Reimbursement limited for popular diabetes medication

Patients who use Wegovy for weight loss not covered by basic insurance

A popular weight loss medication approved for the treatment of 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 administration warned against taking the medication — a semaglutide injection — to shed weight without a doctor's prescription and stressed that using other eligible patients' insurance plans to buy it could result in punishment.

Brand-named Wegovy, the semaglutide injection was developed by Danish pharmaceutical company Novo Nordisk. It was first approved in late 2017 by the United States Food and Drug Administration to control blood sugar among adults with Type 2 diabetes. The drug's use has since been expanded to help reduce the risk of cardiovascular diseases among diabetes patients, and help patients who are overweight or obese lose weight.

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

In China, the drug was approved to reduce blood sugar and control cardiovascular diseases among adults with Type 2 diabetes in April 2021. It was soon added to the national reimbursement list after price negotiations with drugmakers cut the price to less than one-tenth of its listed price in the US.

"Data shows that in January and February of this year, more than 700,000 medical bills for semaglutide injections were reimbursed nationwide, and the financial burden on patients was greatly alleviated," the administration said, adding that China has not approved the drug specifically for weight loss.

The administration has specified eight types of medications that should not be covered by the basic medical insurance plan, including drugs for weight loss, cosmetic improvement and quitting smoking or alcohol.

"Such a rule has been implemented to ensure that the national medical fund can be used to treat diseases and save lives," it said.

"Insurance coverage of semaglutide injections is limited to two medical conditions of adult diabetes patients. Using the drug for weight loss will not be reimbursed."

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

Such actions could result in heavy fines, suspension of medical insurance accounts and even fraud charges, it said.

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

"Doctors will run tests on patients to rule out contraindications before giving prescriptions," it said."Using it blindly carries risks."

Huang Qinghua, a doctor at Zhejiang Provincial People's Hospital's endocrinology department, told the Qianjiang Evening News that before prescribing the drug, doctors order a number of examinations, including tests on blood sugar, blood pressure, liver and kidney function and thyroid and liver imaging.

Huang said in one case, a woman in her 20s who purchased the medicine outside the hospital and injected herself to speed up weight loss was sent to the emergency care department with severe nausea and vomiting.