How Your Pharmacist Can Help With Obesity Treatment

October is American Pharmacists Month, and for people managing obesity, the pharmacist may be one of the most underused members of the care team. Sherrie Singh-Bryan, Pharm.D., a clinical pharmacist at Winn Army Community Hospital and member of the Obesity Medicine Association, spoke with The Educated Patient about how pharmacists can help patients navigate insurance coverage, multiple health conditions and medications that may contribute to weight gain.

Comparing Plans During Medicare Open Enrollment

Medicare open enrollment runs from Oct. 15 through Dec. 7, and Singh-Bryan encourages patients to ask their pharmacist for help. Many pharmacy chains offer tools that compare how a patient’s current medications would be covered under different plans.

Medicare beneficiaries should also know about the Medicare GLP-1 Bridge, a temporary federal program that covers certain weight-loss medications for a $50 monthly copay for eligible people enrolled in Part D. Because the program is new, Singh-Bryan said patients should expect paperwork and be patient as they work through it.

Prior Authorization and Step Therapy, Explained

Like many insurance plans, the Bridge program requires prior authorization, meaning the prescriber must get approval before coverage begins. Some insurers also use step therapy, which requires trying an older, more established medication first. If it causes side effects or doesn’t lead to weight loss, the provider documents that and the patient can move to the next option.

Singh-Bryan acknowledged these requirements can be frustrating, but said older medications have the longest safety track record and tend to cost less. Many insurer programs are also built around obesity treatment guidelines and may include exercise support, such as gym memberships or discounts, that patients don’t realize they have access to.

Exercise Options for People With Limited Mobility

For people who use wheelchairs or walkers, Singh-Bryan said exercise plans need to look different. She suggests looking for a gym with a pool, since many offer water aerobics, or trying chair exercises. Many Medicare plans cover gym memberships, which can make these options more accessible.

Treating the Whole Person, Not Just the Weight

Many people living with obesity also manage conditions like sleep apnea, diabetes, kidney disease or heart disease. Some obesity medications are now approved for more than one use. Zepbound is approved for obesity-related obstructive sleep apnea, for example, and Wegovy is approved to lower cardiovascular risk and to treat a form of fatty liver disease called MASH (metabolic dysfunction-associated steatohepatitis).

Because specialists tend to focus on their own area, Singh-Bryan said the obesity care provider acts as a gatekeeper who weighs all of a patient’s conditions when choosing a medication. Pharmacists help, too. For a patient with diabetes who uses insulin, she said, losing weight can affect blood sugar, so checking glucose regularly becomes especially important.

Medications That May Contribute to Weight Gain

Singh-Bryan said hormonal treatments, including some forms of birth control, and mental health medications such as antidepressants, antipsychotics and mood stabilizers are among the most common medications linked to weight gain. Her first piece of advice: Don’t stop any medication without talking to your doctor.

For birth control, newer formulations may carry less risk of weight gain. Mental health medications can be harder to change, and in some cases, they shouldn’t be switched. Singh-Bryan described a patient with bipolar disorder who had stayed stable on lithium after trying other medications and didn’t want to switch. Instead, they built a plan around it that included an oral GLP-1 medication, diet changes and learning to recognize when her eating was tied to her mood.

When patients are stable, Singh-Bryan said, they are better able to cook, make healthier choices and stay active. She added that many psychiatrists are willing to work with obesity care providers, sometimes pairing a medication that can cause weight gain with one that may help offset it, such as bupropion.