Hurdles to GLP-1s threaten the lives of our patients

Washington Post

2 days ago

The May 26 front-page article 'Patients face new hurdles to affordable obesity drugs' highlighted significant barriers patients and providers face in accessing GLP-1 and dual GLP-1/GIP receptor agonists (such as Ozempic, Mounjaro, Wegovy, Tirzepatide and Zepbound) for weight management. However, one critical group whose lives may depend on these medications was absent: individuals with end-stage organ failure.
For these patients, the path to a lifesaving transplant is often long and uncertain. Many wait years on transplant lists — if they can get on one at all. Obesity is a major obstacle in this process. It not only reduces the likelihood of being listed for transplantation but also increases the risk of poor outcomes posttransplant, including higher rates of failure of their transplanted organ, wound complications, heart disease and diabetes.
GLP-1 medications have demonstrated benefits beyond weight loss, including reducing the risk of heart disease and slowing the progression of kidney disease in certain populations. These benefits could improve both pre- and posttransplant outcomes, offering a critical bridge to transplantation and enhancing long-term survival.
Yet access to these medications is increasingly limited. Many insurance companies have removed them from the lists of drugs that they cover, restricted the duration of use, or required patients to try other, often inappropriate, treatments first and show they aren't working. For people with organ failure, particularly those with kidney disease, there are few to no safe and effective alternatives. This leaves a growing number of patients unable to access the only medications that might improve their transplant eligibility.
Medicare provides indefinite coverage for dialysis — a life-sustaining but extremely costly intervention — yet does not cover GLP-1 medications prescribed for weight loss that could help patients lose enough weight to become eligible for a kidney transplant, ultimately reducing or even eliminating the need for dialysis. Expanding access to these therapies for individuals with end-stage organ failure is not only an issue of equity and compassion — it is also a sound fiscal strategy. By improving transplant eligibility and outcomes, we can reduce long-term dependence on dialysis, resulting in substantial cost savings for Medicare and other health-care payers.
Though cash payment options exist, the out-of-pocket cost — often several hundred dollars per month — is simply unaffordable for many patients. This financial barrier exacerbates existing disparities and deepens inequities in access to transplant care.
Focusing on patients with organ failure presents a clear opportunity to save lives and reduce health-care costs. We urge policymakers and drug manufacturers to prioritize this narrow but critically important population by lowering the cost and improving access to GLP-1 medications. For these individuals, access is about survival.
Sima Saberi, Ann Arbor, Michigan
Vineeta Kumar, Birmingham, Alabama
Mohammad Kazem Fallahzadeh, Winston Salem, North Carolina
Krista Lentine, St. Louis
Hector Madariaga, Cambridge, Massachusetts
Pooja Budhiraja, Phoenix
Vasanthi Balaraman, Memphis
Prince Mohan Anand, Lancaster, South Carolina
Kenneth J. Woodside, Charleston, South Carolina
Sabiha M. Hussain, Philadelphia
The writers are physicians who provide care for people with organ transplants.
The May 30 online Fact Checker analysis, 'Are 4.8 million people on Medicaid 'cheating the system,'' cut to the heart of a growing crisis: the way data is being twisted to justify cruelty, particularly against people like me.
I'm autistic, and I've had to rely on Medicaid — not because I don't want to work, but because I live in a society that doesn't always make room for people like me to thrive, or even survive, on its terms.
I've spent much of my adult life navigating a system that treats vulnerability as a burden and not as a fact of human existence. That's why I was so disturbed by Sen. Joni Ernst's (R-Iowa) response at a recent town hall, when a constituent in Butler County warned that proposed budget cuts under President Donald Trump's administration would lead people to die. Ernst smiled and replied, 'Well, we are all going to die.'
That smile and her dismissive wave of the hand might have been the product of awkwardness. But indifference to injustice can be deeply damaging. Ernst wasn't denying that deaths would happen. She was suggesting they don't really matter because death comes for us all.
There's a chilling difference between acknowledging mortality and brushing off preventable deaths as unimportant. When our leaders fail to take the lives of their most vulnerable constituents seriously, it sends a message: that those lives have no place in their political calculations. That we are disposable.
The Post's Fact Checker analysis showed that the 4.8 million figure cited by House Speaker Mike Johnson (R-Louisiana) was a projection of people who would lose Medicaid insurance if the House bill became law. The people being painted as 'cheaters' are often the sick, disabled, elderly or those caring for others full-time. They are people whose work might not fit into conventional molds, but whose lives and contributions matter deeply.
