The impact and popularity of diabetes medications used off-label for weight loss have been undeniable – from social media testimonials to water-cooler talk amongst colleagues.
Priya Kalia, MD, an obesity-medicine-certified Family Medicine physician at UTMB, has seen patients who have struggled to lose weight benefit tremendously from glucagon-like peptide 1 (GLP-1) injectables, which include Wegovy, Ozempic, and Mounjaro.
“People feel much more motivated and happier and satisfied with their health,” Dr. Kalia says. “I have been able to taper down on medication for high blood pressure and adjust a lot of other medications.”
With the recent news that some insurance providers have stopped coverage of these drugs for weight loss, patients are scrambling to find affordable alternatives.
The University of Texas System’s employee health plan (UT Select) and its Medicare plan for retirees (UT Care) no longer cover this usage as of Sept. 1, 2023. The decision to stop coverage comes after the medications’ skyrocketing popularity increased monthly costs from $1.5 million to $5 million over 18 months, with an adherence rate of 46 percent.
Within UT System, Dr. Kalia says there about 3,100 plan members using these medications. With their previous insurance coverage, patients paid a co-pay of $25 per month, a cost that went down to zero with a coupon. The out-of-pocket cost for Wegovy, for example – about $1,200 a month – is not sustainable for most patients.
Fortunately, there are other options that Dr. Kalia is happy to explore with her patients. Although the $25 co-pay of the past may not be attainable anymore, there are more affordable options than the cash cost of these drugs.
“There are compounding pharmacies that will compound semaglutide with vitamin B, which brings down the cost to about $300 to $400 cash pay,” she says.
The FDA states that consumers should only use drugs containing semaglutide with a prescription from a licensed health care provider and obtained from a state-licensed pharmacy or other facilities registered with the FDA.
Although this is the only alternative for the GLP-1 injectables, Dr. Kalia says other medications can offer benefits. An oral medication sold under the brand name Qysmia combines phentermine and Topamax to act as an appetite suppressant. Dr. Kalia says prescribing the two ingredients separately allows patients to have their prescriptions covered and achieve results.
She also mentions Contrave, which contains naltrexone, an opioid antagonist, and bupropion, an antidepressant, as another option in which the two ingredients can be prescribed separately for this purpose. She can also prescribe buproprion on its own for patients with binge eating disorder.
Dr. Kalia emphasizes that lifestyle modifications should be the first consideration, before medication or bariatric surgery. For new patients who wish to lose weight, she encourages three to six months of diet and exercise changes, like intermittent fasting or a low-carbohydrate diet, to see how they respond before considering other approaches.
Based on the number of patients Dr. Kalia has seen and the results they have experienced with GLP-1 injectables, she is hopeful that some data will be published to demonstrate the extent of benefits achieved through these medications.
She has also seen that patients who see her for weight loss concerns may also have conditions such as fatty liver, high blood pressure, and high cholesterol. And anecdotally, she says she’s seen patients using GLP-1 drugs become pregnant after previously having struggled to conceive.
“Weight determines so many things. It was just published that patients on Wegovy experience a 20 percent cardiovascular risk reduction,” she says. “It's similar to Ozempic, which reduces the risk of heart attacks and heart-attack-related deaths by 26 percent.”
She is also hopeful that as more drugs enter the market, the price will go down so they may be more accessible to more patients.
As one of a few UTMB physicians who are board-certified in obesity medicine, she encourages others to take advantage of CME opportunities from the American Board of Obesity Medicine, which has the potential to benefit patients across all specialties.
Dr. Kalia says she is happy to provide consults or accept referrals from other physicians who see patients with weight-loss needs. She sees patients at the UTMB Health Primary Care Clinic at Bay Colony.
 | Priya Kalia, MD, sees patients at the UTMB Health Primary Care Clinic at Bay Colony. |