SALT LAKE CITY — Kathryn Weber has a lengthy resume of interests.
She’s a hiker, dog lover, waterfall chaser and a kindergarten teacher for the Canyons School District, a job she enjoys.
But a few years ago, she realized she wasn’t able to do all the things she loved the same way.
“I was having a lot of pain, irregular menstrual cycles, hair growth that was abnormal, but mostly the pain was just excruciating,” says Weber. “I was calling into work because I couldn’t sleep because I was in so much pain. I was up for hours at night.”
For months Weber went to several doctors, but no one could tell her what was wrong.
After one last round of bloodwork, she was diagnosed with polycystic ovary syndrome or PCOS.
Per Mayo Clinic’s description, polycystic ovary syndrome is a condition where you have few, unusual or very long periods.
It often results in having too much of a male hormone called androgen and many small sacs of fluid develop on the ovaries that may fail to regularly release eggs.
“There’s not a cure for it, there’s not really a way to treat it. It’s just kind of managing it,” says Weber.
However there was one method Weber found to manage some of her symptoms.
Enter Ozempic.
“It has become Hollywood’s little secret I’d like to say that has really gotten out,” says Dr. Richard Ferguson, president of the Black Physicians of Utah.
Fox 13 sat down with Dr. Ferguson to talk about why women like Weber have turned to drugs meant to treat diabetes like Ozempic to mitigate their PCOS symptoms and how it works.
“They’ll have increased weight gain, they’ll have increased insulin resistance,” says Dr. Fergusion. “It acts on the pancreas and attaches to a receptor that stimulates increased secretion of insulin and production of insulin we need in our body to move glucose from our bloodstream into ourselves, so it helps to lower our elevated blood glucose levels.”
But beyond its intended use for diabetes, many have turned to Ozempic and other drugs referred to as GLP 1 agonists, for weight loss.
“It’s gotten out in the mainstream, where someone says I can pay $800 up to $1,300 a month and now I can get into my old swimsuit, but they may not have a chronic obesity problem with associated risk factors like hypertension, high cholesterol and prediabetic state,” says Dr. Ferguson. “The manufacturer has not made enough to meet this demand, so that’s why there’s a shortage.”
That shortage has created a pricey puzzle for patients like Weber to figure out.
Her insurance company is now denying her coverage for Ozempic.
“They said they’re not covering it anymore because there are so many people using it now for weight loss and in their words ‘misusing it’, so they just were not covering it unless you are diabetic,” says Weber. “I was on the phone with doctors and my insurance trying to send in my bloodwork and show them that look, I’m not taking it for weight loss. I need it for my insulin, but I’m not diabetic, but I still have this problem because of PCOS. They just told me that…nope.”
There are several diabetic drugs that doctors have prescribed for what is called “off-label use”, essentially using it to treat conditions other than diabetes.
PCOS would be included as “off-label use”.
Ozempic is made by Novo Nordisk, it has not yet been indicated by the FDA specifically for weight-loss.
Victoza, also a creation of Novo Nordisk, also has been used for weight-loss but has not been FDA-indicated for that purpose.
Mounjaro, created by Eli Lilly, has not been approved to treat weight loss either.
So far, Wegovy is one of the first GLP 1s approved specifically for weight loss.
According to data tracked by the Iqvia Institute, last year the average number of weekly Ozempic prescriptions rose 33%.
Dr. Ferguson says a promotional deal will often lure people in with coupons located on the drugs’ website.
Consumers may get a discount for the first several months they use it, but long-term, many people stop because the price tag is too high.
“The thing is, if you aren’t able to sustain it, the weight comes back,” says Dr. Ferguson. “Often 60% of that weight will be gained back within three to four months.”
What can be done?
Recently the National Health Service of England and the UK’s Department for Health and Social Care have set new guidelines to limit the amount of GLP 1s that can go to a pharmacy.
They’re also seeking to make sure that insurance companies restrict coverage for those who have chronic weight management associated with other diseases or risk factors.
The pharmacy is just one place where the accountability starts.
“It’s going to start at the doctor or the prescriber at the time,” says Dr. Ferguson. “That is truly saying ‘Every time I probably write this for someone that has a low BMI or a lower BMI, it’s because they want to have a certain image’. That can be rather frustrating just knowing that it is going to someone that is not in as much need. They just have the means.”
Weber has a proposal for insurance companies.
“I even suggested to my insurance company to have me sign a waiver, saying I am not using it for weight loss and to submit the bloodwork to show the actual reason that I need it,” she says. “If you put those stipulations in place, then you would see what I’m actually using it for and I’m not abusing it.”
Fox 13 contacted Weber’s insurance company, PEHP, to see if there was any resolution for her.
This was the response from their chief clinical officer:
"PEHP is not able to comment on any specific patient or coverage request. At this time, Ozempic is only FDA approved for type 2 diabetes management. As with coverage for any drug, we look to FDA and other medically-reviewed data to understand the benefits, side effects, alternatives, and cost relativities in deciding if a coverage change is supported."
Fox 13 also reached out to other insurance providers including Aetna, Cigna and United Healthcare to see how they were handling the distribution of GLP 1s for people like Weber who benefit from their use but aren’t using them for weight loss.
Aetna says they did not want to comment.
FOX 13 did not hear back from Cigna or United Healthcare.