Ozempic Wegovy Mounjaro and the other new weight loss drugs have changed the way we treat obesity.

Many physicians call them groundbreaking.

Thousands of patients who use them report amazing results.

As these meds become more.

And more popular.

People are asking.

How do they work?

Are they safe?

What are the side effects?

Are they available, affordable and for everyone?

I really was trying to avoid even starting the weight loss shots just because I'm like, Why is it so crazy right now?

Why is everybody on these?

I decided after trying different things like dieting and exercising that I did want to try something different.

Coming to you from the Universal Public Media Center.

Welcome to this community conversation.

The new weight loss meds, cure or craze?

Here's your host, Brittany Sweeney.

Welcome to this community conversation.

Obesity affects 42% of all.

Adults in the country.

According to the Centers for Disease Control and Prevention.

In addition, a Pew Research Center study reports that two thirds of Americans claim willpower isn't enough to lose weight.

It's little wonder, then, that the new weight loss drug so many people are talking about, such as this mpic.

We'll go v Majuro and Zip Bound are skyrocketing in popularity.

They've proven highly effective in helping folks lose weight.

These anti-obesity medications are in a class of drugs called G.L.

P one receptor agonists or GLP ones.

One in eight Americans have tried them.

Researchers originally developed them to treat type two diabetes, but discovered that they also decrease appetite and promote weight loss.

62% of those who have used one of these drugs did so to treat diabetes, heart disease or some other chronic condition.

While 38% use them for weight loss alone.

As reported in a recent KFF health tracking poll.

Now, that survey also found that younger.

Adults.

Are more likely to report taking GLP one drugs just for weight loss again, according to Pew.

Nearly 2 million people in the U.S. were taking GLP one medications in 2021, more than three times as many as in 2019, and the number keeps rising exponentially.

Even the investment firm Goldman Sachs has projected a blockbuster future in pharma sales for these medications alone.

So what should we know about these drugs?

Just how effective are they?

Who should use them?

What about safety and side effects?

Joining me now to help us understand more about these new medications is Dr. Angela magdaleno from Lehigh Valley Health Network.

Dr. Magdalena, thank you so much for joining us.

Thank you for having me.

So much to talk about today.

So let's get started.

GLP one.

What are they and how do they work?

Yeah, so GLP one agonists are peptide hormones and they mimic the natural GLP one that we make in our body.

Our natural GLP one only lasts for a few minutes.

These medications last up to a full day or a week.

The way that they work, they kind of work in a triple threat.

I like to say to help with weight loss.

They keep food in your stomach longer, their gut hormones, so they tell your body to hold on the food in the stomach longer so you're physically more full.

They work in the brain to decrease hunger, to decrease sugar, cravings, food in ways my patients put it.

Appetite goes down and then they treat insulin resistance.

They help with insulin sensitivity throughout the body and blood sugars.

And the insulin resistance is a common cause.

Why?

People are having trouble losing weight.

So through that kind of triple threat, it's kind of a new era of weight management medicines compared to our older generations that didn't have as much success.

Sure.

So it's not just the gut or working just in the brain.

It's all three of these different places firing together.

Exactly.

Okay.

So we hear words like semaglutide or turns at the tide.

What's the difference in those and how do they fit into GLP one?

So there's the GLP one.

Agonists are an entire class.

There's a pill version only semaglutide comes in a pill version.

There's a daily injection and there's the weekly injections.

Semaglutide and its cousin medicines are the GLP one agonist and then TRS appetite is the newer version.

It's GLP one agonist plus an additional gut hormone IP.

So the GOP ones are one gut hormone turns up and it's the newest one.

It just came out December of 2023 for weight loss and it is to gut hormones.

So it's slightly stronger, a little more benefit for weight loss.

Sure.

And so what do they treat?

We're hearing weight loss.

We're hearing diabetes.

I know that early on, you know, about a year ago, we heard that people who have diabetes can't get a hold of these medications.

So who is this for?

So it's for both.

So we have found that insulin resistance actually plays a huge factor in why so many people are having trouble losing weight.

The insulin hormone alone tells your body to store body fat.

So when patients have insulin resistance, that comes before pre-diabetes, even before diabetes, that insulin resistance prevents weight loss.

And so it's that struggle right there.

And then on top of it, it helps with appetite and keeping you fuller longer.

So it treats diabetes.

That's what it first came out for these this class of medicines in 2005 for diabetes.

And then we saw the weight loss success and now they're used for both.

Okay.

And so what are you hearing from your patients?

Are you do you have diabetes patients who can't get their medications because now everybody's using them for weight loss or has it kind of leveled out?

And what's the result from these drugs that you're hearing from your patients?

So the supply and demand has been a huge issue up and down when it comes to the medications.

There are versions of it that are only approved for diabetes, and then there are versions for the weight loss.

So it's they're trying to silo it so that the patients with diabetes can continue to get it, even if there's a short supply of the weight loss version.

But of course, there's been some chaos in there and some different prescribing practices kind of causing to the supply and demand issues.

Over the past few months, the supply has been a little better, but it was definitely a big headache for my patients and I with a lot of frustrations, you know, increasing a tradeable drug every month and then having no supply, you have to start back at the bottom dose.

Sure.

And for those who don't know, what does titrate mean?

Correct.

So it's most of these most of them are a once weekly injection.

When you have it in your abdomen or your outer thigh just into subcutaneous tissue, a teeny tiny little needle.

Even my patients who are nervous, it's small, but you take it once a week for four weeks.

And at the end of the four weeks you can increase the dose.

You don't have to.

But we kind of disguise discuss it with my patients.

It's very individualized about should we increase the dose or should we stay on that dose?

But you can increase the dose every four weeks.

For certain injectables, there's four or five doses for the newest Tas appetizer.

