Interesting discussion this morning on some of the new weight loss drugs. I'm coming up on my 20 year med school reunion and I would say Ozempic/Trulicity/Mounjaro/Rybelsus are the only practice altering drugs that have come about during that time. CGRP inhibitors (migraine meds like nurtec/ubrelvy) would be a distant 2nd since they don't affect as many people.

Getting these meds affordably covered, even for diabetics, has been extremely frustrating however. Not to mention the frequent shortages. I've got patients who have finally gotten their blood sugars under control, feeling great and then insurance coverage changes or the coupon no longer works and their $25/month medicine becomes $800/month. Meanwhile the insurance deems me as being of poorer quality because now their blood sugars are out of control again. 🤯

On the other side, to cover these meds for everyone with BMI >30 with co-morbidities and failed other weight loss measures is going to break the system...or is it? Would preventing diabetes, high blood pressure, heart disease save money in the long term? Who knows at this point? I don't support single payer health care but that would be an advantage in that if these meds are shown to save money in the long term, they would be covered. Our hodge podge of insurance plans have less incentive to think of your health in 10 years or 20 years because they will likely not be insuring you then.

In the depths of my frustration of playing the insurance game to get these meds covered, I remind myself that I don't necessarily want my insurance rates doubling or tripling to cover these meds for everyone. So I see both sides.

My last thought after working with thousands of people's health over the last 20 years. Judging obesity as largely a lack of self control is pretty narrow minded. Even "self control" itself is largely determined by genetics and upbringing. I do see it as more of a disease and less a moral failing than I did 20 years ago.

Just some stream of consciousness thoughts I've been ruminating on the last year or so. Getting these meds covered and in stock is so freaking frustrating though!