Why patients are forced to switch to an obstacle medication of the 2nd choice
Tens of thousands of Americans will soon be forced through their health insurance to switch from a popular obese medicine to another that creates less weight loss.
It is the latest example of the consequences of secret business between drug manufacturers and intermediate dealers, known as the Pharmacy Benefit Manager, which is set by employers to monitor the prescription coverage for Americans. Employers pay lower drug prices, but their employees are blocked by competing treatments, a kind of insurance that has become much more common in the past ten years.
One of the largest performance managers, CVS Health's Caremark, decided to exclude Zepbound despite research, which found that this led to more weight loss than Wegovy that would continue to be covered.
These research results announced in December were confirmed in an article published on Sunday in the New England Journal of Medicine. The study included a large clinical study in which the medication, which was financed by Eli Lilly, the manufacturer of Zepbound. Earlier research that was not financed by Eli Lilly gave similar conclusions.
Ellen Davis, 63, from Huntington, Massachusetts, is one of the patients affected by Caremark's decision. “It feels like the carpet was pulled out under my feet,” she said.
After taking Zepbound for a year, she lost 85 pounds and her health has improved, she said. She retired after working at Verizon for 34 years, she was caremark for her drug cover.
In a letter to Verizon, she complained: “This forces the patients to switch medication to their will and without medical justification to a less effective medication.”
Verizon did not respond to inquiries about comments.
The change that Caremark has announced this month has spread quickly online. Joseph Zucchi, a medical assistant in a weight loss clinic in New Hampshire, has set up a petition by Change.org in which the company is asked to reverse the course. Last year, Mr. Zucchi announced that he would receive compensation as a spokesman for Lilly. The petition had more than 2,700 signatures on Sunday afternoon.
Caremark intends to stop reporting for Zepbound in July.
Doctors say that Wegovy, made by Novo Nordisk and Zepbound, are both good medication, but prefer Zepbound for most patients. Now you have far less ability to adapt obesity recipes to individuals.
It is not clear whether the exclusion of Zepbound will lead to higher profits for Caremark.
Novo Nordisk managers said they didn't want to block Zepbound. They distanced themselves from Caremark's move and said that patients and doctors should be able to consume which medication should be used.
David Whitrap, a spokesman for Caremark, said the company made the decision to reduce drug prices. He said the deal would pay the price that Caremarks paid for obstacle to mixtures for medication, by 10 to 15 percent compared to the previous year.
“CVS Caremark could do what PBMS can best do: compete against each other clinically similar products and choose the option that delivers the lowest net costs for our customers,” said Whitrap.
When asked about the examination that Zepbound shows an advantage, Whitrap said that both medication is highly effective and that the results of the clinical studies often distinguish from the results observed in the real world.
The exact prices that employers pay for the medication are secret. According to the Health Transformation Alliance, a group of large employers, a typical monthly price for large employers is between 550 and 650 US dollars.
Without insurance, patients can in most cases receive the medication for 500 US dollars per month. They recently lost a cheaper option than the supervisory authorities hired the sales of copycat versions, which sometimes cost less than $ 200 per month.
Many employers do not pay for Zepbound or Wegovy because they are so expensive. Medicare does not cover the medication for most patients with obesity, and the administration of Trump has recently rejected a bidding plan for an extended cover.
Caremark and two other performance managers together control 80 percent of the prescription market. The other, Cignas Express scripts and Optum RX from Unitedhealth, have not taken any similar measures to block one of the weight brass drugs.
From 2012, the large performance managers increasingly used these steps for a number of medication that disrupted patients and disrupted treatments. Medications will suddenly fall from the regular updated lists of the benefit managers, which are referred to as the wording.
In an analysis financed by the pharmaceutical manufacturers, the researchers found that the number of medication excluded from at least one PBM list in 2022 increased to 548.
The restrictions often change, and patients are not said why. A PBM will cover a medication, but not another, while a competing benefit manager does the opposite.
In most cases, exclusions do not harm the patient, according to experts. In some cases, you can even be advantageous if the patients are forced to switch to a medication that works better for you in the end.
