It seemed like only a matter of time before someone would close this valve. After months of off-label prescribing of Ozempic, propelled by celebrity hype of the diabetes drug which has gained popularity as a weight-loss treatment, some payers have decided to rein in the practice.
According to a report in The Washington Post last week, some 14 Anthem Blue Cross Blue Shield plans cautioned healthcare providers in several states about prescribing Ozempic to non-diabetic patients. As the “education” letter noted, an inquiry undertaken of those physicians’ claims by the plan’s “Special Investigations Unit” revealed that 60% of patients prescribed Ozempic lacked “sufficient evidence” of diabetes, the product’s Food and Drug Administration-approved use.
Such prescribing could put patients at risk, the insurer warned, threatening the 150 or so prescribers who received the letter that it would refer “suspected inappropriate or fraudulent activity…to the state licensure board, federal and/or state law enforcement.” What’s more, the trend has led to nationwide shortages of the drug for diabetics.
Those warnings portend a future reckoning with regard to new drugs like Ozempic, driven by celebrity and social-media buzz around the medications, which are disrupting the way obesity is treated. The new crop of products, known as GLPs, has proven to be highly safe and effective and is stoking a mad dash by patients to access them and by pharma companies to satisfy the market.
But their high costs – the drugs list for $900 or more per month – put payers in a pickle: should they give the GLPs a warm reception, potentially saving money on downstream medical expenses, or tamp down on what’s shaping up to be a colossal short-term liability?
While carriers are frowning on off-label prescribing now, the spigot could reopen if studies pan out showing that Ozempic and its cousins have cardiovascular and other wider health benefits. Novo Nordisk and Eli Lilly are studying whether use of these drugs decreases comorbidities.
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