In states that don’t pay for obesity drugs, ‘they might as well never have been developed’
Joanna Bailey, a GP and obesity specialist, doesn’t like to tell her patients not to use Wegovy, but she’s gotten used to it now.
About a quarter of the people she sees at her small clinic in Wyoming County would benefit from the weight-loss drugs, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance to cover the cost, and virtually none can afford the sticker prices of $1,000 to $1,400 a month.
“Even my wealthiest patients can’t afford it,” Dr. Bailey said, citing something many doctors in West Virginia — one of the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated the haves from the have-nots.”
Such disparities widened in March when the Public Employees Insurance Agency in West Virginia, which pays the bulk of prescription drug costs for more than 75,000 teachers, municipal and other government employees and their families, canceled a pilot program for weight-loss drugs.
Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to control diabetes Medicare covers Wegovy and Zepbound only if they are prescribed for heart problems.
Over the past year, amid rising demand, states have been trying to determine how much to expand coverage for government workers. Connecticut does on the right track to spend more than $35 million this year through a limited weight loss coverage initiative. In January, North Carolina announced it would stop paying for weight-loss drugs after earmarking $100 million for them by 2023 — 10 percent of prescription drug spending.
The problem isn’t limited to public programs. Blue Cross Blue Shield of Michigan, the state’s largest insurer, paid $350 million in 2023 for the new classes of obesity and diabetes drugs, a fifth of its prescription drug spending, and earlier this month announced it would be canceling coverage of the drugs in most commercial plans.
West Virginia’s program for government workers was limited to just over 1,000 people, but at its peak — despite rebates from manufacturers — it cost about $1.3 million a month, according to Brian Cunningham, the agency’s director. Mr. Cunningham said that if the program were expanded, as intended, to cover 10,000 people, the program could ultimately cost $150 million a year, more than 40 percent of current prescription drug spending, which would to serious premium increases.
“I’ve been up at night pretty much since I made this decision,” he said. “But I have a fiduciary responsibility, and that’s my biggest responsibility.”
But for Dr. Bailey and other obesity doctors in the state, the decision was maddening. She said it showed a lack of understanding that obesity is medically classified as a “complex diseasein the same category as depression and diabetes.
Laura Davisson, director of the weight management program at West Virginia University Health System, found that patients taking anti-obesity medications at her clinic lost 15 percent more weight than those who relied solely on diet and exercise. Local legislators have jurisdiction over drug coverage in state programs such as Medicaid, and Dr. Davisson has lobbied in recent months to maintain the Public Employees Insurance Agency pilot program and expand coverage for weight-loss drugs more broadly, but has not made much progress. So far, the issue has not found political resonance, with leading elected officials in the state largely remaining silent.
“Almost everyone is the same,” she said. “They say, ‘I would like to treat obesity. I would like to help people. It’s just too expensive.’ But you can’t not treat cancer because it’s too expensive. Why would you do that with obesity?”
Christina Morgan, a political science professor at West Virginia University, started taking Zepbound in December as part of the state’s obesity drug pilot program. By March, she had lost 30 pounds. Her blood pressure dropped, as did her blood sugar levels. When she heard the program was being canceled, she was distraught.
“I’ll be honest,” she said. “I can’t afford this out of pocket. It’s just not feasible.”
Her doctor warned her about gaining weight and explored her options before her drug coverage expires in July. They were scarce. “She said, ‘Listen – I don’t want you to be diabetic, but if you are, you qualify for this drug,’” said Dr. Morgan. “It’s mind-boggling. They would rather have you get sicker to take this drug.”
In some ways, doctors, patients, health organizations, and pharmaceutical companies are at odds with employers and government health plans in the battle for access to weight loss medications.
Novo Nordisk, which sells Ozempic and Wegovy, and Eli Lilly, which sells Zepbound and Mounjaro, are top donors to America’s largest obesity advocacy groups and are well represented at medical conferences. Most manufacturers mention the stigma surrounding weight on their websites and present their products as ways to, as Novo Nordisk puts it, “change the way the world views, prevents and treats obesity.” And in recent years they have succeeded to some extent.
Although Novo Nordisk and Eli Lilly are promoting coupons for patients with commercial insurance and giving deep discounts to employers and government programs that cover the drugs, Mr. Cunningham said the costs were still staggering for the health care system and for most patients in West Virginia and that claims of social justice could ring hollow from two companies worth more than $1 trillion.
Levi Hall, a pharmacist at Rhonda’s Pineville Pharmacy in Wyoming County, often turns away patients who come to him with prescriptions for the drugs, citing a shortage of supply or exorbitant prices. “It’s like that Geico commercial where the guy has a dollar bill on a string, and he keeps pulling it away when you get close,” Mr. Hall said. “You just can’t get it.”
Mr. Cunningham said he also worried about possible long-term side effects of the drugs that are not yet known, and he noted that West Virginia had good reason not to trust big pharmaceutical companies. The state has been at the center of the nation’s opioid epidemic, with the highest rates of opioid and prescription painkiller overdoses in America. That started in the mid-1990s when Purdue Pharma marketed OxyContin in areas with high disability rates to treat a silent “pain epidemic.”
“The drug companies have created a narrative and have been very effective in creating a coalition of do-good nonprofits, and putting pressure on doctors to prescribe this,” Mr. Cunningham said, referring to obesity drugs .
Mollie Cecil, an obesity doctor from Lewis County, W.Va., acknowledged this skepticism and said her patients sometimes expressed their own distrust of big pharmaceutical companies. But she argued that drugs like Ozempic and Wegovy were categorically different from prescription opioids like OxyContin: They have been on the market for almost two decades, are highly effective and not addictive. And she added: “Obesity is not a silent epidemic. It is a very real epidemic.”
She continued: “So I would wonder if someone has a problem with anti-obesity medications in a way that they don’t have with other disease states. Why do they question obesity best practices and guidelines because of industry involvement, but not question other areas of medicine with the same involvement?”
Especially in West Virginia, Dr. Cecil said – where healthy food can be expensive hard to get and eating habits are passed down from generation to generation, often leading to increased risk of obesity, diabetes, fatty liver disease and stroke — there is an urgent need for medicine.
“These are really effective treatments, and they can make a difference in people’s lives here,” she said. “But they might as well never have been made.”
