EMBRACING CHANGE c .) in the communities where it is difficult to find a prescriber , the use is lower . However , in this age of telemedicine , there are a number of telemedicine organizations with prescribers licensed in Kentucky or other states , who provide prescriptions for GLP-1 drugs . For patients willing to work through telemedicine , there can be ready access to prescriptions for this class of medications . There are companies with such friendly names as Adam Health and Henry Health who are quite willing to prescribe GLP-1 . LillyDirect provides telemedicine prescribing for diabetes and migraines . For obesity , the Eli Lilly branded form of tirzepatide can be obtained .
Financial Coverage — GLP-1 drugs with the diabetes treatment indication by the FDA are typically covered by most private and public insurers . However , GLP-1 drugs when prescribed for weight loss are typically not a covered benefit .
d .) Other factors that have associations with use of these drugs :
• Income level — GLP-1 agonists when used for non-covered indications will cost the patient more than a thousand dollars a month . So only those who have higher incomes tend to be willing to bear this cost . There is a phenomenon of “ microdosing ” with people paying for the GLP-1 out of pocket to extend the period between refills by injecting lower doses . The effectiveness of lower doses is not truly known but there is a dose-dependent effect that is generally seen . That is why the dose of liraglutide in Victoza approved for diabetes is much lower that the same compound in Saxenda . The latter has the FDA approval for weight loss .
• Age — While there appears to be high use in all adult age groups , demographic studies show the highest use is , not surprisingly , in the 40-to-60-year age group .
• Comorbid conditions — Patients with comorbid conditions are more likely to seek out GLP-1 agonists so the weight reduction may improve their feeling of improvement whether the actual weight loss does or does not impact the physiology of the comorbid condition .
• Access to Alternative Weight Loss / Diabetes treatments — There have been studies comparing the effectiveness of surgical approaches vs . semaglutide for weight loss . Haseeb et al ., for example , reported in JAMA Network that endoscopic sleeve gastroplasty at five years post-operatively , the surgical group had a greater weight loss and had lower aggregate cost . This was not seen in the first year after surgery but because the semiglutide costs continued while there were much lower medical or surgical expenses after the first year .
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Putting it all together
Kentucky as a state is among those southern states with high rates of diabetes and obesity . But it is not the worst in either category . Geographically the highest rates of prescribing are around Bowling Green , but there are also high rates of GLP-1 prescribing in Louisville and Lexington areas . Data from Medicaid show that there is a disproportionate representation of prescriptions by nurse practitioners and telemedicine providers . Kentucky Statute KRS 205.559 indicate that there are no requirements for the prescriber to have an in-person examination prior to initial treatment or subsequent telemedicine . While these drugs are generally safe with few known major concerns other than cost , the impacts of such high prescribing levels have the potential to alter how limited health care dollars are allocated . As physicians we understand that with national budgetary constraints , the prescribing of high-cost drugs outside evidence-based medical indications can result in fewer dollars for medical services that are truly medically necessary . Organized medicine should work to ensure that proprietary teleprescribing services have external oversight , and that the Board of Nursing work with the Kentucky Board of Medical Licensure for a consistent assurance of quality and appropriate medical care to Kentucky citizens . In an era of medical service belt-tightening , we all have a stake in the process .
References
1
NewsNation , Aug 27 , 2024 Entin B : Ozempic capital of US is in Bowling Green , Kentucky , dubbed Ozempictown , USA
2
US News and World Reports : The 10 Most Obese States in America | Best States | U . S . News
3
Kentucky Data : 03 04 2021 Kentucky Obesity Fact Sheet . pdf
4
Glaze-Rowe R , Which State Medicaid Programs Cover GLP-1s for Weight Loss & How Much Are They Spending ? Real Chemistry Which State Medicaid Programs Cover GLP-1s Approved for Weight Loss & How Much Are They Spending ?
5
Haseeb M , Chatwal J , Xiao J , Jirapinyo P and Thompson CC , Semaglutide vs endoscopic sleeve gastroplasty for weight loss . JAMA Network Open 2024 ; 7 ( 4 ): e246221
Dr . James is an internist / pediatrician seeing patients at Family Health Center .
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