Though I'm prediabetic, I only weigh 128 pounds (making my BMI 22) and have been thin most of my life, so Ozempic wouldn't be an option for me, even if I went into type 2 diabetes, unless my BMI was greater - so this post is for anyone who does qualify and is considering Ozempic (or even if you don't and just want to use it for weight loss and pay out of pocket, as many do).
And though I'd like to lose 10 pounds still, I'm not about to use Ozempic for it, because temporary use isn't what it's designed for and there is a proven boomerang effect in doing so - you will gain all of your weight back (and then some, if you don't also diet and exercise), with a couple of months.
But before I get to the specifics of Ozempic, a little background ...
So most people know what I do for a living, and that Contract #1 is transcribing the price-test marketing interviews before new drugs launch, between Big Pharma and insurance companies, both public and private, as well as key-opinion-leading clinicians.
Unfortunately, the interviews have dwindled since the Inflation Reduction Act, which goes into full effect in 2025, and isn't targeting inflation as a whole, nor is it regulating prices (I wish).
The IRA only targets Medicare copays - meaning that as of 2025, Medicare members will never pay more than a $50 copay for any pharmaceutical drug, regardless of the price.
Also, Medicare will drop a list of 10 medications every September which Medicare will offer to renegotiate lower prices on, and if pharma won't negotiate, they will no longer be covered - and private insurance will reflect those prices (though will pay slightly more).
Thus, though passed two years ago, it doesn't officially go into effect until 2025, and they've also dropped the first list of target drugs last September as a warning shot - which has left insurance companies and pharma scrambling to figure out how to accomplish this (without actually dropping the price, of course, though some did for insulin before the last list was dropped last year because they knew they'd be on it). 😂
The government doesn't care HOW pharma and insurance companies accomplish this, just that they get it done, so that no Medicare patient ever pays more than $50 for a prescription.
What this means for me and Contract 1 is, I guess there's no sense in doing price-testing if you know you're going to overcharge and may end up on Medicare's shit list, with the Medicare consumer now paying no more out of pocket for any drug than a $50 copay anyway, right? 😂
Thus, the work has dwindled over the past year with Contract 1 and so I picked up Contract 2, going back to regular medical transcription. It takes me 1-1/2 days at Contract 2 to make what I could make in a 3 hours with Contract 1, but c'est la vie; this is the going rate for medical transcription, now, after competing with electronic medical records and outsourcing to India still, when we used to make $50K with benefits.
(At least this newer, smaller company is fair with QA, not cutthroat over few resources, and verbally abusive and bullying because you're not face-to-face, like other companies, and that's worth a million to me!)
ANYWAY - to the point of this post, finally ...
The work that I have received is regarding "me-too" Ozempic-like drugs coming out soon, and I just learned that the the Novo Nordisk type 2 diabetes/weight loss injected drug, semaglutide - the active ingredient their drugs Ozempic, Wegovy and Rybelsus (oral formulation) - has boosted the national GDP of Denmark by 1.7% in 2023, and is expected to rise to 2% in 2024.
So essentially, because the U.S. pays the most for pharmaceuticals out of any country in the world, we have paid for the boost in Denmark's economy - so Denmark is a wealthier country because of semaglutide, mostly because of us!
You're welcome, Denmark! 😂
I say that because America, paying the outrageous prices that we do for drugs compared to the rest of the world, is largely responsible for that boost.
So what is semaglutide and how does it work?
Thus, all of this combined will result in weight loss - on average, at least 20 pounds, but up to 75 pounds has been recorded IF you also diet and exercise, too (and the effects are sustained longer, and more weight is lost, if you also diet and exercise).
Additionally, we already knew that semaglutide showed a reduction in cardiovascular events in people with type 2 diabetes due to the original 2016 SUSTAIN clinical trial, but in November 2023, the SELECT clinical trial just proved that even people without type 2 diabetes showed a reduction in cardiovascular events. (New England Journal of Medicine.)
Then just this past May, a European study showed that semaglutide also reduced the risk of kidney failure in people with type 2 diabetes (not yet published in the NEJM or can't find yet).
Though this study hasn't been done in non-type 2 diabetics yet, we can extrapolate, to a certain degree, that the same would happen in non-diabetics, just like the cardiovascular reduction.
Sounds like a wonder drug, right?
Somewhat, but not so fast - there are some things to consider - especially if American.
THE COST
The official FDA label states that semaglutide (as the injectible product Ozempic) is only indicated for blood sugar control for type 2 diabetics with a BMI over 27% - NOT weight loss.
If you're not diabetic and you want to use injectable semaglutide for weight loss only, you have to buy the exact same semaglutide from the exact same company, only called Wegovy.
(FYI, Novo Nordisk also makes Rybelsus, which is an oral formulation of semaglutide for needle-phobics, but it's less effective and only costs $50 less than the more-effective injection, so most people opt for the injectable.)
Why does the same product, by the same company, have two different product names and lines?
Because Novo Nordisk knew that insurance companies do not cover weight loss drugs. So if they put both blood sugar control AND weight loss indications on the same label for the same product, insurance companies would never cover it, and thus, the product would never be used, for either blood sugar control OR weight loss.
Thus, the solution was to then put the same drug out as 2 separate products, with 2 separate indications.
Smart move, right?
And it worked - your insurance WILL cover Ozempic *IF* you're a type 2 diabetic using it for blood sugar control (after you've tried 1 or 2, even 3 other products first, because of the price).
However, if you're NOT a type 2 diabetic and using it instead for weight loss only, then you MUST use Wegovy and your insurance will NOT cover it - UNLESS - your employer has specifically "carved out" a weight-loss rider on your employer's health plan, but this is rare.
And the cost?
Yes, please - at least and especially with pharmaceuticals.
That's like buying a car every year for the rest of your life!
(For why the pharma market doesn't play by the same market rules as every other product, keep reading below.)
1. A certain amount of volume of Ozempic will be bought over a year's time.
2. Ozempic is their preferred drug over Trulicity (another GLP-1 with somewhat less efficacy), or even excludes Trulicity altogether off their formulary.
3. There will be no prior-authorization requirements other than what's on the label - the doctor attests they have type 2 diabetes without lab-test documentation, 27% or higher BMI - period.
4. There will be no more than one step through another drug first, such as metformin, before you can to get to their drug.
1. Put Ozempic on the formulary - BUT - at parity price to Trulicity, with no volume-utilization guarantee, and they'll just let the prescribers and the market decide what's best to use for the patient.
2. Need at least a 2-year price-freeze.
3. Require patients to get a prior authorization before approval, such as producing lab tests to prove type 2 diabetes rather than just physician attestation, that your BMI must be 35% rather than 27%, and that an endocrinologist has to prescribe it rather than your PCP.
4. Require that patients must have tried metformin and an SGLT first.
5. Require that patients also have to subscribe to a third-party digital health and wellness program for diet and exercise, to ensure optimum outcomes, with proof of usage and results before they'll reauthorize it, next year.
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