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Wegovy is now covered by Medicare for patients at risk of heart disease

SCOTT SIMON, HOST:

Federal government decided this week that Medicare and Medicaid prescription plans will cover the weight loss drug Wegovy, called Ozempic, when it's prescribed for diabetes. That is expected to greatly increase the number of people who take the drug. Though it comes with some caveats. Anti-obesity drugs have to be prescribed to prevent heart attacks and strokes, not just lose weight. How's Wegovy been working for patients already on the medication? We turn now to Dr. Disha Narang, endocrinologist and director of obesity medicine at Endeavor Health, just north of Chicago. Thanks so much for being with us.

DISHA NARANG: Hi. Thank you for having me.

SIMON: Do people walk in and say, look, I've read about this; I want to take it; give me a prescription?

NARANG: Yeah. You know, it does happen quite a bit, especially in my area, just because I do specifically practice obesity medicine. But in all the clinics, this is becoming more and more widely sought after.

SIMON: And how do you feel about that?

NARANG: One of the things is that in the last two years, of course, the social media attention has really grown. And so what it's led to is unprecedented demand nationally, even globally, you know, for these medications. For long-term obesity, it warrants treatment, just like any other chronic disease. However, it is not a temporary fix for a few pounds and that sort of thing. So this is actually a treatment for a disease that we would take for a long period of time.

SIMON: Have you seen it do a lot of good for people?

NARANG: You know, in 20 years of use for diabetes management, these have been game changing in the world of diabetes. It's decreased the need for insulin and other agents that people may need to take. And because they allow for weight loss, it also helps to improve blood sugars and insulin sensitivity. So as we look at it from the weight management standpoint, if we are able to decrease weight for people, that not only, of course, helps with weight loss, but it helps with improvements in blood pressure, cholesterol, diabetes, heart disease, sleep apnea, osteoarthritis. So the list goes on.

SIMON: What about the reputation that Wegovy, Ozempic seems to have earned among a lot of people - and not just late-night comedians - that it's some kind of vanity prescription.

NARANG: I can see how that rhetoric has increased, right? It's been all over social media. People are posting, you know, before and after pictures of themselves. Celebrities are, of course, you know, talking about it. But most people who have struggled with obesity have struggled with it for years. And if it was as easy as, you know, eating a salad every day to lose weight, well, we would have done this already.

SIMON: And what about possible side effects?

NARANG: Well, so the most common side effect is GI-related. So people may have nausea, stomach upset, indigestion, vomiting, you know, diarrhea, constipation, those kinds of things. And those are usually the most common reason why someone might stop the medication. They just don't feel good on it. And as soon as we stop the medication, they start feeling better.

Some of the other side effects are much more rare. And, you know, we have more and more coming out in the media about depression and suicidality. But we've used these medications for almost 20 years. Only in the last year to two years has this come out. If someone might not be a good candidate for the medication, then that's something that we have to make a judgment on ahead of time.

SIMON: And who is a good candidate?

NARANG: A typical patient might be someone who's been struggling with obesity for years. You know, they've come in after years of trying, you know, various programs and diets and things like that. They want to be ready to lose weight because at the end of the day, this is just a resource, right? The people who have long-term success are those who have significant lifestyle modifications, which means, you know, a very conscientious dietary pattern, a regular exercise regimen. And then potentially the medication can be successful. If someone potentially doesn't have that kind of lifestyle or is not working towards that, then they may not find as much success on the medication as someone else.

SIMON: Your patients who have had the most success, the medication has helped them, but they've helped themselves, too.

NARANG: Absolutely. You know, I always say, you do 98% of the job. The medication might do 2% of the job. It's just a resource at the end of the day.

SIMON: How much of a difference do you think there's limited coverage by Medicare and Medicaid will make?

NARANG: I think it's significant. Historically, Medicare and Medicaid never covered anti-obesity medications. The way that insurance has viewed obesity has been a vanity issue, and we have now research to show that these medications can be lifesaving from a cardiac standpoint. And so I think that this data is now powerful enough for them to oblige. And this is happening also, by the way, in the setting of a national and global shortage for these medications. So while it's wonderful that, you know, now we have approval for coverage for these medications, where do we find them, right? Like, right now we are two years into a shortage, right now, for the medication.

SIMON: Dr. Disha Narang is endocrinologist and director of obesity medicine at Endeavor Health, just north of Chicago. Thanks so much for being with us.

NARANG: Thank you so much for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Scott Simon is one of America's most admired writers and broadcasters. He is the host of Weekend Edition Saturday and is one of the hosts of NPR's morning news podcast Up First. He has reported from all fifty states, five continents, and ten wars, from El Salvador to Sarajevo to Afghanistan and Iraq. His books have chronicled character and characters, in war and peace, sports and art, tragedy and comedy.
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