How can prescription drugs help people dealing with excess weight?
Most people who have used medications to help them lose weight report making better decisions about food, thinking about it less, and feeling more in control. These medications work best when you use them with planned meals, exercise, and other healthy behaviors. How do weight loss medications work? When people lose weight, their body begins sending signals to the brain that there is a decrease in stored energy. The brain then sends hormonal and chemical messages that increase appetite, hunger, and cravings. Losing weight and keeping it off is difficult because these signals last until the person has regained most of the weight back. Weight loss medications target these signals and decrease their effect.
Are weight loss medications safe?
Weight loss medications are currently approved as safe by the FDA for long term use. Many of these are undergoing longer-term studies. Each medication has individual risks and benefits. The decision to start a weight loss medication should be individualized with the patient and the health care team. Other benefits of medications: Most medications lead to decreased blood pressure, blood sugar and cholesterol levels because of the weight loss they cause. Some prevent diabetes.
Which medication is right for me?
The first step is to determine your insurance coverage. Some weight loss medications can be cost prohibitive without insurance coverage, so it’s important to be realistic about your options. Each of these medications has different benefits and side effects. They may cause problems with medications you already take. Your doctor can help you decide which is best for you. You might have to try several different medications until you get one that works well. The right medication will help you control portions, decrease snacking, and choose healthier food by decreasing your hunger or cravings. When taking weight loss medications if you do not lose 5% of your starting weight in three months, there is unlikely to be further weight loss. An alternative medication should be discussed with your doctor as a next step.
Will I have to use them forever?
Most people will lose weight for 6-12 months on a weight loss medication, followed by weight maintenance. We are still learning about weight loss and keeping it off long term. Some people will benefit from using these medications to get started. Most will need to keep using them to maintain their weight loss. If a weight loss medication is stopped, there is a strong likelihood that the weight will be regained. Talk to your doctor about what is best for you.
Does my insurance cover the cost of weight loss medications?
Even if a weight loss medication is medically necessary, coverage for the medication is determined by the terms of your policy which supersedes medical necessity. In other words, even if you need the medication insurance will only pay if it is a covered benefit. If the medication is excluded from coverage, you can still fill the prescription but will have to pay out of pocket. Appeals are not possible for drugs excluded from coverage because the denial is not based on medical necessity. The Medicare prescription drug program specifically excludes coverage of anti-obesity medications.
How do I check my insurance benefits?
There are several ways you can find out what weight loss medications are a covered benefit of your insurance policy. It is helpful to find out what medications are a covered benefit of your health insurance policy. Read the drug formulary list in your insurance policy documents or on the website.
Formulary lists are specific for your policy and are divided into drug classes so all weight loss medications will be grouped together. Drugs may be listed at different co-pay tiers and/or have requirements for prior authorization or step therapy.
Call customer service.
The number for customer service is located on the back of your insurance card. Ask if you have “coverage for antiobesity therapy” or are weight loss medications a “formulary exclusion.” If covered, inquire which medications and any requirements for coverage. Ask your human resources department. For employer-based group health plans, coverage for weight loss medications is determined by the employer. Many employers opt-out of coverage to allow for lower monthly premiums. Your human resources department will be able to tell you if antiobesity therapy is a covered benefit.
Injectable GLP-1 Medications FDA-Approved for Weight Loss:
Liraglutide (Saxenda)
1 shot a day
Average weight loss 5-10% initial body weight
Semaglutide (Wegovy)
1 shot a week
Average weight loss 10-15% initial body weight.
GLP-1 medications work in the brain to decrease hunger and food cravings.
Side effects: May cause nausea, constipation, diarrhea, acid reflux, vomiting. Side effects tend to subside over time and are less with smaller meals and avoiding high-fat foods. The dose is slowly increased over several months as tolerated and as needed to achieve weight loss goal.
Contraindications: History of pancreatitis, history (or family history) of medullary thyroid cancer or multiple endocrine neoplasia type 2.
Cost: It’s your responsibility to determine if Saxenda or Wegovy are a covered benefit of your health insurance policy. You can determine coverage and estimated cost information from your insurance company online in real time.
