World
Supply problems and insurance issues make popular weight-loss drugs hard to get
When she prescribes the popular weight-loss drug Wegovy, Dr. Angela Fitch sends patients on a quest she likens to “The Hunger Games.”
They will have to call drugstores over several days to find one with the properly sized first dose. Then they’ll do that again for their second dose, and probably the third. And that’s only if the patient has insurance or the means to afford a drug that can cost more than $1,300 a month.
“This is not for the weak-willed,” said Fitch, who is president of the Obesity Medicine Association and also consults for drugmakers.
Supply problems and insurance complications have made it difficult for people to start — and stay on — Wegovy and similar medications that are transforming obesity treatment, according to doctors and patients around the country. They say getting the high-demand, injectable drugs requires persistence and a fair amount of luck.
People starting on Wegovy have to take injections of gradually increasing strength before they reach the so-called maintenance dose that they stay on.
The drug’s maker, Novo Nordisk, says that demand has forced it to restrict the supply of those smaller, initial doses in the U.S. The company also is warning those taking another weight-loss drug, Saxenda, to expect difficulty filling prescriptions “for the remainder of 2023 and beyond.”
Another drugmaker, Eli Lilly, has said it expects tight supplies until year’s end for its diabetes treatment Mounjaro, which also is prescribed for weight loss.
Finding Wegovy can become a part-time job for patients, said Dr. Diana Thiara, medical director of the weight management clinic at the University of California, San Francisco.
Thiara said some wind up driving 45 minutes or more to get prescriptions filled, a barrier for hourly workers who can’t leave their job and for people without cars.
“It’s usually patients who are a little bit more privileged, able to take off from work to go make those drives,” Thiara said.
One of Fitch’s patients, Mike Bouboulis, has taken Saxenda, Mounjaro or Ozempic, a Novo diabetes drug with the same active ingredient as Wegovy, since around 2019. It became much harder for him to find the drugs in the past year, after their popularity exploded.
Refilling a prescription involved calling five to seven pharmacies.
“They all know what you’re calling for, and they all have the same answer: ‘I don’t know. We’ll see tomorrow,’” said the 35-year-old small business owner who lives outside Boston.
Pharmacy technician Lizzy Nielsen used insider knowledge to start Wegovy earlier this year.
She regularly checked drug wholesalers’ supply lists, refreshing her screen each morning, and then ordering Wegovy for her pharmacy as soon as she saw it in stock.
“I was really lucky … because that’s when it was like starting to be constantly back-ordered,” the 42-year-old West Springfield, Massachusetts, resident said.
While patients have had to deal with shortages of many medications in the past year, those taking weight-loss drugs can face coverage complications too.
The federal Medicare program for people age 65 and older doesn’t cover obesity medicines, but some privately run Medicare Advantage or Medigap plans do, according to Novo. Coverage from Medicaid programs for people with low incomes varies.
Doctors and patients say many insurers have stopped covering Ozempic and Mounjaro outside their approved use for diabetes. Some insurers and employers don’t pay for Wegovy.
Novo Nordisk even offers a form letter on its Wegovy website to help doctors request coverage.
Bouboulis, the Boston-area resident, said his insurer stopped covering Mounjaro earlier this year. He then tried switching back to Ozempic but found that also was no longer covered.
He’s taking low doses of leftover Ozempic until he can find coverage.
“I know the insurance companies don’t want to pay, but between (them) and the pharmaceutical industry, they need to find some kind of nice middle ground because these medications, they can save people’s lives,” said Bouboulis, who has lost around 80 pounds since he started taking them.
Employers and insurers that do pay for the weight-loss treatments often require patients to get pre-approval or to first try other strategies like diet and exercise.
Some require patients to show they’ve lost 5% of their body weight after six months on the drugs in order to continue coverage. Supply problems make that hard, Thiara noted.
“A lot of patients are not staying on it consistently because they can’t get it,” she said.
Dr. Laura Davisson estimates that less than 30% of her patients with insurance through an employer or an individual plan have obesity medicine coverage.
Davisson directs a weight-loss program in West Virginia, a state that consistently ranks as having one of the highest obesity rates in the country. The state’s Medicaid program doesn’t cover Wegovy, but neighboring Pennsylvania’s does.
