New Semaglutide Dose in Diabetes: Value for Obesity?

This is the kind of change that flies under the radar and makes a big difference. This week, Novo Nordisk received FDA approval of a 2 mg dose of semaglutide (Ozempic®) for better control of type 2 diabetes. This higher dose option provides a means for maintaining better glycemic control in patients as their disease progresses. But it also comes very close to the semaglutide dose – 2.4 mg – for treating obesity with Wegovy™.

This can be important because it begins to erase an artificial distinction between using semaglutide for diabetes or for obesity. Some drug plans will deny coverage for the higher doses of semaglutide that a patient with both obesity and diabetes might need. They lean on exclusions of coverage for treating obesity. So they will cover semaglutide at the doses indicated for diabetes. But they won’t cover it at the 2.4 mg dose used for obesity.

It’s a clever game they play to discourage people from seeking treatment for obesity. This game is rigged so the patient loses.

The SUSTAIN FORTE Study

The basis for this approval was a study called SUSTAIN FORTE. It compared the clinical outcomes for the new 2 mg weekly semaglutide dose to a 1 mg weekly dose. The results were clear. Patients achieved better blood sugar control and lost more weight with the higher dose. The most common side effects were GI. In the 2 mg group, 34 percent reported them, which compares to 31 percent in the lower dose group.

Insurance Games

Having a semaglutide dose for diabetes that is closer to the dose for obesity will help with a practical matter – health insurance. Many health insurance plans won’t cover Wegovy because it’s for obesity. For example, Medicare excludes drugs for obesity across the board. Until TROA passes and eliminates that stupid exclusion, the new dose for diabetes will definitely help people who have both diabetes and obesity. Even Medicare drug plans can cover Ozempic – because it’s for diabetes.

Obesity medicine physician Fatima Cody Stanford explains how this affects some of her patients:

“I have several patients with insurance that covers Ozempic without prior authorization. But their insurance won’t cover Wegovy. This approval will help and that’s why we are excited about it.”

So this new dose will bring some patients access to a tool for better control of both diabetes and obesity. It’s one more step in the right direction, part of a long slog to get better obesity care to more people.

Click here for more on the approval and here for the SUSTAIN FORTE study.

Psyche Opening the Golden Box, painting by John William Waterhouse / WikiArt

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March 31, 2022