Black People Are Facing Greater Challenges Accessing Anti-Obesity…

As the popularity of Ozempic and Wegovy soar for their weight loss benefits, some doctors are concerned about disparities regarding access to these drugs.

Fewer Black and Hispanic people are prescribed these medications, yet they are at greater risk for developing type 2 diabetes.

Experts say there are ways to make anti-obesity medications more accessible for everyone.

As the use of the anti-obesity and diabetes medication semaglutide (sold under the brand names Ozempic and Wegovy) increases, concerns regarding who is getting the medication and who isn’t are rising, too.

Even though white people have a nearly 40% lower prevalence of diabetes than Black people, they are about four times more likely than Black people to receive a prescription for semaglutide, according to a September CNN report based on exclusive Epic Research.

The disparity comes down to the “haves and have-nots,” according to Dr. Calvin Smith, assistant professor and clerkship director of internal medicine at Meharry Medical College.

Because Black and Hispanic people are more pre-disposed to having type 2 diabetes, a condition related to obesity, Smith said the groups would benefit the most from taking the medication.

“But the potential of earning money, particularly from those who have the means is what appears to be the driving factor in terms of how these medications are distributed,” he told Healthline.

Why some people are having more difficulty accessing semaglutide

One study found that between 2015 to 2020, 51.1% of US adults met the Food and Drug Administration (FDA) eligibility criteria for semaglutide. However, the percentage of adults eligible for semaglutide was highest among Black adults (56.6%) followed by Hispanic adults (55.0%).

Despite this, the study reported that when compared with white individuals, significantly larger proportions of Black and Hispanic individuals were uninsured, lacked a usual source of care, had low family income, and lacked higher education.

“These medications should be equitably available for those who would benefit from them [most],” said Smith.

Considering the racial composition of the patient population is important, noted Dr. Sethu Reddy, president of the American Association of Clinical Endocrinology.

“For example, if Black people make up 12% of the population and they make up 12% of those that received semaglutide then there may be less ethnic bias than one might think,” he told Healthline.

He pointed to an analysis by Komodo, which reported this stat.

The analysis also found that among people prescribed Ozempic, Mounjaro, Wegovy, and Rybelsus between 2021 and 2022, 65% were non-Hispanic white and 14% were Hispanic or Latino.

For comparison, 59% of the U.S. population is white, and about 19% of the U.S. population identifies as Hispanic or Latino.

“In general, though…the inequities of access to these medications may depend on prior factors — insurance status, access to medical care in general, effect of gender on highlighting weight issues,” said Reddy. “The insurance status is critical. If a certain group is not even eligible for GLP-1 analogs, then right out of the gate, they are at a disadvantage.”

Currently, out-of-pocket costs in the U.S. for a one-month supply of these medications are as follows:

Ozempic: $936

Wegovy: $1,349

Mounjaro: $1,023

Rybelsus: $936

Medicaid may create another barrier to accessing GLP-1 drugs

People on Medicaid may or may not get coverage for anti-obesity medications if they are used for weight loss.

While the Medicaid Drug Rebate Program requires Medicaid programs to cover almost all FDA-approved drugs for medically accepted indications, weight-loss drugs don’t need to be covered. This can vary from state to state.

Smith said in Tennessee where he practices, the TennCare Medicaid program has shifted its coverage, sometimes on a month-to-month basis.

“I had to be abreast of what was available on formulary,” he said. “There’s so much information required for a physician to be able to prescribe these medications. It’s like they don’t want you to do it for those who would benefit from it.”

Ways anti-obesity medications could be made more accessible

While solving all the barriers that contribute to access issues with anti-obesity medications will take effort and time, below are some solutions.

Spread awareness about anti-obesity medications

Reddy said the more Black patients can become educated about their conditions, such as type 2 diabetes and obesity, and treatments for these, the better. He also recommends that people understand their insurance policy choices.

Smith agreed. He said people who are in the know about the latest treatments, can jump on the chance to receive them before shortages and price hikes occur.

“If you are well connected and in the know, you know what pharmaceutical companies are doing well in advance of what the general public knows, and you move accordingly,” he said. “That news and information trickles down, unfortunately, in a manner that the people who would probably benefit the most — who need it the most, are the last to know about it.”

Make discounted programs available and easy to understand

Smith said the most effective approach is to make programs which provide anti-obesity medications at discounted prices or for free more accessible.

“Right now, as it stands, most of my patients are quite health literate and still have a difficult time navigating all the paper work, all the different hoops they have to jump through to get these medications at a lower rate than what [retail] is requiring or demanding,” he said.

The process is even cumbersome for physicians, he added.

“A lot of times the paperwork is exhausting in terms of what I need to do to get one patient an opportunity to take these medications for a discount let alone if I want to get one of these medications for a significant portion of my panel of patients,” said Smith.

Because research shows semaglutide benefits patients with existing cardiovascular disease, and that diabetes has an explicit link to cardiovascular disease, Smith said the medication should automatically be available as a second line drug to the diabetes medication metformin.

Push doctors to prioritize for whom they prescribe anti-obesity medications

Because there is a shortage of medications like Ozempic, Smith said physicians need to make informed decisions about to whom they prescribe them.

“Thinking twice about prescribing one of these medications for someone who might not have the maximum benefit in spite of the fact they may desire it,” he said.

Doctors can consider alternative medications for weight loss before turning to medications like Ozempic for people who are not living with diabetes, he noted.

“I’m going to try those first, reserving these medications for my patients who have diabetes,” he said. “I would advocate for educating residents on prescribing these medications in an equitable way and including equity in the discussion about how we prescribe.”

Educate doctors on health inequity

Educating clinicians about health inequity will make them think about therapeutic choices more broadly, said Reddy.

“There are definitely health inequities in our medical system and one has to recognize systemic bias, which puts ethnic minorities at a disadvantage,” he said.

More diversity in medical advertising can help, too.

“Medical advertising has gotten better in magazines and TV. Reflecting minorities in the ads will spread more awareness,” Reddy said.

As a patient, advocate for the best available treatments

Before meeting with their doctor, Smith suggested that people living with obesity should research anti-obesity medications and push their physician to explain why they won’t prescribe them the medication.

“Most physicians when presented with some type of question as to why they are practicing the way they are will generally air on the side of doing what is in the best interest of the patient,” said Smith.

For people who are not well-versed in medicine or are not comfortable advocating for themselves, he recommends bringing someone they trust to doctor appointments.

“Having someone in there who is informed or just cares about your well-being and can advocate for you [and ask questions] makes a difference,” said Smith.

Encourage Black patients to see Black doctors

In an ideal world, anyone should be able to walk into any doctor’s office and be treated equitably, said Smith.

“But the statistics show that African American patients are usually treated better from an end point in terms of their overall outcomes when seen by an African American doctor,” he said.

For instance, a longitudinal cohort study found that higher levels of Black representation within the physician workforce were associated with longer life expectancy and lower all-cause mortality rates for Black people and all-cause mortality rate disparities between Black and white people.

“This passes through socioeconomic lines. When you think about someone like Serena Williams who had a difficult outcome in her childbirth as opposed to others,” said Smith, “it doesn’t matter what you do, unfortunately, there are still risk factors that are inherent with your race.”

Get more competition on the market

As more anti-obesity medications like Ozempic and Wegovy become available to the public, Smith said this will help with shortage issues and, in turn, help with the disparities around access.

“In other words, as more companies come out with competing drugs, typically that favors the consumers and typically that favors those who suffer from disparities and social determinants of health,” said Smith. “More availability will drive those numbers down in terms of the cost and there will be less disparity.”

Posted : 2023-12-20 21:15

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