Six doses?

Sure.

So you work in the weight loss field bariatric surgery.

Now, these weight loss medications, how do you find what fits your patient?

How do you decide this is what's best and which specific medication to prescribe?

Great.

So when it comes to either medication management or bariatric surgery, I think is what you mean between how do I decide with my patients?

It's definitely a patient discussion.

It's very individualized.

It comes down to, I think most importantly is even taking a step back the pillars of weight management, kind of everybody has to do those.

So nutrition, exercise, behavior, change, water, sleep, stress management, the tools that we add to that won't work as well if you're not doing all of that.

So on top of that, then we add tools as needed to help the individual patient.

So for some patients, a medication is what they prefer.

They're scared of the thought of surgery.

For some people, the thought of a possibly life long injectable medicine for the rest of their life that's having supply issues and very expensive.

They don't like that idea and they'd rather have a one time surgery that gets them the results they want.

So it's very individualized.

Sure.

So how do you know?

You know, you get up, down, you get wegovy, you get them back.

How do you know which one to prescribe?

Or is it just what's in demand right now or what's in stock right now?

Great question.

So it partially depends on their diagnosis.

So for a patient with diabetes, they have the MPIC as Mpic is not approved for weight management.

That's more of a diabetes Trulicity.

Some of those other name brand ones.

When it comes to weight management, we have six Sendo, Wegovy and Zepp out of the brand names and I have been kind of using depending on supply and demand and what's in stock because both of the demand and supply for those have been up and down and then kind of discussing it with the patient.

The difference is that's my new differences.

But overall, the injectable medicines are kind of in a class of their own.

Does the patient have insurance coverage and what's available?

Sure.

Let's talk a little bit about that.

What obstacles, if any, have you seen when it comes to people filling these prescriptions and getting approval through their insurance company to cover it because they can get costly if you don't have insurance covering it.

So for weight loss specifically, that has been the biggest challenge.

My my personal experience has been about 50% of commercial insurances cover it still with paperwork prior authorization.

Most want you to be in a comprehensive, multi-disciplinary program, including those pillars of weight management that I discussed, which is what we do, where I work.

And then beyond that, we have to do the prior authorization paperwork to prove that you're doing all those things.

And then even then, some of them have complete plan exclusions where they do not cover any weight loss medicines.

So it's about a 5050, whether the insurance covers it after a lot of paperwork and hoops that my office has to jump through, or whether they say we won't cover this at all no matter what.

And I've had patients appeal.

And it really comes down to if the insurance covers or not.

If the insurance doesn't cover it, it's about $1,000 a month out of pocket.

Gotcha.

Well, that can be astronomical.

But some people out there are paying for it.

I've heard that That's a big supply chain issue as well.

You know, somebody can pay out of pocket.

They get it first kind of thing.

Are you hearing your patients shopping around a different pharmacies?

Yes, definitely shopping around.

Definitely using good our racks in different websites, coupon savings cards, tur zap attorneys appetite just came out with a viable option.

So right now, currently they're all in auto injectors where you just kind of push a button.

It goes in it's easy, doesn't take much thinking but there's appetite just came out with a vial and syringe where it kind of going back to old school and like insulin is completely out of pocket.

There is they won't go through insurance for this.

You buy it directly from them in a vial and that is still at least 399 per month.

And again, talking about these medicines as an added tool to the pillars of weight management, and these could be chronic lifelong for some people.

So definitely a big pill to swallow.

I'm sure.

As you mentioned, this could be a shot that you have to give yourself for the rest of your life if you want to stay on it.

What is the long term plan here?

Is there a long term plan for a lot of these medications, or have they just come out and it's like, let's try it and see if it sticks?

Well, now it's sticking.

So what's the long term?

So it depends who you ask about what the long term plan is.

The way that I approach it is I discussed this with my patients every patient before I start the medicine and I say that we have the pillars, weight management, and then we add the tools.

And if you're using a tool and then you stop using it, there's a chance that that weight comes back.

There's no guarantee.

We have no way to predict who will have success off the medicine and who won't.

But we do know that the clinical study showed that when patients stopped the medicine, they did have weight regain.

The question is how much?

For some people it was only a little bit.

For some people it was all the way they lost or more.

And I've seen all of that in my clinical practice, but I do have patients who want to come off of it or didn't plan on being on this forever or are paying out of pocket.

And so my personal thought about it is slowly tapering off kind of easing the body off of it rather than an abrupt cessation where maybe the hunger comes back rapidly in the food noise.

So I kind of do a slow, steady taper, which physiologically from a hormone standpoint, makes sense.

And I've had a few people have success, but I do kind of start with if you were on a blood pressure medicine and you stop it, your blood pressure goes up.

So I kind of try to explain that to the patients and and understand that they may want to stay on this long term if they're doing well on it.

Sure.

Let's talk about who should be on this versus who should not be on this.

So patients who are approved FDA approval for these medicines, patients with diabetes, metformin is still first line and then this can be added as an added medication for glycemic control for weight management.

These medicines are approved for patients BMI over 30 or patients with a BMI over 27 plus a weight related comorbidities.

So that would be something like sleep apnea, high blood pressure, cholesterol, diabetes.

And those are the two indications there is The new clinical study came out that showed Cardiovasc ocular decreasing risk of cardiovascular events in patients.

So it can it is also approved for patients with obesity plus cardiovascular disease.

Sure.

So who shouldn't take this?

Great question.

So contraindications, anyone with a hypersensitivity to the JLP one agonist?

Of course.

Always read the label and talk to your doctor about if this is for you.

But anyone with a family history or personal history of medullary thyroid cancer.

So the way I explain it to my patients in rats at high doses for their whole life during the studies, the rats had a higher chance of medullary thyroid cancer.

