Insurance company questions Ozempic for diabetes

People's Pharmacy

Q. I'm a Type 1.5 diabetic (yes, it's a thing), so I rely on insulin (as if I were a Type 1) plus a couple of medications typically prescribed for Type 2. I need all of them to keep my blood sugar under control.

However, when my doctor prescribed Ozempic, the insurance company claims people denied me twice. (Surely, they have degrees in medicine ... don't they?) I am disgusted to read that people who don't even have diabetes are taking Ozempic just to lose weight. Amazing! Are insurance companies paying for this?

A. You certainly educated us about Type 1.5 diabetes. It is also known as latent autoimmune diabetes in adults, and we were not aware of it previously.

Some medications used to treat the more common Type 2 diabetes are not appropriate for your condition. However, Ozempic (semaglutide) is considered helpful.

We think it is unethical for insurance companies to practice medicine by second-guessing your doctor. It is unlikely that insurance is covering the cost of Ozempic for weight loss.

This brand name diabetes drug hasn't been approved to help people lose weight. Some doctors are prescribing it off-label, however. As a result, current shortages are making it difficult for people with diabetes to access this medication.

Q. Some years ago, I worked for an old-time doctor, now retired. He told me that keeping my blood pressure around 140/90 would be just fine as I grow older.

I have learned that the old gent was right. Now I'd just like to convince my current family doctor! She says I'll be much healthier if I can get it down to 130/80 or lower.

A. In general, doctors believe that lower blood pressure is better. However, trying to get blood pressure down to a target range below 130/80 may not be suitable for everyone (American Journal of Medicine, October 2022).

While chronological age is not a good measure for health, people tend to become less resilient as they grow older. A frail older person, particularly one on multiple medications, may not benefit as expected from very low blood pressure. Dizziness, a common adverse reaction, could lead to falls, among other problems. In addition, the more pills one must take, the more likely there could be a dangerous drug interaction.

We discuss high blood pressure, including non-drug approaches, in our "eGuide to Blood Pressure Solutions." This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Questions for Joe and Teresa Graedon can be emailed via their website: www.PeoplesPharmacy.com.