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A12 BUSINESS
Friday 29 december 2023

How to pay for promising medications

like Ozempic

By RONITA CHOUDHURI-
WADE of NerdWallet
Steve Haines always loved
to go for walks, but exercise
had become a nightmare
when he was 380 pounds
and diabetic. The 49-year-
old from Champaign, Illi-
nois, says he would get ul-
cers on his feet after long
walks.
About six years ago, This photo combo provided by the FDA shows an authentic
Haines’ doctor prescribed Ozempic needle, left and a counterfeit needle, right.
Associated Press
Ozempic, a medication
approved by the Food
and Drug Administration macy, Ozempic can cost surance that covers Ozem-
to treat diabetes that also over $11,000 annually. In- pic for diabetes, or are
helps with weight loss. surance provides cover- seeking the drug for weight
Haines lost weight and be- age for some patients, but management and other
gan to feel more active. others must find alterna- non-diabetic reasons, will
Now, at 220 pounds and tive ways to pay, through likely have to find alterna-
with his diabetes under savings or assistance pro- tive ways to pay for the
control, he gets out of the grams or borrowing. medication.
house a lot. UNDERSTANDING INSUR- EXPLORING PAYMENT OP-
“I sometimes walk 10 to 15 ANCE COVERAGE TIONS
miles in a day,” says Haines. Most health insurance Hillary Filstrup, 37, a cus-
Haines is one of many plans, including Medicare tomer success manager in
Americans who live with and Medicaid, cover at Tulsa, tried to get Ozempic
diabetes. According to the least some of the cost to manage her weight af-
Centers for Disease Control of semaglutide medica- ter being diagnosed with
and Prevention, around 1 tion when it’s prescribed polycystic ovary syndrome
in 10 Americans have dia- to treat Type 2 diabetes. and developing insulin re-
betes, and the vast majori- However, coverage can sistance. However, her in-
ty have Type 2, a condition vary depending on an in- surance wouldn’t cover
in which the body can’t dividual’s plan and state the medication since her
control the amount of sug- requirements. condition wasn’t diabe-
ar in the blood. Alvin Carlos, a certified fi- tes-related. Filstrup opted
Ozempic, generically nancial planner based in to pay out of pocket for
known as semaglutide, Washington, D.C., suggests a semaglutide medica-
can be a lifeline for many. calling your insurance pro- tion from a compounding
Semaglutide stimulates in- vider to ask if your plan pharmacy.
sulin secretion and controls covers drugs like Ozempic For those like Filstrup with
blood sugar, which helps and what the out-of-pock- high out-of-pocket costs or
manage Type 2 diabetes. et costs may be. no insurance coverage for
The medication also slows When choosing insurance, Ozempic, there are ways
digestion and sends signals a low-deductible plan can to help pay for the medi-
to the brain that the stom- be better for expected cation.
ach is full, which can lead costs such as ongoing pre- MANUFACTURERS’ SAV-
to weight loss. scriptions, says Carlos. A INGS PROGRAMS
Prescriptions in the U.S. for health savings account or Pharmaceutical compa-
semaglutide medications flexible savings account, nies often offer savings
like Ozempic increased which use pre-tax income cards to reduce out-of-
300% from 2020 to 2022, to pay for health expenses, pocket costs for eligible
despite a high price tag. can also mitigate out-of- patients. Novo Nordisk, the
Depending on factors like pocket costs. manufacturer of Ozempic,
the dosage and your phar- Those who don’t have in- provides a savings card
that can significantly low-
er the cost for up to three
months for qualifying pa-
tients with private or com-
mercial insurance.
PATIENT ASSISTANCE PRO-
GRAMS
Patient assistance pro-
grams are designed to
help uninsured patients
who cannot afford their
medications.q