US diabetes patients face delays as insurers tighten Ozempic coverage

Some patients with type 2 diabetes say they are having more difficulty getting reimbursed for drugs like Ozempic as U.S. insurers implement restrictions designed to deter doctors from prescribing the medication for weight loss.

Novo Nordisk confirmed in a recent email that it is seeing tighter health plan management of GLP-1 drugs including Ozempic and is working to minimize disruption for type 2 diabetes patients. The trend has contributed to a recent dip in U.S. prescriptions, an executive at the Danish drugmaker said at an investor conference last month.

Out of 24 diabetes patients contacted by Reuters on Reddit, 13 reported recent problems getting their health plans to cover Ozempic or Mounjaro, a similar drug sold by Eli Lilly.

Elizabeth Beddow in Texas said her Blue Cross Blue Shield plan required two other drugs be tried before it would pay for Mounjaro, which her doctor prescribed after a diagnosis of type 2 diabetes. Instead, she was prescribed Ozempic in March, which caused extreme fatigue and gastrointestinal issues.

In September, Beddow, 57, was switched to an older drug, Lilly's Trulicity, but said her blood sugar levels are still rising.

Having to start a low dose before moving up to a maximum dose with two different medications was "really hard on my body," she said. "Ironically, my insurance covers Mounjaro without step therapy on January 1."

U.S. regulators approved Ozempic for diabetes in 2017 and Mounjaro in 2022. The drugs, more recently sold under the brand names Wegovy and Zepbound for weight loss, are designed to mimic a hormone called GLP-1 to regulate blood sugar, slow digestion and suppress appetite.

Most U.S. health plans cover GLP-1s for type 2 diabetes, which if uncontrolled can lead to serious complications, including kidney failure and limb amputations.

Sales of the self-injected medications, which have U.S. list prices of over $1,000 a month, quickly soared into the billions, making the companies among the world's most valuable. Sales have been limited in large part only by manufacturing capacity.

https://finance.yahoo.com/news/focus-us-diabetes-patients-face-120000464.html