Check your insurance benefits for: Wegovy at
https://www.novocare.com/wegovy/cost-navigator.html
Check your insurance benefits for: Saxenda at
https://www.novocare.com/saxenda/cost-navigator.html
Without insurance coverage, the cost for a one-month supply of Wegovy is approximately $1,700. If your insurance does not cover Wegovy, you can save up to $500 per 28-day supply of Wegovy with the savings card at https://www.novocare.com/wegovy/savings-card.html. The cost for a one-month supply of Saxenda is approximately $1,700.
If your insurance does not cover Saxenda, you can save up to $200 per 30-day supply of Saxenda with the savings card at https://www.novocare.com/saxenda/savings-card.html.
Injectable GLP-1 Medications FDA-Approved for Diabetes Only:
Tirzepatide (Mounjaro)
Semaglutide (Ozempic)
Dulaglutide (Trulicity)
These medications are NOT covered by insurance without a diagnosis of diabetes. Mounjaro, Ozempic and Trulicity are FDA-approved for the treatment of type 2 diabetes. Even if your insurance policy says these drugs are covered, documentation of a diabetes diagnosis must be submitted for approval. Additional
Medications for Weight Loss:
Phentermine-topiramate (Qsymia)
1 pill a day Average weight loss: 5-10%
Targets centers in the brain involved in appetite and fullness.
Side effects: May cause dry mouth, metallic taste in the mouth, tingling sensation in the fingertips or toes, insomnia, dizziness.
Cost: With no insurance coverage, the price of Qsymia is $128 for 30-day supply.
Qsymia Home Delivery offers a cash-only (no insurance) discounted price of $98. If you choose to use Qsymia Home Delivery, a new prescription will be sent on request. For more information on Qsymia discounts visit: https://qsymia.com/patient/multiple-ways-to-save/
Naltrexone-bupropion (Contrave)
2 pills twice a day Targets the brain to decrease hunger and food cravings.
Side effects: May cause nausea, constipation, headache, insomnia, increased blood pressure.
Cost: You can use the Contrave Coupon Savings Card Program at your local pharmacy. If your insurance covers Contrave, you may pay as low as $20. If you don’t have insurance or if your insurance doesn’t cover Contrave, you will pay no more than $199.
Visit https://contrave.com/save/ to download the Contrave Savings Card. Contrave Home Delivery from Ridgeway Mail Order Pharmacy offers a cash-only (no insurance) discounted price of $99. Sign up at https://www.ridgeway.pharmacy/signup/contrave. If you choose to use Ridgeway Mail Order Pharmacy, a new prescription will be sent on request.
Plenity
3 pills twice a day before meals with 16 ounces of water
Creates a hydrogel to fill the stomach and make you feel full.
Side effects: Diarrhea, distended abdomen, infrequent bowel movements, and flatulence.
Cost: $99 per month. Not covered by insurance.
Mail order pharmacy https://www.gogomeds.com.
Orlistat (Xenical, Alli OTC)
1 pill 3 times a day with meals
Decreases absorption of the fat you eat.
Side effects: May cause diarrhea, oily stools, gas.
Phentermine (Adipex, Lomaira)
Adipex: ½ or 1 pill a day
Lomaira 1 to 3 pills a day
FDA approved for short term use (12 weeks): Targets centers in the brain to decrease hunger. Lower doses of phentermine may be used for long term with close medical supervision.
Side effects: May cause dry mouth, constipation, insomnia, increased blood pressure, rapid heartbeat, anxiety.
Other medications: Older medications and medications used to treat other conditions that have a side effect of weight loss can be used for weight loss under medical supervision by a qualified obesity-medicine specialist.
Not for everyone
Antiobesity medications are approved for those with obesity with a body mass index (BMI) of 30 or higher or people with a BMI above 27 and at least one serious health complication because of their weight.
weight loss. But the most important thing to remember is that no matter what, you must do your part. Your diet, exercise and lifestyle are the key critical components to being healthy and never lose sight of that.
