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The Affordability Barrier: How High Costs of Common Diabetes Medications Exclude Low-Income Individuals from Vital Treatment

Over the past eighteen months, Tandra Cooper Harris and her husband, Marcus, have faced significant challenges in obtaining the medications necessary to manage their diabetes.

Tandra, who experiences blackouts and fatigue without access to Ozempic or similar medications, struggles to maintain her daily activities, including caring for her grandchildren and earning additional income through hair braiding. Marcus, employed as a cook at Waffle House, relies on Trulicity to prevent swelling and bruising in his legs and feet.

Despite attempts by their doctor to prescribe alternative drugs that mimic appetite-suppressing hormones and regulate blood sugar, the couple often finds these options unavailable. Moreover, their insurance coverage through the Affordable Care Act marketplace frequently subjects them to lengthy approval processes or unaffordable out-of-pocket expenses.

“It feels like I’m jumping through hoops just to survive,” expressed Cooper Harris, a 46-year-old resident of Covington, Georgia.

Supply shortages and insurance complications surrounding GLP-1 agonists, a potent class of diabetes drugs, have left numerous individuals struggling with diabetes and obesity without access to vital medication.

One major issue stems from the exorbitant prices set by pharmaceutical companies. According to recent KFF poll data, approximately 54% of adults who have used GLP-1 drugs, even those with insurance, find the costs challenging to afford. However, individuals with the lowest incomes bear the brunt of this burden, facing difficulties accessing doctors and purchasing nutritious foods.

In the United States, Novo Nordisk charges around $1,000 for a monthly supply of Ozempic, while Eli Lilly’s Mounjaro costs a similar amount. Before insurance coverage, prices for monthly supplies of various GLP-1 drugs range from $936 to $1,349, as reported by the Peterson-KFF Health System Tracker. Medicare spending on three popular diabetes and weight loss drugs — Ozempic, Rybelsus, and Mounjaro — surged to $5.7 billion in 2022 from $57 million in 2018, according to KFF research.

The “outrageously high” prices have raised concerns about the financial strain on Medicare, Medicaid, and the entire healthcare system. Senator Bernie Sanders (I-Vt.), who chairs the U.S. Senate Committee on Health, Education, Labor and Pensions, addressed this issue in a letter to Novo Nordisk in April.

Additionally, the steep prices mean that not all individuals in need of these drugs can access them. “They’re already disadvantaged in multiple ways, and this is just one more obstacle,” remarked Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia, whose patients, including Cooper Harris, often face barriers due to being underserved, having high-deductible health plans, or relying on public assistance programs like Medicaid or Medicare.

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