My ACA insurance (because I was unemployed) covered Rybelsus (pill form, which is a much higher dose due to lack of absorption through the stomach), then in like October or November they said "nah" and said "go to Ozempic" I had just completed my first two sets of increases before the final uppage to be on the stable dose, when insurance said "Nah." So my doc RX'd Trulicity to see if they would cover that, which, for some reason they also didn't. I haven't had the time or energy during the holidays to deal with it, so now I'm dealing with increased hunger from going cold turkey off these things all because of bullshit micromanagement from shitty insurance companies on the market place.
If this makes it better and easier for companies to actually pay out for this I am 100% for it, there should not be a constant jerking about for what is or isn't paid. Also - this wasn't for weightloss (which I assume would have been Wegovy approved), this was for diabetes, and it was under control with Rybelsus, and I assume Ozempic, though we were still in the process of building up to it (I was on max dose of Rybelsus and I'm pretty sure I needed the max Ozempic as well). If they had given a reason for the denial it'd be one thing but it was just a blanket denial.
I just hope this makes it easier for folks who need it to be able to obtain it.
Very glad to see this, it's worth noting that the compounded semiglutide pricing (think generic, although it's more complicated than that) has been plummeting ever since it was introduced onto the market. We've seen some pretty incredible results and I really hope they get cheap enough to be prescribed more widely.
It would be easier to squeeze Novo if they included Zepbound from Eli Lilly in the mix - we could argue that if we're going to spend unfathomable amounts on these medications we might as well buy the more effective medication from an American company.
> Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments
Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.
Interesting that they're negotiating semaglutide (Ozempic/Wegovy) but not tirzepatide (Zepbound/Mounjaro). Cynically, maybe a ploy to bolster a US pharma (Lily) as opposed to Danish Novo? I don't know anything about how this program selects drugs to negotiate.
If you were a drug company how much money would you spend on developing an Ozempic/Wegovy follow on drug?
Price controls like this are popular because the benefits are easy to see and the costs are distributed and nebulous. Excepting things like the fires in LA which are distributed and obvious.
The fact that it's up to the insurance provider to choose what medication they cover is so absurd. Your doctor can prescribe medication, and the insurance company can say, "Nah, we choose not to cover that. And we don't cover the generic versions either!"
It's so shitty when you have to change insurance plans, and then get stuck holding the bill for medication that you were taking, but is no longer covered under your new plan -- especially for weight loss drugs that don't seem to be even like 80% covered under any plan you can get on your own.
Insurance should cover everything. Period. Full stop. Just because you change jobs doesn't mean you should ever have to change medications.
Just coming here to say that most of the world (outside the USA) does not need Ozempic at all to be healthy. So maybe this medication is really a luxury.
I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more. At least looking at USA from Europe. The problem of sugar content, dietary choices and portion sizes remains. It is similar to gas guzzling cars.
Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.
Edit:
To serious answers: I was wrong, I stay corrected.
The tradeoff with these price controls is that they make current medications cheaper, but make future medications substantially less profitable, making them less likely to be developed.
It's rare to see this mentioned, so I'm trying to build awareness.
I find something really gross and dystopian about the idea of Ozempic. Developing the willpower to resist short-term gratification, and the ability to make long-term decisions about your diet and health are some of the most important ingredients to living a good life. The idea of letting a drug do the thinking for you because you just can't trust yourself really horrifies me.
Ozempic and Wegovy are selected for Medicare's price negotiations
(apnews.com)188 points by geox 17 January 2025 | 329 comments
Comments
If this makes it better and easier for companies to actually pay out for this I am 100% for it, there should not be a constant jerking about for what is or isn't paid. Also - this wasn't for weightloss (which I assume would have been Wegovy approved), this was for diabetes, and it was under control with Rybelsus, and I assume Ozempic, though we were still in the process of building up to it (I was on max dose of Rybelsus and I'm pretty sure I needed the max Ozempic as well). If they had given a reason for the denial it'd be one thing but it was just a blanket denial.
I just hope this makes it easier for folks who need it to be able to obtain it.
> Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments
Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.
The pharmacies are also in on it https://pmc.ncbi.nlm.nih.gov/articles/PMC11147645/
Price controls like this are popular because the benefits are easy to see and the costs are distributed and nebulous. Excepting things like the fires in LA which are distributed and obvious.
It's so shitty when you have to change insurance plans, and then get stuck holding the bill for medication that you were taking, but is no longer covered under your new plan -- especially for weight loss drugs that don't seem to be even like 80% covered under any plan you can get on your own.
Insurance should cover everything. Period. Full stop. Just because you change jobs doesn't mean you should ever have to change medications.
Anyway, Free Luigi! =P
Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.
Edit: To serious answers: I was wrong, I stay corrected.
It's rare to see this mentioned, so I'm trying to build awareness.