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“All the time. All day. Like, ‘I’m hungry. I need to eat this. Why did I eat this?’ or ‘OK, I’m not going to eat this, it has too many calories,’ ” said Khoury, who runs her own interior design business.

Khoury,37,moved to the US from Chile when she married her husband in 2015. The change in food, and especially the larger portions, led her to gain 30 pounds. Then she had four pregnancies, gaining more weight each time.

Her thoughts became dominated by mental chatter about food, she said, something Wegovy users shorthand on social media as “food noise.”

Eli Lilly launches service to connect patients with telehealth care, deliver medications to their homes

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In January of 2022, Khoury made it to a place people in online weight loss support groups callOnederland: when they hit a weight on the scale that starts with the number one. And she kept going – dropping a total of 80 pounds in 10 months, eventually hitting a low weight of 149 pounds in September of 2022.

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“You start regaining all the hunger back. You feel you haven’t eaten in a year, which is actually pretty accurate,” Khoury said with a laugh.

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“It’s very common for insurance companies to create these hoops that patients have to jump through,” said Dr. Dan Azagury, medical director of the Stanford Bariatric and Metabolic Interdisciplinary Clinic.

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“Obviously, patients are going to discontinue it. They’re like, ‘I’m not going to take this for another three months,’” Azagury said. “Then the insurance will say, ‘well, you haven’t been compliant with your first-line treatments, so we’re not going to cover the more expensive drugs.’ ”

【 - Free Expert-Led Investment Training 】 Exclusive: Older weight loss drugs are making a comeback as Zepbound, Wegovy remain out of reach for many

In other cases, he says his clinic has recently had a couple of patients who were denied coverage for their GLP-1medications because those drugs worked for them.

“We’ve had a patient who started at a BMI of 33, and now they’re at a normal BMI of 22, and the insurance is saying, ‘Well, now you have a normal BMI, so you’re not covered,’ ” Azagury said.

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Having people stop using drugs that have helped them lose weight would be like having someone stop their blood pressure medication after it brought their blood pressure down, Azagury says, or telling someone who’s diabetic, but who has normalized their blood sugar with treatment, to stop their medications and wait for their blood sugar to go back up.

Economists say that, yes, the medications are expensive, but they could also lead to substantial cost savings if they prevent other serious medical conditions like heart disease, diabetes and arthritis. Arecent studyfound that the GLP-1 drug semaglutide, for example, could reduce the risk of cardiovascular deaths, heart attacks and strokes in people who took it to lose weight.

Oneanalysis, by the Schaeffer Center for Health Policy and Economics at the University of Southern California, estimated that Medicare could save nearly $175 billion within 10 years if it covered the new GLP-1 weight loss drugs. It also found that US society as a whole could see as much as $1 trillion in savings over 10 years if all eligible Americans were treatedwith them.

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Dr. Bryan Tysinger, a research assistant professor at USC who worked on the analysis, said there are two reasons.

“The first is that the long-term effects of these drugs aren’t fully known yet,” he said. “If people do need to stay on these drugs long-term, are there long-term health benefits? We just don’t know.”

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Dr. Kimberly Gudzune, the medical director for the American Board of Obesity Medicine who treatspeople withobesity and diabetes at Johns Hopkins, said her practice has been getting so many new requests for time-intensive prior authorizations from insurance companies that it had to hire an additional staff member to help.

“We actually hired a pharmacy tech part time in order to help us process through all of the prior authorizations that are needed because the volume is just so astronomical,” she said.

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Gudzune said she understands that insurers need to control costs, but the requirements she’s seeing seem reactionary and not based on what research shows about the treatment of obesity.

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“There are a lot of tough discussions that are being had in clinical practice about ‘where do we go from here?’ and oftentimes we don’t really know yet,” she said.

Khoury tried to stay on Wegovy. Her new insurance company pays for a medicine with the same active ingredient if it is used to treat diabetes, and Khoury is insulin-resistant, which can be a prelude to type 2 diabetes. But she doesn’t meet the criteria for diabetes, so the insurance company said no.

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Royal Arc Electrodes Limited Stock Trend Analysis ✌️【Capital Growth】✌️ Expert analysis of global stock trends, futures data, and real-time stock market quotes to help you plan your next investment move. She tried getting less-expensive versions of the medications from Canada but ultimately turned to a compounding pharmacy in New York to buy a custom-made version of her old weight loss drug — semaglutide — that has some B vitamins mixed in.

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But the agencyhas also warnedthat it has received reports of adverse events in some people who used compounded semaglutide. It says the active ingredients in compounded versions may not be the same as in the approved versions of the drugs.

Drugmakers Novo Nordisk and Eli Lilly said theirown testshavefound impuritiesand inaccurate strengths of inactive ingredients in some compounded versions of these medications.In an open letter posted online last week, Lilly said a compounded product “was actually nothing more than sugar alcohol.”

Khoury says she’s been using compounded semaglutide for about a month. She hasn’t lost any weight, but she has quit smoking, she says. Many users have reported that in addition to quelling food cravings, GLP-1 medications cancut addictionsto other substances.

Her out-of-pocket costs rose from $20 a month to $350 per month, which is still pricey but manageable for the time being.

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