SEATTLE — About a year ago, Sean Crawford, a real estate agent on Bainbridge Island, began to take weight loss medication.
Crawford, 46, didn’t think much about his weight for most of his life. That changed after he reached his 40s and had kids. Finding it harder to hit the gym and to stay active, Crawford began to put on pounds and struggled to lose them.
Then he heard in the news about a drug called semaglutide. Through a telehealth platform, he got a prescription for Wegovy, a brand-name version of the medication approved by the Food and Drug Administration for weight loss and weight-related problems. The results were immediate and dramatic. He dropped 20 pounds in his first two months on it and has lost 57 pounds since.
Over the past few years, a new class of weight loss drugs has skyrocketed in popularity, with demand so high that it has occasionally led to severe shortages. Technically known as GLP-1 receptor agonists, they help users control blood sugar and appetite and are used to treat both diabetes and obesity. Semaglutide is one such GLP-1 drug, and brand-name versions of it include Ozempic and Wegovy.
But the drugs can cost hundreds of dollars a month or more, depending on dosage, and most health plans don’t cover them for weight loss use.
Crawford’s insurance pays for his Wegovy only because he also has high cholesterol, he said. This puts Crawford in a bit of a bind: He wants his cholesterol to reach healthy levels, but he also worries that it could disqualify him from Wegovy coverage.
He hopes to taper the medication off completely by the end of this year. But without coverage, he would never have been able to access the medication, which he said has helped him develop a healthier relationship to food. Its sticker price is a whopping $1,300 for a four-week supply.
“There’s no way I could afford to pay $1,000 a month,” Crawford said in an interview in late September.
As in Crawford’s case, many individual and employer-sponsored health plans cover GLP-1 drugs only to treat diabetes, or under narrow circumstances to mitigate other conditions. But such broad limitations mean that many people seeking to lose weight have little to no access to drugs they think will be effective. Some Washingtonians are fighting for access through litigation: At least three separate lawsuits are winding their way through the state court system challenging lack of coverage for weight loss drugs — though they could take years to resolve.
Washingtonians with limited means have it particularly hard. For instance, one-fifth of the state population is on Medicaid, a public health insurance option for low-income people. In Washington, the program doesn’t cover anti-obesity drugs under any circumstances. This contrasts with other states like California, Michigan and Virginia, where the program pays for weight loss medication, albeit with certain limitations. In addition, 14% of Washington residents are on Medicare, the federal insurance program for older adults. The program is prohibited from paying for drugs for weight loss.
As a result, most people in the state are left on their own to afford pricey weight loss drugs. Here’s how some are managing to do it.
Buying off-brand medication
For Madison, 25, an employee at Fred Hutchinson Cancer Center, it’s impossible to disentangle weight from overall well-being. She has endometriosis, and her doctor also suspects that she has polycystic ovary syndrome. Both conditions have been linked to weight gain. Madison asked to withhold her last name to protect her privacy as she shared medical history details.
She also has degenerative hip dysplasia, which will require her to get a hip replacement in five years. Earlier this summer, she began looking into GLP-1 drugs to lose weight — a goal that she sees as inseparable from dealing with her health conditions and managing hip pain.
“They’re kind of the same thing in my head, because the weight gain that I’m trying to lose is from those illnesses,” she said in an interview in early fall.
But her health plan doesn’t see it that way. It covers GLP-1 drugs for a few health conditions, but not for weight loss specifically. She makes between $65,000 and $70,000 a year; spending $1,000 a month on weight loss medication was out of the question. Instead, she buys what’s known as compounded semaglutide from an online pharmacy called Henry Meds, which costs between $200 and $300 a month.
Unlike brand-name GLP-1 drugs, compounded versions are not approved by the FDA. Pharmacies can produce them only in times when the FDA declares drug shortages. The medication comes in a vial that she has to measure out precisely and administer with a syringe. “I actually really preferred to do the pens,” she said, referring to the brand-name versions of the drug that come in premeasured injectors. “But they’re so much more expensive.”
GLP-1 drugs, including the brand-name products, aren’t without side effects. Many who take them have reported nausea or other gastrointestinal issues, which may be mitigated with other medication. The FDA advises patients to take additional precautions when using compounded versions of the drugs, which have occasionally been linked to adverse reactions. As with other medications, it’s recommended to seek professional medical advice before taking these drugs.
Health plans apparently are hesitant to add coverage of GLP-1 drugs for the same reason that people want it.
“They’re worried that the costs are just going to sink them,” said William Dietz, director of the Stop Obesity Alliance, a coalition of organizations out of George Washington University aimed at combatting obesity. “Because of, firstly, how prevalent this problem is, and secondly, what the demand would be for these products at the current costs.”
In Washington, nearly 39% of people have obesity, slightly under the national rate of nearly 43%, according to an analysis of 2013-21 data by the National Opinion Research Center at the University of Chicago. But it’s not just people with obesity who might seek out GLP-1 drugs for weight loss use. Many others believe that these drugs can help them reach a weight goal, set better eating habits or alleviate other health conditions, raising the demand exponentially.
For Madison, even the compounded semaglutide remained a significant expense. But she decided to go forward with it in August because she thought she would save money on food in response to the drug’s suppression of her appetite. That’s exactly what happened.