Rats have more of the C cells in their thyroid than we do.

They have a slightly more increased risk of this anyway.

There's been no known reported linked cases in humans related to these medicines, but there is a black box warning.

So I discussed that with every patient and I check if they have a family history of this rare thyroid cancer.

It's medullary thyroid cancer.

It's a very rare kind of thyroid cancer in humans.

So that would be a reason that a patient should not take it.

Another possible caution with use would be a history of pancreatitis.

This medicine is a gut hormone.

It works on the level of gut.

So certain gut conditions you would want to be very careful using this medicine.

It could predispose to another additional history of pancreas another episode of pancreatitis, which is severe stomach pain and vomiting.

Anyone with inflammatory bowel disease should discuss with their gastroenterologist.

Anyone with gallbladder issues should check and anyone pregnant.

No one pregnant should be trying to lose weight.

That's not the time we use these weight loss medicine.

So we want to be cautious with all of this.

Sure.

And I just want to touch upon side effects because there are some side effects that come with these medications, correct?

Yes.

Everything has risks and benefits.

Nothing's free.

Right.

So what are some of those side effects that you're hearing firsthand from the from the folks that you've prescribed it to?

So the most common side effects are definitely mild nausea.

Most of my patients tell me it's the day after the injection.

Some women describe it as kind of a yucky morning sickness.

Most people feel better if they eat it some small something, get it in their stomach and then it gets better.

Some people get worsening acid reflux and that makes sense of keeping food in your stomach longer so that acid reflux could occur.

And then constipation or diarrhea are both very common.

And they make sense because it's a gut hormone and it's impacting your gut.

We do talk about symptom release by educate all my patients that mild tolerable symptoms are okay.

That's the goal.

Anything severe or anything where you're calling out of work, Are you new to work?

No, it's not okay.

That's not the goal.

You need a lower dose then.

But most people feel better if they eat smaller, more frequent meals.

Really prioritize protein.

A lot of patients tell me they'll make dinner.

They sit down with a plate of food, they take two bites and they're full.

And they say to themselves, I'm going to take a few more anyway, because they're used to it.

And if they push past that, that's when they feel yucky and it kind of sits like Thanksgiving dinner in their stomach.

So most of my patients have said if they listen to that warning of, okay, I should stop and maybe save this for later, that's when they feel their best.

Absolutely.

And there's a warning for folks who are on these medications who are going to get surgery, correct?

Correct.

So because it keeps food in your stomach longer before surgery, you would want to hold this at least 1 to 2 weeks before you should talk to your surgeon and the anesthesiologist pre-op or the doctor who's prescribing the medicine.

But because it keeps food in your stomach longer when you're getting intubated prior to your surgery, there could be some residual food in there if you don't stop it in advance.

Okay.

So make sure you're checking with your physician before you have any kind of surgery or that kind of thing.

Absolutely.

Is there anything else you think patients should know about the GLP ones?

I think one one of the big things that I counsel my patients for is, you know, it's so important to really prioritize muscle and protein.

So movement, exercise what you're eating.

So a lot of people want to lose weight really fast.

They want to take these medicines and the way just comes off.

But I really try to personalize it and individualize it with my patients.

I think the goal is losing a half pound or £2 a week.

That is where, you know, you're mostly probably losing body fat.

You're not losing muscle.

So muscles and organ, it's so important to our overall health.

It decides our metabolic rate and keeps us healthy.

As we age, women lose 5% of their muscle mass every decade after age 30.

So it's critical that people on these medicines are trying to exercise at a strength training routine if they can, and eat enough protein.

And then that's how they won't lose their muscle while they're losing weight.

So that's really how I counsel my patients.

It's not about rapid weight loss.

It's about healthy weight loss.

You want to lose the body fat, not the muscle.

Dr. MAGDALENO This is some really wonderful information.

Thank you so much for joining us and explaining it all to us.

Thank you so much for having me.

Absolutely.

Well, patients have been prescribed these medications for a variety of reasons, everything from weight loss to diabetes and other health conditions.

We visited a business in Bethlehem where two of the women there are on the GLP one journey.

To a deep sleep and.

Then working in the world of skin care.

Britney Warner and Lyric Rigby are constantly surrounded by beauty stereotypes.

And because you have a rolling appointment here and through.

The two work together at Warner's Bethlehem Spa, glow with the flow, skin care and share a common goal of wanting to lose weight.

I was sick and tired of like my clothes not fitting right, and I just wanted to feel a bit more confident.

I wanted to go through my own, like, weight loss journey of working out and just eating healthier.

And it truly ended up not working out at all in the end.

And I just never saw progress.

When she went to Egypt.

Both women are now exploring the world of injectable GLP one's.

And I really was trying to avoid even starting the weight loss shots just because I'm like, why is it so crazy right now?

Why is everybody on these?

But so I decided after trying different things like dieting and exercising, that I did want to try something different because I did try a different weight loss route before with diet pills, and I did not like how they made me feel.

And I'm like, Well, these are horrible.

So what are my other options?

Being at your highest weight is so uncomfortable, especially if it's something you're not used to.

Although they share the same goal of setting a few pounds, the two are taking different avenues to get their medications.

Frisbie approached her primary care doctor and was told she was pre-diabetic.

Her physician then went over weight loss options, including bariatric surgery.

But I just felt like the surgery was so dramatic and like drastic, and I just didn't want to go that route.

So I told her that I was interested in possibly doing the injections.

And then she ended up saying, well, I was going to bring it up to.

The mom of two.

I ran into supply chain issues but was finally able to start using Zep down a tree zipper tied manufactured by Eli Lilly and Company.

But the reason that we also went with Zap was because the other options were not like, available.

They were in high demand, they were low stock, whatever the case may be.

