--- title: "Woman Sues to Get Wegovy Covered by Her Health Insurance" description: "A public employee in Washington State is suing to get her health insurer to cover Wegovy, the expensive, headline-grabbing weight loss med." date: "2023-10-12" modified: "2023-10-12" authors: - name: "Noor Al-Sibai" job_title: "Senior Staff Writer" link: "https://futurism.com/authors/nooralsibai" url: "https://futurism.com/neoscope/woman-sues-insurance-wegovy" categories: - "Health & Medicine" - "Medical" - "RX and Medicine" tags: - "insurance" - "ozempic" - "semaglutide" - "wegovy" --- # Woman Sues to Get Wegovy Covered by Her Health Insurance ![A public employee in Washington State is suing to get her health insurer to cover Wegovy, the expensive, headline-grabbing weight loss med.]() *\Image: Michael Siluk/UCG via Getty / Futurism\* Amid a [months-long shortage]() of semaglutide-based diabetes and weight loss drugs, one woman is suing her insurer for not covering the medication. As the [*New York Times* reports](), Washington State nurse Jeannette Simonton was told that her insurer has a blanket ban on weight loss meds and would not cover her prescription for Wegovy, the semaglutide injectable that's swept off shelves this year. So now she's suing the Washington State Health Care Authority — the agency responsible for purchasing public employee health insurance — for discrimination, arguing that obesity is a [legally recognized disability in Washington]() and that insurance, therefore, must cover it. As such, it's a significant case for Simonton's specific employer, but could also be a sign of things to come across the country. Semaglutide, the crucial ingredient in Wegovy and its diabetes sister drug Wegovy, belong to a class of drugs called glucagon-like peptide-1 agonists, or [GLP-1 agonists]() for short. Originally used as a diabetes drug because of its ability to lower blood sugar levels, semaglutide for weight loss was [approved by the Food and Drug Administration in 2021]() after drug manufacturers found that it also helped patients feel fuller and [eat less](). Over the past few years, Wegovy and Ozempic have become the [stuff of headlines]() and [memes]() as more and more people — already an [estimated 1.7 percent]() of the total American population, or 5.68 million people — are prescribed the injectable that many users consider to be a [revolution in weight management](). In spite of all those prescriptions, however, Wegovy and Ozempic are increasingly difficult to acquire due to an [industrial shortage](). And those lucky enough to find them in pharmacies are often forced to pay for the drug, which can [run more than $1,000 per month](), out-of-pocket because their insurers, like Simonton's, [refuse to cover them](). "They’re being penny wise and pound foolish," the 57-year-old nurse told the *NYT*. "What will they be paying in 10, 15 years if I don’t continue to lose the weight?" Simonton's argument is a common one: that the imposing cost of the medication, which has no generic, will [ultimately save her and her insurer money]() because it will preclude obesity-related health issues. She may be correct, but not all experts agree. "These drugs are insanely expensive and desired by a ton of patients, and the patient can never get off them," James Gelfand, the president and CEO of the employer advocacy group ERISA Industry Committee, [told *Insider* over the summer](). "The drug companies, providers, and patient groups are insisting that weight loss will improve health and therefore offset these massive costs. That's not true." In Simonton's case, however, the proof has been in the pudding. After a lifelong struggle to control her weight, the nurse was initially prescribed Moujnaro, another GLP-1 agonist injectable, and for a while had the drug's costs mostly subsidized by its manufacturer, Eli Lilly. When that payment help stopped coming, her doctors prescribed her Wegovy, and in spite of looking for ways to get it paid for, were unable to find a solution. Simonton ultimately decided to go to a compounding pharmacy to get an [unauthorized GLP-1 agonist](). Even that off-label version has had its cost, however: the nurse told the *NYT* that she's shelled out close to $2,000 out-of-pocket so far, and has had to dip into her retirement fund and even spend less on groceries to cover it. In her suit against the state healthcare agency, Simonton is seeking to recoup the money she's already shelled out and force the state to pay for state employees' Wegovy prescriptions in the future, which she's seeking class-action status to do so. In the meantime, [drugmakers]() and [members of Congress]() are aiming to change restrictions that bar Medicare from paying for weight loss medication. The potential black swan? Even as all this insurance and supply drama plays out, we're learning [more and more]() about [semaglutide's potential risks]() — and because nobody has been taking it *that* long, it's always possible that we'll discover some terrible long-term effect. **More on semaglutide:** [*Walmart Spies on Ozempic Patients' Shopping Habits, Finds They're Buying Less Food*]() ## Author At Futurism, I've often been drawn to unpacking the narratives that underlie technological, scientific and medical progress, with a special interest in areas of conflict and ambiguity that end up setting agendas and steering the fates of both elites and the hoi polloi. I'm a committed generalist, but I often find myself returning to work involving NASA and the private space sector, the effects of AI on media and society, and the mechanics of the pharmaceutical industry, with a specific focus on the spread of GLP-1 drugs like Ozempic and Wegovy. Prior to Futurism, I worked for publications ranging from Media Matters and Truthdig to Raw Story and Bustle. I'm also the author of "Myspace Scene Queens," a 2024 title in Instar Books' acclaimed "Remember the Internet" series. My work at Futurism has been cited by outlets including the New Yorker, Slate, Nieman Lab, the Verge, the MIT Technology Review, the Sunday Times, and the Daily Beast. I grew up in North Carolina, attended the University of North Carolina at Asheville, and now live in Brooklyn, New York. In my free time, I'm an avid reader and music fan; you can probably find me at a local poetry reading, concert, underground rave, or DJ set. I'm the proud parent of an ineffable orange cat named Mee-Mow. ### Author social links [Bluesky]()