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A New Obesity Drug Could Help Millions Of Americans. Its Future Hinges On Insurance

LULU GARCIA-NAVARRO, HOST:

A promising new drug to treat obesity got approved for sale this month. In clinical trials, Wegovy helped people drop an average of 15% of their body weight, far more than other drugs on the market. But as NPR's Yuki Noguchi reports, a major question remains. Will insurers cover its cost for the many millions of people who might benefit?

YUKI NOGUCHI, BYLINE: Marleen Greenleaf's entire family in Trinidad struggled with obesity.

MARLEEN GREENLEAF: My husband has diabetes. My sister has diabetes. My brother has diabetes.

NOGUCHI: Greenleaf is 58 and an administrator at a charter school in Washington, D.C. She tried numerous diets. They all failed. In 2018, she joined a clinical trial of a new drug, a once weekly shot that changes the way her brain signals hunger. She noticed the change immediately.

GREENLEAF: With the medication, there was something that triggered in my brain to tell me that I was not hungry. I also wanted to eat healthier. I was looking at options, reading labels, looking at the calories, not just the calories but also the sugar.

NOGUCHI: She didn't crave her favorite chocolate chip cookies. Over the 68-week trial, she dropped 40 pounds. Her blood pressure fell, which qualified her to donate her kidney to her husband, who was on dialysis.

GREENLEAF: It was one of the best gifts of life that I could have ever done because of this.

NOGUCHI: But after the trial, Greenleaf regained some of the weight. Now she wants to resume the Wegovy shots.

GREENLEAF: My only challenge actually is getting the insurance company to approve it.

NOGUCHI: Insurance coverage, it turns out, is a giant question not just with Wegovy, but with obesity drugs in general. The out-of-pocket price can reach $1,000 to $1,500 a month, putting it out of reach for many, unless insurance covers it. Some private insurers do cover obesity drugs, though it's too early to tell whether Wegovy will be. America's Health Insurance Plans, the industry's trade group, declined comment. Medicare does not cover medicines for obesity, but some state Medicaid programs do.

Fatima Cody Stanford is a leading obesity researcher at Harvard. She's closely followed the Wegovy trial.

FATIMA CODY STANFORD: I'm excited about it.

NOGUCHI: Stanford says the drug acts on the brain, so people eat less and store less of what they eat. That helps address the excess weight, but it also helps with numerous related diseases of the liver or heart, for example. And there are few side effects to boot. But, she says, it will be of little use if it's not also affordable for patients.

CODY STANFORD: Before I even bring up that drug with my patients, I'm looking to see which insurance they're having on the left side of my screen because that will determine whether I bring it up because if it's out of reach, I won't bring it up.

NOGUCHI: Stanford says her patients on existing obesity medications do extraordinary things to keep their coverage so they can stay on them.

CODY STANFORD: Several nurses here at the hospital that are my patients stayed working - they were supposed to retire - stayed employed so they could stay on their injectable medication because that's how beneficial it was to them.

NOGUCHI: Douglas Langa is executive vice president of the North American Division of Novo Nordisk. The company makes both Wegovy and the current market leader, a drug called Saxenda. Wegovy triples Saxenda's average weight loss. But Langa acknowledges it's hard to get doctors, patients and politicians to recognize obesity as a disease and that, therefore, insurance should cover drugs to treat it.

DOUGLAS LANGA: There's a medical component to this that needs to be recognized. This is a disease state like we should be treating any other disease state.

NOGUCHI: And that's also what Langa is telling insurance companies, making the case for why prescriptions for Wegovy should be covered. His company is also heavily lobbying Congress to pass legislation to allow Medicare to cover obesity medications. He argues it makes sense. It's the root disease underlying so many others.

LANGA: We do believe that insurers understand that this is a gateway into 60 other health conditions.

NOGUCHI: And, he says, the need is hard to ignore. More than 100 million people in the U.S. alone struggle with obesity. Yuki Noguchi, NPR News.

(SOUNDBITE OF MISLED CHILDREN'S "10") Transcript provided by NPR, Copyright NPR.