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US diabetes patients face delays as insurers tighten Ozempic coverage

Diabetics struggle for Ozempic access as insurers prioritize weight loss. Join the fight for justice - Free case evaluation available.


December 12. (The Justice Now) – Patients who have type 2 diabetes say that they have a more challenging time receiving reimbursement for medications such as Ozempic since U.S. insurers impose restrictions to prevent medical professionals from prescribing the medicine to help lose weight.

Novo Nordisk has recently confirmed in an email that it is experiencing more stringent health plan management of GLP-1-related drugs, such as Ozempic, to reduce disruptions for people with type 2 diabetes. This trend contributes to a decline in U.S. prescriptions, an executive from the Danish drug maker announced at an investor event earlier this month.

Of the 24 diabetics contacted via Reuters on Reddit, 13 have experienced recent issues finding their health plans to include Ozempic or Mounjaro, the drug that Eli Lilly manufactured.

Elizabeth Beddow in Texas said her Blue Cross Blue Shield plan required that two other drugs be tested before they could cover Mounjaro, which her doctor prescribed following a diagnosis of Type 2 Diabetes. However, instead of that drug, she was given Ozempic in March. It led to extreme fatigue and digestive problems.

In September, Beddow, who is 57, was switched to an older medication called Lilly’s Trulicity. But the doctor said her blood sugar levels are climbing.

Starting a lower dose before moving to a maximum quantity using two different medicines is “really hard on my body,” she explained. “Ironically, my insurance covers Mounjaro without step therapy on January 1.”

U.S. regulators approved Ozempic for treating diabetes at the end of 2017 and Mounjaro by 2022. The medicines, now being sold under the brand names Wegovy and Zepbound, to reduce weight are designed to simulate a hormone known as GLP-1, which regulates blood sugar and slows digestion. They also decrease appetite.

The majority of U.S. health plans cover GLP-1s for type 2 diabetes, which, if not controlled, can cause grave complications, such as kidney failure and leg amputations.

The sales of self-injecting drugs are a huge success, with U.S. list prices of more than $1,000 per month quickly reaching billions, making the businesses one of the most valuable in the world. The growth of sales has been limited chiefly solely by the capacity of manufacturing.

“What’s resulted in a more heightened focus on prior authorization for diabetes GLP-1 drugs is the increased volume from off-label prescribing for weight loss,” said Cory Midlam, director of Willis Towers Watson’s pharmacy practice, which provides advice to employers regarding benefits.

Health insurance companies Aetna, UnitedHealth and Cigna have yet to respond to requests for information.


Patients with diabetes have reported to Reuters they had prior authorizations, where doctors require insurance approval before prescribing medication, which has delayed by weeks or months their ability to begin an entirely new treatment or remain on the medication they’d previously taken. Some said their insurers forced patients to test other medicines before doctors could prescribe a more unique drug.

A recent JP Morgan survey of U.S. benefits executives revealed that seventy-four per cent of major employer-sponsored health plans required diabetic patients to have prior approval for GLP-1. A third of them planned to increase the requirement as they face increased spending on these drugs as weight-loss instruments.

Doctors often must prove diagnosis and that other medicines like generic metformin could not regulate blood sugar or cause inexplicable adverse side effects.

This year, the weekly average of Ozempic prescriptions grew 33% in the first and third quarters. However, it has fallen by over 6% to around 431,000, according to Iqvia Institute for Data Science.

Doctors and patients are preparing for January’s significant changes when health plans for individuals typically announce new coverage conditions.

“It may be that January 1, all of a sudden something that was covered is no longer,” doctor. Robert Gabbay is the chief science officer for the American Diabetes Association.

Cost is also an issue, specifically for those with higher-deductible plans. “Depending on the coverage, some people still find it not affordable. That is certainly a problem,” Gabbay stated.

Via an email, Lilly stated that it would continue assisting people with type 2 diabetes in accessing Mounjaro in Tanzania and that certain insurers might require confirmation for diagnosis or evidence of prior medication usage.

“You have to get prior authorization every year … For us physicians, much of our time is spent doing paperwork. We all have to do it, but it is a barrier,” said the doctor. Anne Peters is an endocrinologist at Keck Medicine of USC in Los Angeles.

She said patients must stay on the prescribed medication and not be forced to stop the drug due to insurance coverage. If the disease is managed according to her, it is more likely to avoid cardiovascular disease. This ultimately kills the majority of people diagnosed with diabetes.

“If it were an ideal world, you would use drugs like GLP-1s, associated with weight loss, early,” Peters stated.

Stand Up for Your Health with a Free Ozempic Case Evaluation

The Ozempic lawsuits are a stark reminder that even life-changing medications can come with serious risks. If you’ve used Ozempic and experienced Gastroparesis or any other debilitating side effects, know that you’re not alone. You have the right to seek legal recourse and potentially receive compensation for the harm you’ve suffered.

Don’t let your voice be silenced. By participating in a free case evaluation, you can help hold Eli Lilly accountable and ensure others are aware of the potential dangers associated with Ozempic.

Here’s why you should apply:

  • Expert legal guidance: Our experienced team of Ozempic lawsuit attorneys will review your case and advise you on your legal options at no cost.
  • No upfront costs: You don’t have to pay anything to start the process. We work on a contingency fee basis, meaning we only get paid if you win your case.
  • Justice for your suffering: You deserve compensation for the physical, emotional, and financial burdens you’ve faced due to Ozempic’s side effects.

Taking the first step is simple. Just click the link below and fill out a short form. Our team will reach out to discuss your case and answer any questions you may have. Remember, knowledge is power. By sharing your story, you can contribute to a collective effort for justice and potentially prevent others from experiencing similar harm.

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