While the insurance companies are struggling with the costs of the GLP-1 medicines, some seek to open patients

After losing 50 lbs on an injection weight loss drug, Kyra Wensley received a sudden letter from the director of pharmacy entitlements in April.

The letter said that her request was rejected for coverage, because she had a BMI less than 35 when Zepbound began. She was the 25 -year -old girl who lived in New York taking Zepbound without an accident for several months, so she was confused: Why was her body mass index, which was about 32 when she started, became only a problem now?

Winsley had no interest in quitting an effective drug. She said: “Exit immediately like this, it has been said easier than doing it.”

Her doctor fought to keep her on the GLP-1, the category that includes weight loss and type 2 OzemPIC, Wegovy, Mounjaro and Zepbound. But Winsli eventually had to turn from Zepbound to Wegovy to meet her plan’s requirements. She said she does not like Wegovy as much as her old drug, but she is now lucky to be on any GLP-1.

Many research indicates that such medications should be used indefinitely to maintain weight loss and related health benefits. But with existing prices Almost $ 1,000 per monthThe general and private motivations are struggling to keep up with An enlarged demand For GLP-1 weight loss drugs, in some cases, you remove or restrict their coverage as a result.

North Carolina Midikid plans End of GLP-1 coverage For weight loss on October 1, a little more than a year later Start coverage. Pennsylvania plans to reduce the coverage of medical aid for beneficiaries at the highest risk of complications from obesity. And in spite of Modern reports From a potential federal experimental program to expand the GLP-1 obesity coverage under Medicaid and Medicare, it is likely that all Medicaid government programs are under pressure due Severe spending discounts In the recent budget reconciliation package in President Donald Trump’s law.

Indeed, many GLP-1 users He resigned within a yearand Studies indicate Often due to side effects, high costs or insurance problems. Now, an increasing number of researchers, motivated and service providers are explored, which aims to reduce some patients from their drugs after they took this for a certain period of time or lost a certain amount of weight.

The National Institute of the United Kingdom of Health and Care, which creates instructions for National Health Serviceand It recommends limits for two years On using some weight loss medications, such as Wegovy. The concept was raised in a modern institute for clinical and economic review A report on reasonable prices For obesity medications.

Mark FederickWhich directs the value -based insurance design center at the University of Michigan, Argue If some people who use GLP-1 are transferred to lose weight in the end, more people can benefit from it.

He said: “If you will spend one billion dollars or 100 billion dollars, you can either spend it on a number of people for a long period of time, or you can spend it on more people for a short period of time.”

Employer Federick, University of Michigan, is doing it already. The drug plans the prescription In two years If it is only used for weight loss.

Jimmy Bennett, spokesperson for Wegovy and Ozmpic Novo Nordisk, rejected the comment on the concept of Deprescription, noting that its drugs are dedicated to chronic conditions. “Speak to their health care provider about dose and duration needs.”

Studies have shown that people usually recover A large amount of weight Within a year Glp-1 stopping medicationsAnd that many people who eventually left return to drugs.

“There is no criterion for care or the golden standard on how to weaning now,” he said, he said Alison AdamsObesity and internal medicine doctor with health care in the United Kingdom in Kentucky.

But mathematics explains the reason for the attractive coverage of time for the motivated who are struggling to pay the costs of the recipes benefiting from the GLP-1, Michelle JordinCVs Caremark.

“From a rock and a difficult place.” “They will have to look at everything and trim dollars everywhere they can.”

Pennsylvania was looking for strategies to save costs even before the new federal spending law, according to Brandon Kawina, the press secretary of the state’s humanitarian services management. Pennsylvania spends $ 1.3 billion on GLP-1 drugs this year.

Federick said that the plans may witness real savings, if they cover the GLP-1 for the loss of initial weight, then transfer people to cheaper options-such as reasonable drugs or behavioral health programs-to preserve them.

Many companies are keen to sell insurance companies, employers and individuals on behavioral alternatives. one power healthand Which announces Weight management program that focuses on nutrition as “a” stabilized approach to the GLP-1 clinical “. A study funded by Virta 154 people suffering from type 2 diabetes who stopped using GLP-1 drugs but continued to follow the Virta program, and concluded that their weight did not increase significantly after a year.

The researchers of the European weight management company as well I mentioned recently This extract slowly from medications may help maintain weight loss.

“The initial question” for employers and insurance companies was whether to cover the GLP-1 for obesity, “said Sami Inkinin, CEO of Virta. “Now, basically, everyone comes to the middle and asks,” How do we cover these medications with responsibility? “

Ancinin said that part of the responsible coverage is to provide other forms of support to patients who stop using GLP-1 drugs, by choosing or otherwise.

However, for some people, maintaining weight loss without GLP-1 is still a challenge, even with other options available.

Laila, who lives in Michigan, lost about 80 pounds in about 18 months on Weghfi. But she had to leave drugs when she reached 26 and left her parents’ insurance plan this year. The plan of the employer has stopped covering the GLP-1 to lose weight soon.

She tried Lily, who only asked to get to know her first name because she was not outside her family as a transgender, other drugs since then, and previously tried to lifestyle to control her weight. But she said nothing is working well for her as she dies.

I have recovered 20 lbs since I got out of the medicine at the beginning of the year and worried that the number will continue to rise, which may contribute to future health problems.

“Just give people drugs,” she said. “It looks cheaper and safer in the long run.”