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      Some States Say They Can’t Afford Ozempic and Other Weight Loss Drugs

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      Public employees in West Virginia who took the drugs lost weight and were healthier, and some are despondent that the state is canceling a program to help pay for them.Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients that they can’t take Wegovy, but she has gotten used to it.Around a quarter of the people she sees in her small clinic in Wyoming County would benefit from the weight-loss medications known as GLP-1s, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance that covers the cost, and virtually no one can afford sticker prices of $1,000 to $1,400 a month.“Even my richest patients can’t afford it,” Dr. Bailey said. She then mentioned something that many doctors in West Virginia — among the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated between the haves and the have-nots.”Such disparities sharpened in March when West Virginia’s Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.Over the past year, states have been trying, amid rising demand, to determine how far to extend coverage for public employees. Connecticut is on track to spend more than $35 million this year through a limited weight-loss coverage initiative. In January, North Carolina announced that it would stop paying for weight-loss medications after forking out $100 million for them in 2023 — 10 percent of its spending on prescription drugs.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How to Care for Yourself as a Caregiver

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      Forget yoga or weekend escapes. There are more realistic tools to put in place, experts say.Once a quarter, Bich Le, 52, travels from her home outside of Minneapolis to St. Augustine, Fla., where she moves into her father’s guest room for three weeks.The health care executive is one of five siblings who take turns caring for their widowed 90-year-old father, who has lung cancer and requires constant assistance. While she’s in Florida this month, she will miss her daughter’s final high school prom; she missed it last year, too, due to her caregiving duties.The drugs Ms. Le’s father takes to manage pain can “negatively impact how he treats people,” she said. When he becomes volatile, Ms. Le said, she mostly tries to ignore it and “not add to the stress of the situation.” She tells herself to “just care for him and just let it go.” But sometimes, when she’s exhausted, his temper grates.“What runs through my brain is: ‘A simple thank you would really go a long way,’” she said. “‘You have me, or you have a nursing home.’”Caregiving can be fraught for the estimated 53 million Americans who assist family members and friends. And factors like financial strain and isolation can add to psychological distress. In a 2017 survey of 1,081 caregivers conducted by AARP, 51 percent of respondents reported feeling worried or stressed. But there was a surprising upside: The majority — 91 percent — also reported feeling pleased that they were able to help.How can caregivers hold on to that feeling amid the stress, fatigue and resentment that also come with the role? There are strategies for feeling “less burdened or stressed by the daily problems” they encounter, said William Haley, a professor of aging studies at the University of South Florida.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Walmart Is Shutting Health Centers After Plan to Expand

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      The 51 locations, next to Supercenters, proved too costly to be profitable, the retailer said.Walmart, the world’s largest retailer, said Tuesday that it was shutting down its health care centers, a network that only last year it said it planned to expand.The retailer said in a blog post that its 51 health centers across five states would close. The centers were next to Supercenter locations. The plans won’t affect the more than 4,600 pharmacies and more than 3,000 vision centers within Walmart stores.Walmart started the health-care clinic initiative in 2019 in Dallas, Ga., with centers providing primary care, labs, X-rays and electrocardiograms, counseling, and dental, optical and hearing services. Many were in smaller towns where customers might lack access to quality care, and the company had said it was focused on affordability. In 2021, Walmart started offering a virtual option when it acquired MeMD, a telehealth provider.“This is a difficult decision, and like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time,” the company said Tuesday.Walmart said it was still deciding when it would close each center. In addition to Georgia, centers are in Arkansas, Florida, Illinois and Texas. Workers within the centers will be paid for 90 days and will be eligible to transfer to other Walmart or Sam’s Club locations, the company said.Offering health care is more difficult than selling consumer goods like laundry detergent and car parts, said David Silverman, a retail analyst at Fitch Ratings, noting the layers of government and insurance providers involved.“The attempts to enter these spaces and some of the failures of doing so really underscore the challenges and complexities of operating in the U.S. health care space,” Mr. Silverman said.In March 2023, Walmart said it planned to double its health center locations. It said that by the end of 2024, it expected to have more than 75 Walmart Health Centers and expand to states like Missouri and Arizona.In 2021, Amazon, Berkshire Hathaway and JPMorgan Chase ended their high-profile joint health care venture, which sought to explore new ways to deliver health care to their employees. In March, Walgreens said it had closed 140 of its VillageMD clinics and planned to close 20 more. More

