You Might Qualify for Ozempic With Insurance—Even If You Thought You Didn’t: New Study Reveals
Discover how millions of U.S. adults now qualify for semaglutide drugs like Ozempic with insurance
The use of semaglutide, the generic name for the popularized drug Ozempic, has increased significantly in the past year. So much so, that it has become the top-selling drug in the United States in 2023, with net sales of $13.8 billion. But so often it can feel out of reach for many who may have been told they’re ineligible for GLP-1s. But all that could change: with new research comes the possibility of expanded eligibility for more U.S. adults than ever before.
While many were denied eligibility based on the weight-management indication, which is often not covered by insurance, it turns out that there are other indications that many adults do qualify for, according to a new study conducted by JAMA. In fact, about 39 million U.S. adults could potentially qualify for the drug. Read on to find out if this includes you.
Study results: expanded criteria for semaglutide eligibility
“A total of nearly 137 million adults, representing more than half of all U.S. adults, are eligible for semaglutide therapy,” the study states. “Although most of these individuals are eligible for semaglutide based on the weight-management indication that is not universally covered by payers, we estimate that more than 39 million adults qualify for indications other than weight management alone.”
Woman's World Answers
Before this study, it was estimated that only about 15 million U.S. adults qualified for indications other than weight management. JAMA has found a significant increase in numbers, which means you might qualify too.
Who might now qualify for Ozempic and other semaglutide drugs?
While semaglutides, often Ozempic, are not always so easily available, the new study explains that it should be easier to gain access to the drug. Since weight management is often not an indication covered by insurance, there are other things to look out for that can allow you to receive coverage, therefore making for easier access.
Apart from diabetes, the health condition the drug was originally marketed for, another indication that can possibly earn you coverage is secondary prevention of cardiovascular disease. The results of the study explain that semaglutide is indicated for secondary prevention of cardiovascular disease to about 8.9 million adults.
“A total of 39.3 million US adults were eligible for diabetes or secondary prevention of CVD,” the study states. But only 13 million of the previous number were insured by Medicare and 4.7 million were insured by Medicaid, leaving a significant number of people not covered by either form of insurance.
Eligibility exclusions: Who is not covered for Ozempic therapy?
While the results of the study cover the three broad indications of weight loss management, diabetes and secondary prevention of cardiovascular disease, there were a few key criteria that were excluded from the study.
While conducting, JAMA notes that any individuals with end-stage kidney disease who were undergoing dialysis were excluded from the study. Another key group not included in these results was anyone who had a history of undergoing any type of weight-loss surgery.
What this study means for access to semaglutide therapy
The significant number of U.S. adults who are eligible for semaglutide shows how consequential it could be to the health of the country’s population. Not only that, but the ability to afford semaglutide therapy was difficult for more than half of the adults who had taken the drug before.
The study concludes that “efforts to increase equitable uptake should be coupled with strategies to ensure that the cost of semaglutide is commensurate with the value of the health benefits it produces.
If you’re curious about whether you qualify for semaglutides like Ozempic, talk to your doctor. They can assess your health needs, review your medical history and determine if you’re eligible based on the latest guidelines and study findings. This latest study may just open the door for many more people to take control of their health.
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