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About one in eight, or 12%, respondents in a recent survey said they had tried one of the new diabetes or weight loss drugs, with only about half of them (6%) still taking the costly medicines at the time they were polled.

The nonprofit health research organization KFF on May 10 released results of a poll done about medicines like glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide (Ozempic and Wegovy, Novo Nordisk) and the dual glucose-dependent inulinotropic polypetide/GLP-1 tirzepatide (Mounjaro, Zepbound, Eli Lilly). The survey found many patients covered part or all of the cost of the medicines, which have list prices of $936-$1349 before insurance coverage, rebates, or coupons.

The survey was conducted between April 23 and May 1, 2024, online and by telephone among a sample of 1479 US adults, KFF said.

People who participated in the phone survey received a $15 incentive via a check received by mail. Many web respondents received a $5 electronic gift card incentive, with some harder-to-reach groups receiving a $10 electronic gift card, KFF said.

The margin of sampling error including the design effect for the full sample is ±3 percentage points.

The poll found about 79% of respondents who took these drugs reported getting these medicines or a prescription for them from their primary care doctor or a specialist.

Less common ways to get these medicines included an online provider or website (11%) or a medical spa or aesthetic medical center (10%).

Insurance Varies

Among the respondents with health insurance who report ever taking these drugs, more than half (57%) say their plan covered part of the cost of these drugs, and they paid the rest. About one in four (24%) said their health insurance covered the full cost, while one in five (19%) insured adults who have taken these meds say they paid for the full cost themselves, KFF said.

These findings reflect the kind of challenges clinicians see in practice as they try to help patients obtain the drugs.

In an interview before the poll was released, Stacey Bartell, MD, medical director for career and practice at the American Academy of Family Physicians, told Medscape Medical News that some plans had rescinded coverage for the use of these new costly drugs for weight loss alone.

In other cases, health plans have sought new prior authorizations in cases where patients already were taking one of these medications for diabetes. In time, the plans will again cover these drugs, but the new authorizations add unnecessarily to the administrative burden.

"So it will be approved, but the frustrating part for us is that we're following diabetic guidelines; we're expecting that medication will be covered," Bartell said.

The KFF poll found that about half (54%) of respondents who have taken one of these drugs said it was difficult to afford the cost, including about one in five (22%) who say it was very difficult.

Medicare Rules

The KFF poll also found that while 8% of adults aged 65 and older say they have taken a GLP-1 medication for a chronic condition, only 1% say they have taken a GLP-1 drug to lose weight.

Older Americans and those with disabilities face a tougher hurdle in obtaining these drugs for weight loss. There's a specific legal restriction against coverage of obesity drugs by the Medicare Part D plans, which are estimated to cover about 56 million people.

While designing the Medicare Part D pharmacy plan in 2003, members of Congress deliberately excluded weight loss drugs from coverage, in part due to their recent memories of the dangerous fen-phen diet pill combo.

For now, a prohibition technically remains in place against Medicare coverage of weight loss drugs, although there's notable support in Congress to end this restriction. A bipartisan House bill intended to allow Medicare to cover obesity treatments has the backing of about 100 members of Congress or almost a quarter of the chamber's members. The companion Senate measure has the backing of about 23 of that chamber's 100 members.

But changes made in March could open a pathway for many more people in Medicare to get weight loss drugs.

The US Food and Drug Administration (FDA) on March 8 approved a new indication for the Wegovy form of semaglutide. It cleared the weight loss drug as a means of reducing the risk for cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.

On March 20, the Centers for Medicare and Medicaid Services (CMS) said obesity medicines that win FDA approval for additional medically accepted indications may be covered by Part D plans for that specific use, CMS said. The agency cited the example of a GLP-1 drug with an approval for reducing cardiovascular events. This medicine could be covered in the case of a patient in need of chronic weight management who also had established cardiovascular disease.

Kerry Dooley Young is a freelance journalist based in Washington, DC.