“For me, it’s either they have coverage through insurance, or they’re not taking it,” she said. “No one can afford it.”
Coverage may improve over time, as it has with other obesity treatments like bariatric surgery.
About 46% of large U.S. employers cover obesity medicines like Wegovy, according to the benefits consultant Mercer. Another 18% are considering it. Mercer’s experts say employers are still trying to learn about how the added cost will affect them and what other support patients may need.
Dr. Deborah Horn says she thinks supply problems and coverage will eventually smooth out, but it may take a couple years. She noted that the FDA may soon approve Mounjaro to treat obesity, which could improve coverage.
Drugmakers also are developing other weight-loss medications, including easier-to-take pills.
In the meantime, more patients are realizing that they can get medical help for their disease and don’t have to manage it on their own, said Horn, an obesity medicine expert at UTHealth Houston.
“I feel like this is the beginning of the change in obesity care, where we will see every year better and better medications coming to market and people getting their disease under control,” she said. “We’re just in the hard part … right now.”
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
World
What to know about Linda McMahon, Trump’s pick for Education secretary
WASHINGTON (AP) — Linda McMahon has been a constant presence in Donald Trump’s tumultuous orbit, serving in his first administration and supporting his presidential campaigns. Now he’s chosen her to serve as Education secretary.
Here’s a look at McMahon’s background, from business to politics.
McMahon went from wrestling to politics
McMahon is married to Vince McMahon, whose father was a prominent professional wrestling promoter. They followed him into the business, founding their own company that’s now known as World Wrestling Entertainment, or WWE. It became a juggernaut in the industry and American culture.
When Trump was the star of the reality show “The Apprentice,” he made an appearance at Wrestlemania in 2007. The billionaire entertainment mogul participated in an elaborately scripted feud that ended with Trump shaving off Vince McMahon’s hair in the middle of the ring.
Linda McMahon stepped down from her position as WWE’s chief executive to enter politics. She ran twice for a U.S. Senate seat in Connecticut, but lost in 2010 to Richard Blumenthal and in 2012 to Chris Murphy.
Shifting gears, she focused on providing financial support to candidates. McMahon provided $6 million to help Trump’s candidacy after he secured the Republican presidential nomination in 2016.
What to know about Trump’s second term:
Follow all of our coverage as Donald Trump assembles his second administration.
Teaching was an initial career goal
McMahon served on the Connecticut Board of Education for a year starting in 2009. She told lawmakers at the time that she had a lifelong interest in education and once planned to become a teacher, a goal that fell aside after her marriage.
She also spent years on the board of trustees for Sacred Heart University in Connecticut.
McMahon is seen as a relative unknown in education circles, though she has expressed support for charter schools and school choice.
McMahon was part of Trump’s first presidency
A month after defeating Hillary Clinton, Trump chose McMahon as leader of the Small Business Administration. The agency gives loans and disaster relief to companies and entrepreneurs, and it monitors government officials’ compliance with contract laws.
When McMahon was chosen, she was praised by Blumenthal and Murphy, the two Connecticut Democrats who defeated her in Senate campaigns. Blumenthal called her “a person of serious accomplishment and ability,” while Murphy said she was a “talented and experienced businessperson.”
Unlike other members of Trump’s first administration, McMahon was not shadowed by scandal or controversy. She frequently promoted his trade and tax policies.
“She has been a superstar,” Trump said when she left the administration in 2019. “The fact is, I’ve known her for a long time. I knew she was good, but I didn’t know she was that good.”
She kept supporting Trump after leaving the administration
McMahon didn’t leave Trump’s orbit. She chaired America First Action, a super PAC that backed Trump’s reelection campaign in 2020. He lost to Democrat Joe Biden, and McMahon helped start the America First Policy Institute to continue advocating for Trump’s agenda and prepare for a potential return to the White House.
When Trump ran for president this year, McMahon was the co-chair of his transition team along with Howard Lutnick, the chief executive of financial services company Cantor Fitzgerald. As part of that role, McMahon has been helping to plan Trump’s new administration.
Once he takes office, perhaps McMahon’s biggest task will be to eliminate the agency she was hired to oversee. Trump has promised to close the Education Department and return much of its powers to states. Trump has not explained how he would close the agency, which was created by Congress in 1979 and would likely require action from Congress to dismantle.
