June 12, 2023 – Insurance firms begin sending warning letters to doctors and healthcare providers suspected of using a practice called off-label prescribing of the drug Ozempic.
The warning letters, first reported from The Washington Postinclude threats reminiscent of the potential of reporting “suspected inappropriate or fraudulent activities … to the state licensing authority or federal and/or state law enforcement authorities.”
It's the newest chapter within the story of the favored, highly effective and really expensive drug for diabetes that causes rapid weight reduction. Off-label prescribing signifies that a drug has been prescribed for a reason aside from its FDA-approved uses. The practice is common and legal (the U.S. Administration for Healthcare Research and Quality says 1 of 5 recipes within the USA are off-label uses).
But insurance firms are fighting back because a lot of them don't cover weight-loss drugs but do cover diabetes treatments. The insurance firms' letters suggest that prescribing doctors are failing to document in a patient's medical record that the patient actually has diabetes.
Ozempic, which is FDA-approved to treat diabetes, is analogous to the drug Wegovy, which is approved for weight reduction. Ozempic typically costs greater than $900 monthly. Both Wegovy and Ozempic contain semaglutide, which mimics a hormone that helps the brain regulate appetite and food intake. Clinical studies show that after taking semaglutide for greater than 5 years, people lose a mean of 17% of their body weight. However, once they stop taking it, most individuals gain a whole lot of the burden back.
Demand for Ozempic and Wegovy has soared, resulting in shortages and tactics to source the drugs outside the U.S. In addition, health officials have warned of the hazards of counterfeit versions of the drugs. CDC says that 42% of individuals within the United States are obese.
“Obesity is a complex disease that involves an excessive amount of body fat,” explains the Mayo Clinic. “Obesity is not just a cosmetic problem. It is a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.”