It wasn't available.

In just a few short months time.

She lost £20, but due to more trouble getting her medication and having the pharmacy shop, she started the alternate medication.

Wegovy a semaglutide manufactured by Novo Nordisk.

I don't have time to search pharmacies for this medication.

Those same supply chain issues are the reason Warner took another row.

I decided to go with a med spa because I saw the difficulties of trying to get a hold of the shot itself.

So this is the injection that I take weekly, and it is a small needle.

Without a prescription.

Werner is able to purchase Semaglutide injections from a medical spa where a doctor and nurses are on staff.

I just had my primary doctor order the blood work and then you have to be approved to make sure you're a candidate as well as if you were using insurance.

And then you do pay a monthly fee to to get your shots every month.

The price tag of the med spa shops can be more than quadrupled out of a traditional prescription covered by insurance.

Werner pays $375 a month for four weekly shots.

Rigby pays a $3 monthly copay.

It's a very small needle, so it's not bad at all.

It doesn't even hurt.

It doesn't hurt to me.

And you inject in your stomach.

Just a few months in.

The medications seem to be working for both ladies.

I am about four months in and I've lost.

The last time I was at my appointment, which was maybe three weeks ago, £12, which I'm pretty happy with because I wanted a slow decline in weight loss.

They say the side effects have calmed down as time goes on as well.

It hasn't been bad, like there were a few times where I felt a little bit more noxious, but the nausea is very minimal.

I've kind of like almost like that nausea that when you feel like you're hungry and you have to eat something and then you kind of eat something and it it kind of acquired through nausea a little bit, I'll be like, okay, now, today I'm really feeling it.

I have thrown up a couple of times, but typically that's because I've eaten something that my body's just not agreeing with.

Because when you take the medication, the whole point is to change your eating habits and you shouldn't eat too greasy because it messes with your stomach and then unforgiving way.

They also both say they do not plan on being on the medication forever.

My long term goal actually isn't just about me.

It's also about my kids.

I want to make sure that I'm doing good for me so that way I can do good for them.

And then we can all be on like good eating habits because I don't I don't want my kids to go through what I went through or ever have to deal with massive weight gain or anything like that.

I have a weight loss goal and once I get down to that, then I'll revisit with the nurse that the meds fall to the side moving forward.

If I if it's something I have to stay on a little bit longer or I mean, at the end of the day, it's making healthier lifestyle choices and.

In the end, the Estheticians say they are happy with their choice to try the medications that so many are using to get on a path to a healthier, happier lifestyle.

So I definitely am enjoying that.

I'm able to lose weight and I do know that I have to continue to make healthier choices.

As far as like exercising and working out.

So continue to see an improvement like it works hand in hand.

You can't just take the shot and expect to lose weight without doing any making lifestyle changes with it.

Don't ever feel ashamed for the route that you choose to go because everybody's experience is going to be different.

Whether you lose weight naturally or you need a little bit of extra help, you'll get there and it'll be amazing in the end.

And we thank those ladies for sharing their stories.

As we heard, insurance coverage of these medications can vary from patient to patient and company to company.

Here now to shed some light on that side of the medication world is Capital Blue Cross Chief Medical Officer Dr. Jeremy Wigginton.

Dr. Wigginton, thank you so much for being here today.

Thank you.

So much for having me to talk about this this.

Topic.

Absolutely.

And insurance that side of the of this topic is such a big side of it.

So where do we start when it comes to insurance?

Do insurances just cover this for everybody?

So it does get a little bit complicated.

And as you mentioned, it does vary a good bit, but in general, the GLP one medications that are now being used for weight loss have varied coverage on the pharmacy benefit.

So that's something for people to keep in mind that these medications, even though the majority of them are actually injectable medications, they're either dosed in a little pen type device where you can inject yourself based on the dial or they may come in a vial if they're compounded or if they're they're pre dosed, you may have to draw them out into a syringe and and inject them.

But those medications, if they're covered on insurance, typically are covered on the pharmacy benefit.

So for diabetes, they are very, very well covered today.

So if you have a diagnosis of diabetes in general, the GLP one medications are covered very well, typically at what we call a preferred brand.

So co-pays may be around 20 to $40 if you have diabetes on in getting these medications.

But on the weight management side, if you're using GAAP ones for weight management, the coverage really, really varies.

Most coverage today is through what we call an employer based health plan.

So if you are employed and you get insurance through your employer, that is typically how most coverages are provided today for these medications for weight loss.

But even then there is a lot of variation.

And if there is coverage, typically they fall on what is called a non-preferred brand tier of that pharmacy benefit.

So co-pays could even be as high as even $100 per prescription.

If you are getting a covered under your health insurance plan.

But as you said, there is still a lot of variation.

Sure.

When you say a preferred brand, we heard earlier in the program that something like Ozempic is specifically for diabetes, whereas something like Zepp Bound or we go, we are covered for weight loss.

Is that what you mean by preferred brand?

That's correct, yes.

The brand names are called either Wegovy Ozempic Zepp down, but then the generic name is either Semaglutide or or such as turns up at Tide.

And so there are a couple that are primarily used, but they can have different brand names based on why they're being used or if they're being used for diabetes.

They're typically called Ozempic or Manjari.

But if they're being used for weight loss, they're slightly different formulation and dosing.

So those are typically called wegovy and they're bound for the weight loss.

Okay.

And so where does pre diabetes fit into all of this?

Pre-diabetes is actually a condition that is of great interest currently because it is typically related to having a higher BMI or a higher weight.

Currently, even for the diabetes indication, prediabetes is not unfortunately not a current covered diagnosis for for the diabetes medication such as Ozempic or Montero, but for the weight loss medications for those JLP one's pre-diabetes is certainly a condition of interest.

