining these medications. This gap is stark given the higher prevalence of obesity and diabetes in these communities, which emphasizes the urgent need for systemic change in healthcare access.
**Editor:** The recent CDC data showing that over 1 in 3 adults in certain states are living with obesity highlights an alarming trend. What do you believe are essential steps for addressing this issue?
**Professor Galvani:** We need a multi-faceted approach. First, promoting healthier communities is crucial—ensuring safe places for physical activity and access to nutritious foods. Additionally, we must work on policy reforms to make these effective treatments more accessible and covered by insurance. This includes advocating for changes within Medicare and Medicaid, as well as pushing private insurers to reconsider their coverage policies.
**Editor:** Thank you, Professor Galvani, for your insights and for highlighting such an important public health issue.
**Professor Galvani:** Thank you for having me. Addressing these access issues can significantly improve health outcomes and save countless lives.