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      Maximizing Profits at the Patients’ Expense

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      More from our inbox:The Brave Trump JurorsBlack Voters ‘Want to Be Courted’ by DemocratsBetter Than Debates NATo the Editor:Re “Patients Hit With Big Bills While Insurers Reap Fees” (front page, April 7):Chris Hamby’s investigation uncovers the hard truth for patients who receive care from providers outside their insurance network. While most of us try to save out-of-pocket costs by using in-network health professionals and hospitals, it’s not always possible. And there’s no way to determine what we’ll owe until after we get that care — when it’s too late to reconsider based on the costs we’ve incurred.So, it’s more important than ever for the government to swiftly implement an essential element of the No Surprises Act: Providers should have to give patients an advance explanation of benefits so patients can estimate their financial burden before they get treatment, in or out of network.Health price transparency is improving, but it’s outrageous that even two years after the No Surprises Act passed, everyone except the patient knows the price of a procedure or doctor’s visit in advance, leaving patients unpleasantly surprised.Patricia KelmarAlexandria, Va.The writer is senior director of Health Care Campaigns for U.S. PIRG.To the Editor:This is just the latest example of the schemes deployed by insurers to maximize profits by cutting reimbursements to physicians and shifting medically necessary health care costs onto patients.Whether it’s through third-party entities like MultiPlan or using tactics such as narrowing provider networks and restrictive prior authorization policies, insurers have the perverse incentive to boost revenue over offering adequate payment for quality patient care under the guise of “controlling costs.”More and more patients are being forced to decide whether they should forgo treatment because their insurer won’t pay the bill.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Insurance Companies and the Prior Authorization Maze

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      More from our inbox:Elect the U.S. Attorney GeneralFriendship MemoriesA Leadership GapInsurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.To the Editor:Re “‘What’s My Life Worth?’ The Big Business of Denying Medical Care,” by Alexander Stockton (Opinion video, March 14), about prior authorization:Mr. Stockton’s video captures a current snapshot of an important truth about medical insurance in our country and in doing so does a service to all citizens by making them aware of this threat to themselves and their families.The immediate truth is that medical insurance companies are inadequately regulated, monitored and punished for their greed. In their current iteration they are bastions of greed, power and money. They need to be reined in.But there are other truths as well. Some physicians, just like some pharmaceutical companies, are unable to contain their greed and allow avarice to cloud their judgment, compromise their ethics and in some cases cross the line to Medicare fraud or other illegal activity.Medical care in our country is very big business involving billions of dollars. Without proper controls, regulation and monitoring, malfeasance follows. The challenge in such a complex and multifaceted context is how to implement such controls and monitoring without making things worse.Ross A. AbramsJerusalemThe writer, a retired radiation oncologist, is professor emeritus at Rush University Medical Center in Chicago.To the Editor:The Times’s video exploits tragic outcomes and does not mention basic important facts about the limited yet key role of prior authorization in ensuring that patients receive evidence-based, affordable care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A UnitedHealthcare and Mount Sinai Dispute May Force Thousands to Switch Doctors