And so if there is coverage for weight loss, typically pre-diabetes is certainly a consideration.

And with health care providers to prescribe those medications for weight loss.

So again, a little bit of variation there.

But on the weight loss, there is definitely consideration for prediabetes.

Sure.

So I should ask, there are studies coming out saying that the GLP ones are treating and having a positive effect on things like fatty liver and other, you know, health conditions.

Addiction seems to be treated by these.

Do we see health insurance coverage leaning towards covering these medications for other health conditions like heart conditions, these fatty liver conditions, alcoholism, other addictions, that kind of thing?

Yes, but it does take time.

And so, like I said, primarily we have the coverage for diabetes today, but you may have seen recently the FDA approved a wegovy to treat patients with known cardiovascular disease, but also associated obesity.

So now Wegovy is being added for coverage through Medicare to treat those patients that have obesity but also known cardiovascular disease to prevent things like heart attack and stroke.

So there is certainly a trend for insurance companies to start looking at these additional indications.

I will say the evidence is still very new.

So for some of those additional things like gambling addiction, alcohol addiction, sleep apnea, that research is still ongoing and there's been a lot of data produced.

So we are always looking at that data, looking to see what's being released, talking about it with our community physicians, pharmacist.

And I do think in the next several years there will be continued additions of some of those other diagnoses that we've seen benefit in.

Sure.

Do you think this will replace bariatric surgery?

I do not think it will replace bariatric surgery.

And I've talked to many surgeons and other experts in the industry.

What we do think is it will become another option.

Of course, bariatric surgery does have its benefits and its impact on individuals may also depend on what that clinical scenario is for getting bariatric surgery.

But I do think that the GLP ones will add another option.

Some patients may actually need both.

They may need a GLP one and bariatric surgery or some some patients may see enough benefit from the GOP ones that they don't need to consider bariatric.

Bariatric tends to be reserved for those patients with very, very high beam eyes that need to need a lot of weight loss.

Whereas we are seeing about 20 to 30% of body fat loss with the GOP wants for weight loss.

So if you need more weight loss than that for a medical condition, bariatric will likely still be something to consider for those medical professionals making those recommendations.

Sure.

Dr. Wigginton, you brought up Medicare.

How does that fit into this, the coverage options for traditional insurance versus Medicare and both for the patients who are taking this for diabetes versus somebody who wants it for weight loss?

Sure.

Medicare also covers very widely for the diabetes indication.

They do not currently cover for solely the weight loss indication.

But like I said, they are working to add coverage for wegovy for those patients that have obesity but with associated heart disease or cardiovascular disease.

So Medicare is expanding its coverage to those additional indications.

But right now for solely for weight loss, Medicare does not have standard coverage, unfortunately.

Sure.

And as a doctor working for capital Blue Cross, I'm sure you talk to clients every day.

What are you hearing from there?

What are their questions on the insurance side of the aisle?

Sure.

Of course.

The question becomes, what really is the benefit for our members on our plan?

Can we talk about how many people might need to take this medication?

What might we see in terms of our long term health benefits?

Can we see improved rates of diabetes?

Can we see less heart disease?

And so we're having those conversations all the time that if we're adding coverage for obesity, what could be those benefits to your members that are on your health plan?

And so as as I was just talking about, there are known benefits, but there are also some known limitations.

There can be side effects.

There's also been a lot of data recently that showed that of people who take the medications for weight loss, not a huge percentage of them actually can stay on it for very long.

So only about 30 to 40% of patients who take the medications solely for weight loss stay on it for a whole year.

And that's been shown through a couple of very large clinical studies.

So we are looking for ways to ensure patients, if they do start on the medication, that they can stay on it for long periods of time so that they can be on it long enough to see both the weight loss but also the additional reduction of other clinical conditions such as heart disease.

So if you're only online for a little bit of time, that may not be long enough to see those long term health benefits.

And so that's another thing that provides some variation between carriers is that some plans may require enrollment and specific support programs.

Some of them may require different BMI ranges for coverage.

So I always tell patients members that if you have those questions about what's the what is your coverage, what are those criteria, how you know, should you be looking or asking specific questions to your own health care provider, call that number on the back of your ID card, your insurance ID card, and ask those questions, that customer service rep. And they can certainly answer those questions for you no matter who your carrier is.

Sure.

You mentioned that these folks who are using it for weight loss don't stay on it for very long.

Do we know the reason why?

Is it because of coverage?

Is it because they're meeting their goal weight and they think, you know what, I'll just go off of it?

Was there a reason why they went off of it?

That research is still ongoing, but we think it's a mix of those things.

We think it may be a mix of some of the side effects, nausea and GI upset can be something that can be significant for some people.

So we're working on how do we get providers to work with those patients, maybe with different dosing regimens to maybe overcome some of those side effects?

Some people do say that they only wanted to take it long enough to see X amount of pounds lost.

And so they feel like they've sort of met their need for taking the medication.

They may not want to spend more money on it, so they may, you know, discontinue self, discontinue the medication.

And for some people it's purely cost.

Like I said, even with insurance, sometimes the cost can be high.

And so some people just don't persist on it very long because of that out-of-pocket cost.

Sure.

So from an insurance perspective, long term, are we treating people and then they meet their goal weight and then kicking them off, so to speak, or does it vary from company to company?

Is there a maintenance plan?

What is the long term outlook from an insurance perspective?

Sure.

Again, today that does vary.

But if you look at the medical literature, there is no there is no direction to take patients off the medication once they start.

So even if you take it for weight loss and you see success, the recommendation today is that you don't stop it.

You continue to take it to maintain that weight loss, to see those long term health benefits.

However, some people say, you know, I don't want to continue to take it, but we don't actually know the best way to take people off that medication today.

