90: Why Are Americans Paying More for GLP-1s? Exploring the Senate Hearing and the Fight for Affordability with Kim Carlos

The soaring costs of GLP-1 medications in the United States have become a significant barrier for those seeking effective solutions for weight management. While other countries provide these essential treatments at a fraction of the price, many Americans are left grappling with hefty out-of-pocket expenses that can hinder their ability to live healthy, fulfilling lives.

This disparity not only marginalizes individuals struggling with obesity but also places a heavy burden on our healthcare system. As people battle high medication costs and limited access, the implications for overall health and well-being are profound.

In a recent Senate HELP Committee hearing, advocates like Kim Carlos, host of The Plus SideZ podcast, took a stand for affordable access to GLP-1s, highlighting the urgent need for change. Simply wearing a shirt that read, “Make GLP-1 Affordable,” Kim and her family garnered national attention and sparked a conversation about the importance of community engagement in addressing healthcare accessibility.

Read on for insights from the Senate HELP Committee hearing, where advocates like Kim emphasized the urgent need for affordable GLP-1 medications. We’ll highlight key moments from the hearing, discuss how these high costs affect individuals and families, and learn how we can all advocate for meaningful change in healthcare access.

The Senate HELP Committee Hearing: Key Insights

On September 24, 2024, the Senate Committee on Health, Education, Labor and Pensions (HELP) held a crucial hearing in Washington, D.C., addressing the rising prices of Novo Nordisk's diabetes and obesity medications, Ozempic and Wegovy. Among the attendees was Kim Carlos, host of The Plus SideZ podcast and a dedicated obesity care advocate.

Kim's journey into advocacy began with her struggles with weight, which she has faced since childhood. After a health scare in July 2022, she started on Saxenda (liraglutide) and found relief from the incessant “food noise” that had long plagued her. “It was life-shattering for me,” she said, recognizing the transformative impact these medications could have on individuals dealing with obesity.

Through her podcast, Kim combines personal experiences with expert insights to educate others about obesity as a chronic disease. She aims to bridge the gap between patients and healthcare providers, advocating for accessible and affordable treatments. Her presence at the hearing was a critical step in amplifying the need for systemic changes in obesity care, underscoring the urgency for effective medications to be available without excessive financial burden.

Key Insights from the Hearing:

• High Cost of GLP-1s: Senator Sanders highlighted that Ozempic costs American patients about $969 a month, while Wegovy costs $1,349. In contrast, these drugs can be purchased for significantly lower prices in other countries, such as $155 for Ozempic in Canada and $140 for Wegovy in Germany.
• Clinicians’ Concerns: Doctors expressed frustration over high prices forcing them to prescribe less effective treatment options. The lack of insurance coverage for weight loss medications leaves many patients unable to afford necessary treatments, even with drug company discounts.
• Call for Action: The clinicians called for manufacturers to lower their prices and urged Congress to take measures to ensure patients can access these medications without excessive financial burden.
• PBM Commitments: Senator Sanders announced that major pharmacy benefit managers (PBMs) such as UnitedHealth Group, CVS Health, and Cigna agreed to expand coverage for Ozempic and Wegovy if Novo Nordisk reduced the list prices of these drugs. This contradicts pharmaceutical companies' claims that price reductions would lead to narrower coverage.
• Novo Nordisk CEO Testimony: Lars Jørgensen, CEO of Novo Nordisk, faced scrutiny over the high U.S. prices. While he acknowledged that most commercial insurance plans cover Ozempic, he expressed skepticism about the PBMs’ commitment to making medications more affordable and did not commit to lowering prices during the hearing.
• Pricing Structure Challenges: Jørgensen stated that the list prices are just starting points for negotiations with PBMs and insurance companies. However, Senator Sanders countered that even with discounts, the net prices for Americans remain excessively high compared to prices in other countries.
• Potential Impacts on Patients: The hearing underscored the urgent need for accessible, affordable obesity and diabetes treatments, as many patients are currently priced out of effective medication options that could significantly improve their health and quality of life.

The Impact of High Medication Costs

High medication costs, especially for treatments like GLP-1s, often hit underserved communities the hardest, particularly ethnic minorities and low-income families. As Kim points out, when patients can’t afford their medication, healthcare professionals end up making tough calls that aren't in the patients’ best interests, putting their health at risk.

Kim shares her experiences from primary care, where she faced challenges with medication coverage. Many patients would fall into the Medicare "donut hole," leading to broken treatment plans and worsening health. This cycle makes it harder for people to work, support their families, and fully engage in life.

The discussion around obesity and medication often gets tangled up in debates over unhealthy food options and access to treatments. Kim argues we need to tackle both issues head-on—sick people need affordable medications while we also push for better food quality.

In countries like the UK, obesity medications aren't covered by the NHS, but patients manage to navigate the system without the same struggles seen in the U.S. Kim highlights stories of patients traveling abroad to find cheaper meds, which paints a concerning picture for many Americans who are stuck.

While Kim is hopeful for change, it’s also important that we recognize the importance of talking about these challenges in bigger forums. She emphasizes the need to act fast before a whole generation ends up facing preventable health problems, urging policymakers to think about the long-term impact of ignoring these issues.

Advocating for Change

It’s important to raise your voice, and you don’t need to become a TikTok star to do it. Everyone can get involved, whether that means engaging with content online, sharing it with friends, or having a simple conversation with someone in your office who might be struggling. A quick, “Hey, have you heard about this podcast?” can make a difference—every little bit helps.

If we don’t speak up, who will? In this country, people who are overweight often feel dismissed when they share their struggles. We need to have open conversations about why weight loss medications are essential for many of us, why obesity is recognized as a disease, and why some folks will require these treatments long-term. If we don’t tell our stories, the narrative will be crafted by those who don’t truly understand our experiences.

To dive deeper into these important conversations and be part of the movement, check out The Plus SideZ podcast on YouTube, Apple Podcasts, Spotify, or visit their Website.