Dr Ian Neeland Discusses Uptick in Patients Seeking Semaglutide for Weight Loss

The increased demand for semaglutide to treat obesity has lead to more referrals for weight loss management, but challenges arise in conversations with patients due to insurance coverage limitations, with some patients unable to afford the medication despite its effectiveness. According to Ian Neeland, MD, these conversations prompt comprehensive evaluations, counseling on potential side effects, and a pharmacist-led dose escalation protocol to facilitate the transition for those who can access it.

Neeland serves as director of cardiovascular prevention and codirector of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, as well as associate professor of medicine at Case Western Reserve University School of Medicine.

Transcript

Have you observed an increase in the demand for semaglutide as a treatment for obesity, and how has this affected your practice and the conversations you have with patients?

So the answer is, have I seen an uptick in interest in weight loss with semaglutide? For sure. A lot of people have been referred to me and our program for weight loss specifically. It's definitely an appropriate referral to have that conversation and to medically assess one's status with regard to risk factors in the setting of living with obesity or overweight, and also what options there might be. As a cardiologist, I don't specifically do chronic weight management with these patients, although I definitely get plenty of referrals for that reason, and what I'll usually offer is a referral to one of our chronic weight management programs that we have in our institution. But I many times will start a GLP-1 [glucagon-like peptide 1] receptor agonist for the patient, if it's for the obesity indication.

It's a difficult conversation sometimes to have, because often insurance does not cover chronic weight management for these medications, and so the patient would have to pay out of pocket. Some of my patients are well-to-do and can afford that cost, [but] many others cannot. It's unfortunate because we have something to offer individuals, but many times they can't get it, and not because of the shortage, per se, just because of the cost of the medication. And certainly over time with more options in the market, those costs will likely come down as things go generic. But for the meantime, it can be a difficult conversation to have with patients that we have effective medications but I'm not sure you can utilize it because you can't necessarily afford it and insurance won't cover it.

But when a patient comes looking for Wegovy for weight loss, obviously you want to do a comprehensive evaluation of their medical history [and] what potential indications or contraindications may there be to GLP-1s and for weight loss. Obviously, counseling and education about potential side effects and ways to mitigate those effects is very important, and also a plan going forward. What we utilize here is a pharmacist-led dose escalation protocol where the pharmacist will assess side effects [and] assess how the patient's [responding to] the medication before going to the next level. So that eases that transition and facilitates it for patients so they can get to the maximum tolerated dose and most effective dose that works for them, so that's how we kind of handle that situation.