We're still trying to figure that part out in the medical community how to do that.

But some coverage plans, again, may offer enrollment and support programs.

And those support programs may have direction to say if you want to come off the medication.

Here's our recommended way to do that in order to maintain that weight loss.

So it is a little bit varied, but but for today, we consider those medications really to be considered as a lifestyle change and a lifetime commitment if we want to see those long term benefits.

Sure.

Some really great information.

Dr. Wigginton from Capitol Blue Cross, thank you so much for shedding light on the insurance side of things.

Of course.

Thanks for joining us.

And although these drugs were originally developed to treat diabetes, they are proving to help with other health conditions.

As we just heard, that's the case for a Greater Lehigh Valley woman who found herself with an unexpected heart condition years ago.

This is from last year.

nice.

Awesome.

For Tina Fry of East Greenville, managing the number on the scale has been difficult most of her adult life.

Just before graduating high school, I started picking up a lot of weight.

I don't know if it was like hormone changes or what, but I just really struggled and I tried losing weight a lot of times and it just was never successful.

I tried just about every method you could think of.

Then in 2010, her health conditions became more complicated after she contracted hand, foot and mouth disease known as the Coxsackievirus from her son.

And in rare cases, it's one in 10,000 adults can get the adult version in 101 and 100,000 of those.

It can go to your heart or your brain, which is what happened to me.

The virus attacked her heart muscle.

Doctors said she needed a transplant, but her weight stopped her from being.

They said that I was too heavy to qualify for a transplant, that I needed to lose weight.

Being scared out of my mind, they suggested actually weight loss surgery and I did have weight loss surgery and I lost probably £80.

And then over the years I regained it.

For I was able to reduce her heart failure symptoms.

But putting the extra pounds back on put her at risk once again for complications.

So her heart doctor suggested a different approach.

When I talked to my cardiologist, she said there was a lot of studies out there today saying that these two GLP one medications protect people with heart failure.

In February, the mother of one started on a term separated called zip bound.

The day I took the medication, I knew something was different.

In my mind had never been so quiet in my entire life.

It shut off the food noise completely.

I didn't have the food, the compulsions, the desire to eat.

It was unbelievable.

So these are the injector pens.

He would pull this cap off the needles in there.

You would twist this to unlock it when you're ready and then push the plunger down with this so you could inject it in your stomach.

The back of the arm or your thigh.

Fries.

There's a few side effects, like nausea plagued her at first, but quickly dissipated.

Her only other obstacle has been insurance coverage and availability.

I've had to call all around to every local pharmacy.

The insurances can be difficult sometimes they change things.

Even though I had a pre-authorization, they terminated it and they said they needed to reevaluate my weight.

Since she began the medication, she's lost £80.

But it was the first time in my life that I could eat the way I wanted to.

Healthfully, eating whole foods, balancing my carbs, my proteins and watching my calories without white knuckling it the entire time.

Since her weight loss, Fry says, she has renewed focus on eating better and has even taken up hiking.

She says it's the first time in four decades that she feels she has a positive relationship with food.

I feel like I need this medication for the rest of my life.

I really do feel like it's quieted the food noise.

If I stop taking it when it's like towards the end of my dose, when we're getting ready to take the next one, that food noise comes back.

Without having to increase her dosage more than once.

Fries says her health has improved as well, giving her the confidence to walk back into the doctor's office without worrying too much about her heart.

My cardiologist is extremely happy and we have an echo coming up to see if it's made any impact there.

She's just happy that I've lost the weight, taken the strain off of my heart, that I do feel better and my heart failure symptoms have reduced such.

And we thank Tina Frei for sharing her story.

A University of Pennsylvania professor recently coauthored a New England Journal of Medicine article about how these GLP one meds should be allocated given the shortages.

We had the opportunity to speak to Dr. Ezekiel Emanuel, Professor of Medical Ethics and Health Policy.

Dr. Emanuel, thank you so much for joining us.

my great pleasure.

Thank you.

And thanks for agreeing to shed some light on this topic.

Now, you wrote an entire article about GLP one's who these should be allocated to.

So give me some background.

Why did you decide to write this article and what was your main focus?

Well, one of the biggest challenges in modern medicine is how to allocate what we call scarce resources situations where you don't have enough medicine or other facilities for patients.

And the question arises who gets priority and who gets further down the list?

We saw that in COVID with the vaccines.

Initially, we didn't have enough vaccines.

It took a year before we had enough vaccines for everyone.

And so the question is who gets priority?

And we realize that the GLP one's very effective drugs, very important for diabetes, for obesity, but also for cardiovascular disease, kidney disease and other conditions.

But there's a huge shortage.

We don't have enough drugs being produced for all the patients who could potentially benefit.

And so the real question is how should we allocate this, which patients should we prioritize?

Sure.

And so what were some of your findings in this article?

Well, I'll be really blunt with your audience, which is I came into this thinking, wow, we should probably prioritize diabetic patients and that, you know, people with obesity or overweight should go further down the list.

But when we began looking at both the ethics of the situation, as well as what various consequences of the diseases are, it came that priority should really be given to people who have obesity.

So here are the considerations.

When you allocate resources.

The first consideration we put on the table is you want to decrease the number of deaths, but also maximize the number of life years people have.

Some people die younger, some people die older.

People who die younger lose more a lot more years of life and they should get priority.

Then you want to reduce the number of complications people have, whether it's heart disease or kidney disease or cancer or other co-morbidities that come with diseases.

And the last thing you want to do is increase the quality of life.

Well, when you look at those criteria, the people who suffer the most are people who have obesity, severe obesity, their BMI body mass index is over 40, sometimes over 45.

And they should get priority.

And then because the number of years of life that you save is important, younger people should be prioritized over older people.

And then you also have diabetes.

