As a healthcare professional, I have seen firsthand the struggles that individuals with type 2 diabetes face when it comes to managing their weight. Fortunately, there are FDA-approved medications that can help with weight loss, such as Ozempic (semaglutide) and Mounjaro (tirzepatide), which may be covered by your insurance. However, recent proposals have raised concerns about the coverage of these weight-loss drugs under Medi-Cal, California's health insurance program for low-income individuals. It's no secret that many insurance companies, including commercial insurers and Medicare/Medicaid, do not cover weight-loss drugs. In fact, Medicare is prohibited by law from covering them.
This is because weight loss is often seen as an aesthetic need rather than a medical one. However, the American Medical Association (AMA) disagrees with this viewpoint, which we will discuss in more detail later on. If you are considering taking prescription medication for chronic weight management, it's important to know which drugs are approved by the FDA for this purpose. Currently, there are six FDA-approved medications for long-term use: orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Zepbound). Four of these medications are approved for adults and children ages 12 and older.
Additionally, there is another approved medication called setmelanotide (IMCIVREE) that is limited to individuals with specific rare genetic disorders, as confirmed by genetic testing. If you are prescribed one of these medications, you can continue taking it as long as you are benefiting from the treatment and not experiencing any serious side effects. But what about injectables specifically approved for weight loss? Recently, the FDA approved versions of the GLP-1 drug, such as Wegovy (semaglutide), Saxenda (liraglutide), and Zepbound (tirzepatide), for chronic weight control. According to the FDA, these prescriptions are meant to be used in conjunction with a low-calorie diet and exercise to manage weight and reduce the risks of obesity-related diseases. However, your health insurance may not cover these medications unless you have a medical condition related to obesity, such as high cholesterol or high blood pressure. Having a high BMI that indicates obesity or being overweight may not be enough to qualify for coverage.
The newest prescription drugs approved for treating obesity are Wegovy (semaglutide) and Zepbound (tirzepatide). Other older medications include Saxenda (liraglutide), Contrave (naltrexone-bupropion), Alli and Xenical (orlistat), and Qsymia (phentermine-topiramate). Studies have shown that prescription weight-loss medications used for more than 12 weeks, known as long-term use, result in significant weight loss compared to inactive treatment with no medication (also known as a placebo).Rapid weight loss can often lead to sagging skin and wrinkles. Some medications are approved for individuals who are obese, while others are also approved for those who are classified as overweight but not obese.
If you are an adult with a BMI that indicates you are overweight or obese, your healthcare professional may prescribe a medication to help with weight loss. You may have heard the term "face from Ozempic" used to describe the change in appearance of individuals who have lost a significant amount of weight. Under the brand name Ozempic, this medication is approved for treating type 2 diabetes. However, under the brand name Wegovy, it is approved for weight loss. Taking these medications for a year can result in a total body weight loss of 3-12% more than what is achieved with lifestyle changes alone.
Losing between 5-10% of your starting body weight can have significant health benefits, such as improving blood sugar, blood pressure, and triglyceride levels. Over the course of a year, individuals who take prescription weight-loss medications in addition to following an exercise and healthy eating program lose 3-12% more of their starting weight compared to those who only make lifestyle changes. In a 17-month study specifically looking at the effects of Zepbound on obesity, individuals taking the highest dose (15 milligrams) lost an average of just over 20% of their body weight. When comparing studies that measure how a 2-milligram dose of Wegovy affects weight loss in individuals with type 2 diabetes, Zepbound remains the top choice. Losing fat in the face can change the shape of features and make the eyes and cheeks appear sunken. While Ozempic is primarily used for treating type 2 diabetes, some doctors also prescribe it for weight loss.
However, there have been anecdotal reports of patients who stop taking one of these medications because their insurance no longer covers it or they switch to a new insurance company (e.g. due to a job change) and are no longer eligible for coverage. Under the governor's proposal, weight-loss drugs Ozempic and Wegovy would no longer be covered by California health insurance for low-income individuals. As a healthcare professional, I believe it is important to advocate for the coverage of these medications for individuals who can benefit from them. Weight loss is not just about aesthetics, but also about improving overall health and reducing the risk of obesity-related diseases.
If you are considering taking prescription weight-loss medication, talk to your healthcare provider about your options and whether they may be covered by your insurance.