World
Brazil's first lady aims explicit joke at key target of husband's administration: 'F–k you, Elon Musk'
The first lady of Brazil turned heads when she dropped an f-bomb directed at Tesla CEO Elon Musk during an official event over the weekend.
At the time, Brazil’s first lady, Janja Lula da Silva, was speaking about misinformation on social media during a pre-G20 social event on Saturday. The G20 summit began on Monday in Rio de Janeiro.
Lula, who is married to Luiz Inácio Lula da Silva, stopped mid-speech when she heard a ship’s horn blaring in the distance.
“I think it’s Elon Musk,” the first lady joked in Portuguese. “I’m not afraid of you, by the way.”
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“F–k you, Elon Musk,” Lula added in English, prompting cheers from the audience.
The clip, which was posted on X, drew the attention of Musk, who responded with laughing emojis.
“They will lose the next election,” the entrepreneur wrote.
‘FIRST BUDDY’: ELON EARNS FAMILY STATUS IN TRUMP WORLD AS MUSK EXPANDS POLITICAL FOOTPRINT
Brazil banned X in September, prompting outrage across the world. Brazilian Supreme Court’s Justice Alexandre de Moraes imposed the ban, citing misinformation on X, which the judge felt was not adequately moderated on the platform.
The country lifted the ban a month later, and de Moraes wrote that the decision “was conditioned, solely, on [X’s] full compliance with Brazilian laws and absolute observance of the Judiciary’s decisions, out of respect for national sovereignty.”
“X is proud to return to Brazil,” X said in a statement at the time. “Giving tens of millions of Brazilians access to our indispensable platform was paramount throughout this entire process. We will continue to defend freedom of speech, within the boundaries of the law, everywhere we operate.”
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The Brazilian first lady’s joke took place two days before the G20 summit officially began. President Biden was present at the summit, though he did not appear during the annual family photo with fellow world leaders and missed the photo-op “for logistical reasons,” the White House said.
Reuters and the Associated Press contributed to this report.
World
G20 Summit: Brazil's president calls for more action on climate change
President Luiz Inácio Lula da Silva’s comments came the day after representatives of the G20 nations endorsed a joint statement that called for a pact to combat hunger, more aid for Gaza, an end to the war in Ukraine and other goals.
Brazil’s president opened the second day of the G20 Summit by calling for more action to slow global warming, saying developed nations must speed up their initiatives to reduce harmful emissions.
Luiz Inácio Lula da Silva focused Tuesday’s session on environmental challenges, saying developed nations should consider moving their 2050 emission goals forward to 2040 or 2045.
“The G20 is responsible for 80% of greenhouse effect emissions,” Lula said. “Even if we are not walking the same speed, we can all take one more step.”
During the summit, which was held at Rio de Janeiro’s Modern Art Museum, G20 leaders gathered to discuss changes in the world order from heightened global tensions to changes on the international political stage.
The agenda focused on working to reinforce multilateral cooperation before US President-elect Donald Trump assumes office in January.
EU leaders also took the opportunity to hold bilateral meetings on the sidelines of the summit.
In a meeting with Chinese President Xi Jinping, French President Emmanuel Macron reaffirmed France’s commitment to strengthening relations with China and insisted that the two countries shared the same views on promoting peace in Ukraine.
“The world in which we live, as you just reminded us, is made up of instabilities, tensions and growing wars. And I believe that we truly share a common vision in upholding the United Nations Charter and promoting a peace agenda,” Macron told Jinping.
“We meet again on the 1000 day of the War of Aggression launched by Russia against Ukraine, and I know that you share, as we do, the desire for a lasting peace, respectful of the United Nations Charter, and that you share, as we do, the same concern after Russia’s bellicose and escalating declarations of nuclear doctrine,” he added.
A joint statement signed by representatives of the G20 nations on Monday night called for urgent humanitarian assistance and better protection of civilians caught up in conflicts in the Middle East, plus affirmed the Palestinian right to self-determination.
It also included Brazil’s proposal to tax billionaires’ income by 2%, focused on ways to eradicate world hunger and pledged to work for ‘transformative reform’ of the UN Security Council.
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