Now, the leading reason we have type two diabetes with about 3738 million Americans is obesity.

So by addressing obesity, actually, as it were, kill two birds with one stone.

But people who've got diabetes, even if they don't have obesity, also should get priority.

If they failed other treatments for obesity, for their diabetes, like metformin, like these new drugs.

LGT drugs.

So you need to be careful about who is getting prioritized.

But it's really severely obese patients, younger, severely obese patients at the top and diabetics who are younger but also can't tolerate other drugs or don't respond to other drugs.

Sure.

And that's not what we're we're generally seeing right now.

We're seeing that the folks who have diabetes are being prioritized.

But you're saying younger folks who are overweight and struggling with obesity should be prioritized?

Well, in the United States, we don't have a way to create one rule that applies to everyone in the population.

We've got a medicare rule, which is basically we don't cover any drugs for people who have obesity, which I think is a mistake.

That's a sort of old standing view based upon prejudice, that obesity is a lifestyle condition.

Well, if obesity is a lifestyle condition, diabetes is a lifestyle condition.

Most of heart disease is a lifestyle condition that just doesn't work.

Similarly, lung cancer is a lifestyle condition.

That's not a coherent way of addressing the problem.

Then there's a separate each insurance company has its own policy.

Each employer might have their own policy.

Medicaid in the 50 states and the District of Columbia will have their individual policies.

It's a bit of chaos in the United States, and it's not uniform across all of those groups.

But because Medicare won't cover these for obesity and a lot of insurance companies won't cover them and a lot of states won't cover them, we actually allocate it in the worst possible way in the United States, and that's on the basis of ability to pay.

And that is, as I've written extensively, the most unethical way to allocate and prioritize patients for scarce medical resources.

We would never, never think, your access to the COVID vaccines should depend upon your ability pay for that COVID vaccine.

That is totally unethical.

And unfortunately we're repeating that for Ozempic would go be Maduro and all the other GLP ones.

We need to fix that problem in the United States.

Sure.

Do you have a proposal to fix that problem?

What do you think the answer is here?

The answer is a uniform problem, a uniform policy across the country.

And given the fragmentation of our health care system, that each one of these groups, employers, insurers, Medicare, Medicaid, have a different policy and can develop a different policy.

We need to develop a coherent policy through Medicare and then begin disseminating it.

Medicare Advantage plans, the exchange plans, and make all the insurance companies adopt a uniform policy that does prioritize people who are going to benefit the most.

And again, those are people with obesity who tend to be of severe obesity over 40 BMI and who have severe co-morbidities and diabetic patients also who haven't responded to other treatments.

Sure.

Dr. Emanuel, how do you see this impacting overall public health in the next few years to next couple of decades?

Well, first of all, in the short term, these are very effective drugs.

We have to figure out how to keep more people on them and not have the side effects affect them.

We have to combine the drugs with lifestyle changes that include changing a diet, more exercise, things that we know are beneficial both for obesity and for diabetes.

But the long term plan can't be.

Well, people will eat as kids, young adults.

They'll get obese, and then we'll treat them with a super expensive drug.

Even if the drug came down, that's not an optimal way of actually living a life.

And so I think we need to combine a policy to make these drugs more available to high risk patients with a more, frankly, important public health initiative.

We Need to get people to stop drinking sodas.

Those are empty calories and we know they increase.

We need to get people stop eating as much ultra processed foods, those Cheetos and potato chips and Doritos and whatever else you have.

Those are not good for people.

We need to increase the consumption of fruits and vegetables because we know those add not only antioxidants, but they add fiber, which is necessary to change the microbe biome.

We need to increase children's physical activity.

And instead of subsidizing foods that aren't good for people, we need to enhance the fruits and vegetables and eggs and yogurts, kimchi and those other kinds of foods.

It's not actually that complicated.

The most important thing to getting to a healthy diet.

Stop doing the bad stuff and the bad stuff is sugar sweetened sodas and other sugar sweetened beverages and ultra processed foods.

Buy more fruits and vegetables, fishes, yogurt, as I mentioned, eggs.

That's the direction people have to be going.

And we have to start that early and we have to have a national effort.

We know we can do it.

We did it with smoking.

At one point, we had nearly half the adult population smoking and we've driven it down to the low teens.

We can do this and we need to start now.

One of the things I urge my research assistants and people who I have some influence on is learn how to cook.

It's actually fun.

I love to cook, I love to bake and, you know, eat healthy.

But we can't rely on these drugs.

These drugs are important because people who are obese, they're it's hard to lose weight once you become obese.

And I have to say, that's actually one of the things I'm most pessimistic about.

We have 20% of our children are obese and another 16% are overweight weight.

And that's a very bad formula because they're likely to be obese and overweight for the rest of their lives with all the complications, whether it's diabetes or joint problems or heart problems or liver problems, that we've got to reverse that We have to, you know, invest in the future.

Investing in the future is investing in our kids and making them healthy through a good diet and exercise.

Sure.

That seems to be a theme throughout this program that it's a lifestyle change.

Dr. Ezekiel Emanuel, thank you so much for some wonderful information today.

Thank you.

Appreciate it.

Take care.

Here.

Earlier, we heard one of the patients talk about using a medical spa as her route for getting her medication, although the price tag is a bit higher than that of a prescription.

It's proving to be easier to get GLP one through a med spa.

Here now to talk about that is nurse injector Katie Kelly joining us now from Misha esthetics in Allentown.

Thank you so much for joining us, Katie.

Thank you for having me.

Okay.

So for those who don't know, what does a medical spa do?

So a medical spa is a place where you can come and get a static procedure like Botox and fillers.

But again, it's a medical procedure.

So we require everyone to fill out a health history form.

We have a medical director and we're all our INS or nurse practitioners.