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      As Mount Sinai Hospital and UnitedHealthcare haggle over pay rates, patients may have to pay out-of-network prices if they want to keep their doctors.Stalled contract negotiations between UnitedHealthcare, the health insurance giant, and Mount Sinai Health System, a leading New York City hospital system, are forcing tens of thousands of New Yorkers to switch doctors or risk paying out-of-network prices.The impasse has dragged on for months. Mount Sinai has sought to raise prices significantly, but the insurance company has refused to agree to pay the new proposed rates. As a result, Mount Sinai’s hospitals are now out of network for patients insured by UnitedHealthcare or Oxford, which are subsidiaries of the same company. But the issue is about to become even more urgent for many patients because many Mount Sinai affiliated doctors — in addition to the hospitals themselves — are about to be removed from UnitedHealthcare’s network, starting March 22. That means patients with United who have employer-sponsored or individual plans will be billed out-of-network rates when they see a Mount Sinai affiliated doctor at a doctor’s office.The negotiations have sent many patients scrambling to find new doctors. UnitedHealthcare says about 80,000 Mount Sinai patients are affected.What Happened?The dispute between the insurance giant and the hospital system is a rare instance in which health care contract negotiations have spilled into public view.Mount Sinai sought to negotiate better rates with UnitedHealthcare, demanding that the insurance giant pay the hospital more for doctor visits and hospital stays. United claims Mount Sinai was asking for rates to go up some 58 percent over the next four years.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      ‘Fix the Damn Roads’: How Democrats in Purple and Red States Win

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      When Gov. Josh Shapiro of Pennsylvania got an emergency call about I-95 last June, his first thought turned to semantics. “When you say ‘collapse,’ do you really mean collapse?” he recalled wondering. Highways don’t typically do that, but then tractor-trailers don’t typically flip over and catch fire, which had happened on an elevated section of the road in Philadelphia.Shapiro’s second, third and fourth thoughts were that he and other government officials needed to do the fastest repair imaginable.“My job was: Every time someone said, ‘Give me a few days, and I’ll get back to you,’ to say, ‘OK, you’ve got 30 minutes,’” he told me recently. He knew how disruptive and costly the road’s closure would be and how frustrated Pennsylvanians would get.But he knew something else, too: that if you’re trying to impress a broad range of voters, including those who aren’t predisposed to like you, you’re best served not by joining the culture wars or indulging in political gamesmanship but by addressing tangible, measurable problems.In less than two weeks, the road reopened.Today, Shapiro enjoys approval ratings markedly higher than other Pennsylvania Democrats’ and President Biden’s. He belongs to an intriguing breed of enterprising Democratic governors who’ve had success where it’s by no means guaranteed, assembled a diverse coalition of supporters and are models of a winning approach for Democrats everywhere. Just look at the fact that when Shapiro was elected in 2022, it was with a much higher percentage of votes than Biden received from Pennsylvanians two years earlier. Shapiro won with support among rural voters that significantly exceeded other Democrats’ and with the backing of 14 percent of Donald Trump’s voters, according to a CNN exit poll that November.Biden’s fate this November, Democratic control of Congress and the party’s future beyond 2024 could turn, in part, on heeding Shapiro’s and like-minded Democratic leaders’ lessons about reclaiming the sorts of voters the party has lost.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      6 Reasons That It’s Hard to Get Your Wegovy and Other Weight-Loss Prescriptions

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      An array of obstacles make it difficult for patients to obtain Wegovy or Zepbound. Finding Wegovy is “like winning the lottery,” one nurse practitioner said.Talk to people who have tried to get one of the wildly popular weight-loss drugs, like Wegovy, and they’ll probably have a story about the hoops they had to jump through to get their medication — if they could get it at all.Emily Weaver, a nurse practitioner in Cary, N.C., said she told her patients that finding Wegovy was “like winning the lottery.”Here are six reasons why.1. Demand is very high.Fueled in part by TikTok videos and celebrity testimonials, people are increasingly seeking prescriptions for appetite-suppressing medications. The drugs in this class have long been used to treat diabetes but more recently have been recognized for their extraordinary ability to help patients lose weight. The medications are injected weekly and have sticker prices as high as $16,000 a year.About 3.8 million people in the United States — four times the number two years ago — are now taking the most popular weight-loss drugs, according to the IQVIA Institute for Human Data Science, an industry data provider. Some of these prescriptions are for diabetes. The medicines are Novo Nordisk’s Ozempic and Wegovy (the same drug sold under different brand names), and Eli Lilly’s Mounjaro and Zepbound (also the same drug).We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More