Previously, she spent between $75 and $100 a week on groceries; now she spends just $50 a week, having cut all her spending on snacks. She also mostly stopped eating out or ordering takeout. “I don’t crave food at all anymore,” she said. When she does eat, she just focuses on getting enough fiber and protein. Otherwise, she said, she doesn’t think about food at all.
Long-term health
For older Washingtonians, weight loss medication costs can be particularly inaccessible with a limited retirement income.
Phyllis Barnes, 70, lives with her husband in Port Townsend. Earlier this year, she became concerned about her vitals — cholesterol, triglycerides and glucose primarily — which had crept up over time. Diabetes runs in her family, and she wanted to take preventative measures to avoid it. Weight loss medications have been linked to a decrease in all three vitals, so she got a prescription from her doctor for Zepbound, whose active ingredient is tirzepatide, another GLP-1 drug.
The brand-name medication costs $1,100 a month. Barnes and her husband are retired, so they live mainly off Social Security payments or distributions from their retirement accounts. Barnes is also on Medicare, the federal health insurance program for people ages 65 and older. However, Medicare is banned from paying for medications for weight loss use, owing to somewhat outdated ideas about their effectiveness and purpose.
“When Medicare started covering prescription drugs, weight loss medications were sort of seen as a little bit more of a cosmetic product, rather than a product that was justified on clinical grounds,” said Benedic Ippolito, a senior fellow in economic policy studies at the American Enterprise Institute, a think tank.
There are some instances in which Medicare does cover GLP-1 drugs, including for people with diabetes, or those over a certain body mass index who also have heart disease or sleep apnea. But Barnes doesn’t meet any of these criteria. In fact, she’s taking GLP-1 drugs and paying for them out of her retirement savings to avoid those conditions specifically. For Barnes, taking weight loss medication to prevent getting sick is effectively more expensive than taking it as treatment.
Despite the high out-of-pocket cost, Barnes decided to commit to using Zepbound, which she saw as an investment in her long-term health. But the decision illustrates a unique financial situation that older people face: They must weigh their present-day health spending against their projected future needs, which are likely to be even more costly. It can be a fraught choice to make.
“There’s more uncertainty,” Barnes said in an interview last month. “Whenever you draw money out of your [retirement account] to pay a medical bill you’ve taken, you’re selling shares that would appreciate in value in years to come.”
After four months, she switched to a compounded version of tirzepatide, which costs $400 a month.
Barnes said that she still counts herself as lucky; at the end of the day, she wanted weight loss medication, and she got it.
“As you get older,” Barnes said, “you take a hard look at your life and the years you want to spend on this Earth and what quality of life you want to have — and that’s where my decision flowed from.”
“That’s a lot of money”
To afford GLP-1 drugs, some have gone to great lengths, literally.
Lilla, 38, a longtime resident of Northeast Seattle, first began looking into weight loss medication in late 2022. She requested to withhold her last name to protect her privacy as she shared health details.
Lilla had struggled with weight and fitness throughout her life. Then the pandemic hit, and its isolating early years made those longstanding challenges even harder to manage. After reading up on potential benefits and risks, she went to her nurse practitioner and got a prescription for Wegovy, the same drug that Crawford sought. The medicine shortages early last year meant that Lilla had to call countless pharmacies and crisscross King County to fill her prescription each month. But finding it wasn’t the only difficulty — financing it was as well.
Like many health plans, Lilla’s insurance didn’t cover Wegovy for weight loss use. Out of pocket, a month’s supply came with a price tag of more than $1,300. Even after applying a coupon from the drug manufacturer, it cost $861 a month.
To afford it, Lilla used money that she would have otherwise put into an emergency fund. She hasn’t had any unexpected expenses crop up since she began Wegovy. Nonetheless, she’s frustrated that she had to forgo a significant amount of savings to make it work.
“You should not need to pay this much for this medication,” she said in a recent interview.
In summer 2023, Lilla traveled to Eastern Europe to visit family. There, she went to a pharmacy to refill her prescription. She found herself taken aback by how inexpensive the medication was overseas. For a one-month supply, she paid just $276 — about one-fifth of the sticker price in the U.S. “I was just shocked,” she said. She’s been asking herself since: “How much does this actually cost off the factory floor?”
Today, Lilla gets Wegovy from Costco, where it costs $650 a month. She travels to Eastern Europe about once a year and tries to stock up on a few months’ worth of the medication while abroad. She’s comfortable with the drug now and typically spaces out her injections to make a typical month’s supply last twice as long.
The medication itself has been transformative, she said. With the help of Wegovy paired with exercise, Lilla has lost around 30 pounds. She’s energetic instead of lethargic, and she no longer experiences a constant internal hankering for food — a sensation commonly referred to as “food noise.”
But the relief that Wegovy has brought her is tempered by the reality of how much she’s paid for it. She estimates that she’s spent $10,000 on the medication in the U.S. over the nearly two years that she’s been on it.
“That could have been $10,000 toward a down payment for a house or a new car,” she said. “I felt like I had to do this for myself and my health and to thrive. But it’s not a joke. That’s a lot of money.”