Sure.

So when someone's coming to get these medications, how does that work?

Walk me through the intake.

Yeah, sure.

So we meet for a consultation and we have to make sure that they actually are a good candidate for GLP ones.

So the consultation includes a lot of education, so I have them fill out their medical history.

I also go over a medications, allergies, any past surgeries and what they're looking to attain.

They it's really important that their BMI is 25 or greater.

They have to be at least 16 years old or older with a parental consent if they're less than 18.

We're looking at a comprehensive medical panel, metabolic panel, excuse me.

So we're looking at your blood glucose levels and just making sure that you are a candidate to receive the medication.

Sure.

So this isn't where anybody can walk in and get this medication and be good to go.

So, no, they need bloodwork.

Correct.

And there are some prior things they need to do before heading into the medical.

Absolutely.

Okay.

So once they are approved, what happens then?

Yeah.

So in the consultation I do review how to do the injection.

So we work with a compounding pharmacy that sends the medication directly to their home.

And so I educate them on how to give the injection, what the dosage is going to be, how frequently to give it.

And then we have a charting app and it's a patient app that we're able to communicate and text back and forth with each other.

If they have any questions whatsoever, they can reach out to me.

We can face time each other so they don't feel like I just gave them a medication.

I'll see you in three months.

Sure, sure.

And so at Meesha, you do not deliver the injection or do not or administer the injection.

You send it home with them.

I know other medical spa's.

It kind of varies from place to place.

Correct.

Okay.

And so what are you hearing from your patients who started these?

Yeah, we've had great success.

We have hundreds of clients that are on the GLP ones with success anywhere from £10 to up to 85 £100 weight loss.

So great success stories.

Of course, it comes with side effects, but we manage that.

Again, they're texting me, we're guiding them.

We're holding their hand through their journey of weight loss.

Sure.

What are some of the side effects you've heard about?

Yeah.

So mostly nausea, a little bit of constipation, maybe some diarrhea.

So we go over with them.

What supplements or medications they can take to kind of navigate through some of that?

We talk about dosing and make sure they're on the proper dose, that they're not experiencing Some of these effects.

Sure.

You talked about using a compounding pharmacy.

Have you had any issues with the supply chains that we're hearing?

So many pharmacies, we're hearing patients shopping around, calling from pharmacy to pharmacy to see if they have their medication and if they have their medication, if they have that dose that they need.

What's your perspective?

What are you seeing firsthand?

We are not experiencing any supply issues whatsoever.

Our Semaglutide clients are able to get it when they need it.

Great.

Great.

And are you use you say, semaglutide versus the terms at the side?

Do you use both?

Are they interchangeable?

Are you just getting one and are they brand names or is it different in a medical spa?

Yeah.

Good question.

We use both.

So we talk with a client, especially reviewing their history.

Do they have any GI issues to begin with?

Then maybe we go with they trans appetite rather than semaglutide.

I myself am my personal attorney.

I have lost £52.

I started with Semaglutide at six months and I hit a plateau.

So I try that his appetite and that kind of put me over the hump and I was able to lose the remaining weight that I was.

My goal weight was more.

Sure.

And Katie, let me ask you this.

People who are going on this, what is their long term plan when you hear from them?

Yeah, it varies.

Some people a goal weight in mind.

Some people are like, I just want to feel better.

Some people are working with their physicians to lower their blood pressure or improve their diabetes.

So everyone's goal is different and it's very individual.

I always tell my clients, Don't compare yourself to your girlfriend or your sister if they happen to be on medication because everyone's journey is very different.

Absolutely.

And I mentioned the price tag as we were coming into this segment.

What I've heard from two different patients and it varies from patient to patient, but earlier in the program, we heard one patient paying close to $400 at a med spa versus another patient who is diagnosed and has a prescription, a $3 co-pay.

So where does that price tag come in and how much does it really vary from pharmacy to med SVA?

Yeah, So our pricing is very competitive and we do seek out pharmacies and we're always checking to see if there is a more competitive price out there.

The pharmacy we're using right now for Semaglutide is about $190 per vial.

Now, the vial last, depending on what dosage the client is on, it can last anywhere from six weeks to 12 weeks.

Tara's appetite is a little bit more expensive, is $190 for a vial, but that vial has less of the medication in it.

And then our follow up visits are in the beginning, about four weeks and then eight weeks.

And then we're following about every 12 weeks doing a phase time visit virtually.

So it's more convenient for the client.

So it really varies.

But the cost, I feel, is very competitive.

Sure.

It sounds like the cost is a bit higher, but it seems like it's easier to get through these medical spas.

Yes.

I do want you to talk about, if you could, the safety measures that are in place, because I know that we've heard stories in the news, different medical supplies that weren't reputable.

So how do you know a medical spa is reputable and that safety practices practices are in place?

Yeah.

So you want to check to make sure that the practitioners that are working at a med spa are registered, that we have licenses, we have a medical director, we are certified.

So we can provide these services safely.

We've all worked in hospitals.

We've taken care of clients and patients.

So we all have experience.

Wonderful.

Is there anything else you'd like to add on this subject?

I think it's just a great journey.

I'm so happy that we provide this service for our clients because until now there wasn't anything that could help you lose weight on a consistent basis.

And I think this is part of the future.

I think this is what's going to be called longevity medicine, and that may show wellness.

We're looking into more ways to not only help you look better on the outside, but help you feel better on the inside.

Wonderful.

Katie Kelly, thank you so much for sharing this information with us.

Thank you.

Thanks for being here.

Well, that's all for this community conversation.

Thanks to all of our guests for joining us.

And, of course, you for watching.

From all of us here at PBS 39 and Lehigh Valley News.com.

I'm Brittany Sweeney.

Have a good night.