Reimbursement limited for popular diabetes medications

Patients who use Wegovy for weight loss that is not reimbursed by basic insurance

A popular weight-loss drug approved for treating diabetes was added to China’s national drug reimbursement list in 2022, but coverage will be limited to diabetes patients, the National Healthcare Security Administration said last week.

The government warned against using the drug – a semaglutide injection – to lose weight without a doctor’s prescription, stressing that using other eligible patients’ insurance plans to buy it could lead to punishment.

The semaglutide injection, branded Wegovy, was developed by the Danish pharmaceutical company Novo Nordisk. It was first approved by the U.S. Food and Drug Administration in late 2017 to control blood sugar levels among adults with type 2 diabetes. The drug’s use has since been expanded to help reduce the risk of cardiovascular disease in diabetic patients and to help overweight or obese patients lose weight.

Demand for the injections rose significantly after some celebrities attributed their weight loss to the medication. Tech mogul Elon Musk said on social media that his slim figure was down to a combination of Wegovy injections and fasting, while US talk show host Oprah Winfrey has reportedly taken the drug to maintain her weight.

In China, the drug was approved in April 2021 to lower blood sugar levels and control cardiovascular disease among adults with type 2 diabetes. It was quickly added to the national reimbursement list after price negotiations with drug manufacturers reduced the price to less than a tenth of the price. listed price in USA.

“Data shows that in January and February this year, more than 700,000 medical bills for semaglutide injections have been reimbursed nationwide, and the financial burden on patients has been significantly eased,” the government said, adding that China has not specifically approved the drug approved for weight gain. loss.

The government has specified eight types of medications that should not be covered by basic health insurance, including medications for weight loss, cosmetic enhancement and smoking or alcohol cessation.

“Such a rule has been implemented to ensure that the National Medical Fund can be used to treat diseases and save lives,” the report said.

“Insurance coverage of semaglutide injections is limited to two medical conditions of adult diabetic patients. Use of the drug for weight loss is not reimbursed.”

The government added that some people might be tempted to feign diabetes or ask relatives or friends diagnosed with the disease to help them access cheaper injections.

Such actions could result in large fines, suspension of health insurance accounts and even fraud charges, the report said.

For consumers willing to pay out of pocket to buy the drug to support their weight management, the government warned of potential health risks.

“Physicians will conduct tests on patients to rule out contraindications before issuing prescriptions,” it said. “Using it blindly carries risks.”

Huang Qinghua, a doctor from the Department of Endocrinology of Zhejiang Provincial People’s Hospital, told Qianjiang Evening News that before prescribing the drug, doctors conduct a number of examinations, including tests on blood sugar levels, blood pressure, liver and kidney function and imaging of the thyroid and liver.

Huang said that in one case, a woman in her 20s who bought the drug outside the hospital and injected herself to accelerate weight loss was sent to the emergency department with severe nausea and vomiting.