Wegovy recipients not always prioritizing those in greatest need

Wegovy recipients not always prioritizing those in greatest need

The Challenges of Obtaining Weight Loss Medication Coverage


In a world where obesity rates continue to rise, finding effective weight loss solutions is of paramount importance. For individuals like Cindy Martinez, weight management has been a lifelong struggle. However, a breakthrough moment arrived when she discovered semaglutide, a medication that helped her shed 20 pounds in a matter of months, without feeling constantly hungry. Martinez’s experience is a testament to the potential benefits of this medication and the hope it brings to those with obesity and related conditions.

Semaglutide and its Benefits

Semaglutide, also known by its brand names Ozempic, Rybelsus, and Wegovy, is a GLP-1 agonist used to treat various health conditions, including obesity and type 2 diabetes. Research has shown that certain doses of semaglutide can help individuals with overweight or obesity achieve weight reductions of 12% to 15%. The drug affects brain signals, resulting in a feeling of fullness with smaller portions of food. Additionally, semaglutide has the potential to quiet “food noise,” the constant thoughts about eating that often lead to excess snacking.

Cindy Martinez experienced the positive effects of semaglutide during a clinical trial. However, her elation quickly turned to frustration when she realized her insurance would not cover the medication once the trial ended. Semaglutide’s high cost of $1,000 to $1,500 per month made it unaffordable for her. Martinez was disappointed that her insurer failed to recognize the preventative benefits of semaglutide, insisting on waiting until she developed type 2 diabetes before considering coverage.

Dr. Jorge Moreno, a Yale Medicine obesity specialist who treated Martinez, bemoans the common problem of insurance companies considering weight management drugs medically necessary only after diabetes has developed. This approach ignores the cascading effect obesity has on various health conditions such as heart disease, stroke, high blood pressure, and atherosclerosis. Even a 5% to 10% reduction in excess body weight through treatments like semaglutide can have significant positive impacts on blood pressure, cholesterol levels, blood sugar control, quality of life, and mental health.

Unequal Access to Weight Loss Treatments

Martinez’s experience highlights the issue of unequal access to weight loss treatments, particularly for historically marginalized groups and people of color. Dr. Veronica Johnson, an obesity medicine specialist, explains that the highest rates of obesity are observed among Black, Hispanic, Native American, Alaska Native, and Pacific Islander populations. These groups are also more likely to develop related conditions such as diabetes, high blood pressure, heart attack, and stroke compared to other groups.

Unfortunately, lack of insurance coverage and financial barriers often impede access to quality obesity care for these communities. Additionally, language barriers can serve as an additional obstacle. Evidence already suggests that people from Black, Hispanic, and low-income backgrounds face challenges in accessing semaglutide drugs for type 2 diabetes. It is probable that similar disparities exist for treating obesity alone, though further data is needed to confirm this. This inequality perpetuates the cycle of health disparities, as those who can afford medications like Wegovy are most likely to benefit from them, while individuals who would benefit the most are left with limited treatment options.

Dr. Johnson notices this disparity in her practice, where those seeking weight management care are predominantly postmenopausal White women. This observation raises concerns about the limited availability of effective obesity treatments for individuals who do not fit within this demographic. Addressing this disparity is crucial to ensure everyone has equal access to potentially life-changing treatments.

Insurance Companies’ Biases

The lack of coverage for weight loss medications and treatments is rooted in biases and stigmas surrounding obesity. Society often views obesity as a lack of willpower or a lifestyle choice rather than a chronic disease that warrants comprehensive management. However, perspectives may be shifting as newer medications, like semaglutide, demonstrate the ability to save lives and reduce cardiovascular risks.

Dr. Jamy Ard, an epidemiology and prevention professor at Wake Forest University School of Medicine, points out that insurers face increasing pressure to justify their denial of medications that have proven benefits. The prevalence of obesity necessitates recognizing it as a long-term condition requiring comprehensive treatment, comparable to other chronic diseases such as diabetes or high blood pressure.

The Consequences of Limited Access

When Martinez could no longer afford semaglutide, she quickly regained all the weight she had lost during the clinical trial. Her back pain and constant hunger pangs returned, and she now worries about the worsening of her prediabetes. Martinez refuses to accept defeat, advocating for the inclusion of semaglutide in insurance coverage. Her determination prompted her employer to consider finding an insurance plan that covers Wegovy for prediabetes and obesity. However, that change won’t occur until the end of the year, leaving Martinez to manage her condition with alternative medications and lifestyle modifications.

Martinez’s story exemplifies the challenges individuals face when traditional approaches to weight loss fail, leaving them with limited options. Losing weight without medication is not always feasible for everyone, and alternative treatments may not be suitable for every individual. The need for comprehensive obesity management, including access to effective medications like semaglutide, is urgent.


Equal access to weight loss treatments, including medications like semaglutide, is crucial for individuals struggling with obesity. Insurance companies must recognize obesity as a chronic disease, prioritizing comprehensive management rather than waiting for conditions like type 2 diabetes to develop. By expanding coverage and addressing disparities in access, insurers can contribute to reducing the burden of obesity-related health issues and ensure that individuals like Cindy Martinez have the opportunity to lead healthier lives.