Insurers Tightening Coverage: Diabetes Patients in the US Experience Delays – The News Teller

Title: Type 2 Diabetes Patients Struggle to Access Medication for Weight Loss as US Insurers Tighten Restrictions

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Some patients with type 2 diabetes are facing difficulties in accessing drugs like Ozempic for weight loss as US insurers implement restrictions to deter doctors from prescribing these medications. The tightening of health plan management for GLP-1 drugs, including Ozempic, has caused a decline in US prescriptions, according to Novo Nordisk, the Danish drugmaker.

Novo Nordisk, the manufacturer of Ozempic, confirmed the trend and assured that they are working to minimize disruptions for type 2 diabetes patients. However, patients are reporting challenges in obtaining reimbursement for Ozempic or other similar drugs such as Mounjaro, manufactured by Eli Lilly.

A survey conducted among 24 diabetes patients on Reddit highlighted that 13 of them encountered recent issues with their health plans covering Ozempic or Mounjaro. Insurers now require patients to try other medications before Ozempic or Mounjaro can be prescribed, resulting in delays and potential interruptions in treatment.

Furthermore, some patients experienced adverse effects when forced to switch from Ozempic to Trulicity, an older drug. This raises concerns not only about the availability but also the suitability and safety of alternative medications for individuals.

Ozempic was approved by US regulators for diabetes treatment in 2017, and Mounjaro gained approval in 2022. These drugs, currently sold as Wegovy and Zepbound for weight loss, mimic a hormone called GLP-1 to regulate blood sugar, slow digestion, and suppress appetite. Due to their efficacy in preventing serious complications such as kidney failure and amputations, most US health plans cover GLP-1s for type 2 diabetes.

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However, insurers’ imposition of prior authorization requirements has become a major barrier to accessing these medications. A recent survey revealed that 74% of large employer-based health plans mandate prior authorization for GLP-1 drugs. This bureaucratic process of seeking insurer permission can cause delays for patients, hindering their ability to begin or continue vital treatment.

While the average number of weekly Ozempic prescriptions rose by 33% between the first and third quarters of this year, it has since dropped by over 6%. This decline indicates the growing challenges faced by patients in obtaining reimbursement for these medications.

In preparation for changes in January, when individual health plans often introduce new coverage terms, doctors and patients are bracing themselves for potential disruptions. However, cost remains another worrisome concern, especially for patients with high-deductible insurance plans.

Eli Lilly continues to support individuals with type 2 diabetes in accessing Mounjaro, mentioning that some insurers may require confirmation of diagnosis or prior diabetes medication use.

Physicians emphasize the importance of patients remaining on their prescribed treatments to prevent complications such as heart disease, a leading cause of death among people with diabetes. Nonetheless, doctors express their frustration with the excessive paperwork and bureaucracy involved in obtaining prior authorization for essential medications.

As the dynamics of health insurance coverage continue to evolve, it is imperative to ensure that patients with type 2 diabetes have timely access to medications that are proven to be effective in their treatment and overall well-being.

Phil Schwartz

"Food expert. Unapologetic bacon maven. Beer enthusiast. Pop cultureaholic. General travel scholar. Total internet buff."

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