However, some exclusions carry out turmoil in patients and doctors.
In 2022, Caremark forced the patients to switch from a widespread blood thinner to Xarelto. There were some anecdotal reports on blood clots in patients whose treatment was interrupted by the change. Medical groups criticized Caremark's move sharply. The company restored the reporting on Eliquis six months later.
People with autoimmune diseases such as arthritis are also often forced to change medication. People with asthma have to move to another inhalator and then switch to another.
“It has become increasingly intrusive,” said Dr. Robyn Cohen, asthma specialist at the Boston Medical Center.
Patients with Caremark already flood employers with calls and e -mails and questions whether they are affected by employers. You sign the characters' lists of medication, but do not play an active role in creation.
The change from Caremark only applies to some people with private insurance, whose employers opted for the most popular list of the medication of the benefit manager. The move does not affect patients who take the versions of the medication for diabetes.
Patients have the opportunity to switch to wide or one of three other weight loss medication that are not popular because they are not very effective.
Mr. Whitrap said Caremark would offer people who may need an alternative to an “medical exception from case to case”, e.g.
But many people will not qualify for exemption. In interviews, the patients said that they had expressly visited Zepbound and did not want to change.
“I chose Zepbound with my doctor,” said Carl Houde, 49, from Saugus, Mass.
Some patients stated to use their own money to stay in Zepbound. For Victoria Bello, 28, from Syrakus, NY, Zepbound has brought considerable health benefits and she is concerned about losing it.
“I hadn't expected it to change out of nowhere,” she said. “I'm worried about the future of my health and that my health progress will be.”
The study financed by Eli Lilly compared the medication directly in a clinical study with 750 people over more than 16 months.
People with a high dose of Zepbound lost an average of £ 50, compared to £ 33 for people who took away. Both drugs that take patients as injections cause side effects such as nausea, vomiting, diarrhea and constipation. In the study, the rates of these side effects between the two medication were generally similar. In both groups, a small number of patients due to side effects to stop the medication.
The two drugs work in a similar way, but have an important difference. Wegovy imitates the effects of only one hormone that is involved in the appetite. Zepbound does this with two. Scientists believe that imitation will lead more hormones to more weight loss.
Dr. Jason Brett, Executive at Novo Nordisk, said in an interview on Friday that the number of pounds that lose patients was only part of the treatment of obesity. Both drugs have shown that they can improve heart health, but only Novo Nordisk has received the regulatory approval to market its medicine in this way.
The doctors argue that both medication should remain available, since some patients actually lose better than on Zepbound, lose more weight or have fewer or milder side effects.
Doctors say that due to the variation of the way, how patients react either to wide or to Zepbound, is optimal to have both available.
Caremark's defense lawyer say that it only did his job to block Zepbound.
Performance managers negotiate with drug manufacturers to receive payments known as discounts that ultimately reduce prescription drug costs for employers. As part of these shops, the manufacturers also pay fees for PBMS. These fees can add hundreds of millions of dollars for the largest blockbusters. Caremark received significant fees for weight loss medication even without the exclusion of Zepbound.
Novo Nordisk and Eli Lilly have a duopoly on the booming market for weight loss drugs, but Novo Nordisk has lost market shares in Eli Lilly.
Caremark negotiated with both drug makers how much they would pay in discounts to keep their product available. Neither Novo Nordisk nor Eli Lilly would say how much it offered. Novo Nordisk said it did not ask or paid to block Zepbound, and claimed that the exclusion was completely Caremark's decision.
“We believe that in the best interest of patients and doctors it can make the choice,” Lars Fruergaard Jorgensen, Managing Director of Novo Nordisk this month to the analysts of Wall Street.
Elisabeth Degallier, 56, from Rochester, Minnesota, said Zepbound was life -changing. She is upset about Caremark's decision. “I felt that they didn't look at science,” she said. “They looked at the dollars.”
She added: “It fright of the future. I am in a few other expensive medication that I am really dependent on. Will you just cut them?”