Ernst's comment might have sounded like a joke to some. To me, as someone who knows how fragile survival can be, it sounded like a warning. A government that makes light of your death is not a government that's protecting your life.
Matthew Lovewell, Pittsburgh
We are facing a crisis in coverage for obesity care, leaving countless Americans struggling to access treatment for this chronic disease. As highlighted by the May 26 front-page article 'Patients face new hurdles to affordable obesity drugs,' the lack of obesity care coverage for GLP-1 medications not only strains an inundated health-care system and its overwhelmed providers, but also has a significant human and financial cost for patients, insurers and employers.
The status quo must change.
Despite obesity being recognized as a chronic, treatable disease that is associated with more than 200 other health conditions, insurers continue to place barriers on coverage for obesity care. Furthermore, the Centers for Medicare & Medicaid Services' recent decision not to expand coverage of obesity management medications through Medicare and Medicaid underscored the ongoing struggle individuals living with obesity face in accessing care.
The costs of not treating obesity are staggering. Collectively, diseases linked to obesity cost our nation's health-care system more than $1.7 trillion each year. Additionally, obesity costs employers approximately $425 billion annually in the form of increased medical costs, disability payments, workers' compensation programs and absenteeism.
Providing coverage for the full range of evidence-based care is crucial in addressing the significant consequences of obesity. Patients should be able to work with their health-care provider to decide on the best evidence-based obesity treatment — and have insurance coverage for that care. We must all call on insurers, employers and policymakers to ensure comprehensive obesity care is covered just like any other chronic disease — it's only fair.
Millicent Gorham, Washington
The writer is CEO of the Alliance for Women's Health and Prevention.
Regarding the May 28 front-page article 'RFK Jr. remolds policy on covid':
Although the coronavirus vaccines for children and adults are safe and effective, the Food and Drug Administration removed them from its recommended immunization schedule for healthy children and pregnant women. This is incredibly irresponsible.
Children play a significant role in the transmission of the coronavirus. During the pandemic, more than 70 percent of household coronavirus transmissions originated with a child, and data shows that young children can be considerable transmission vectors within households, despite having lower viral loads. Many infected children are asymptomatic, making it harder to identify and control the spread. This means children who might be infected but do not show symptoms can transmit the virus to others.
It is true that most children generally present with mild disease and exhibit lower hospitalization rates than adults. However, infected children can experience long covid and its long-term effects, including fatigue and muscle weakness.
Pregnant women also face a higher risk of developing severe coronavirus complications compared with nonpregnant individuals. Without vaccination, they are more likely to require intensive care and mechanical ventilation, are at a higher risk of mortality and severe illness, and are four times more likely to be hospitalized than vaccinated pregnant women.
Coronavirus infection during pregnancy can lead to serious complications, including a higher risk of preterm birth, an increased likelihood of developing preeclampsia and a greater chance of gestational diabetes.
And a mother vaccinated against the coronavirus can transfer protective antibodies to the fetus, providing immunity to the newborn after birth.
The benefits of coronavirus immunization far outweigh any potential risks, establishing it as a vital preventive measure for children and all pregnant women. It is irresponsible not to recommend and support its use.
A.J. Russo, Chincoteague, Virginia
The writer is author of 'Vaccine Development and the Understanding of Immunity.'
I am a doctor, and I spent the majority of my career as executive director of the Pasco County Health Department in Florida. Limiting access to the coronavirus vaccine conflicts with recommended public health policy. Denying and discouraging lifesaving vaccines to at-risk groups will increase the rates of death and disability caused by this serious disease. Political interference with recommended public health policy concerning this disease has already taken a terrible toll on Americans. Yet politicians turn a blind eye to their responsibility bucking professional and expert guidance from the New England Journal of Medicine and the Centers for Disease Control and Prevention. Those who allowed this disease to race through the American population should be held accountable, not shielded.
Now again, an untrained and questionably informed bureaucrat, wants to compromise protections for millions of Americans who should be getting the vaccine. I believe the Food and Drug Administration's changes to its approval process for the coronavirus vaccine has a serious potential to allow this disease to race out of control again.
I continue to have full confidence in the recommendations made by professional public health scientists and doctors. When government agencies choose to blind themselves to studies and recommendations, we all pay a terrible price.
Marc J. Yacht, Hudson, Florida