Weight loss drugs: As the market grows, people with diabetes are paying the priceThank you for reading this post, don't forget to subscribe!
The drug Jeremy Mitchell takes to manage his diabetes, Ozempic, has become a new weight-loss fad, and now he’s having trouble finding it.
Mitchell, 39, of El Dorado, Kansas, was diagnosed with type 2 diabetes in 2020.
It runs in his family. His father, a double amputee, died last month aged 62 after complications from diabetes.
“That worries me,” Mitchell said. “I have three children that I want to see grow up, and I want to see my grandchildren grow up, and for me, Ozempic has helped me manage my blood sugar.”
When Mitchell was diagnosed, his A1C — a long-term measure of blood sugar control — was in the sky-high 10 percent.
After learning he had diabetes, he lost about 50 pounds through diet and exercise. But when he took a less active job, he found he couldn’t keep it up. Some of the weight has shifted back.
In May, his doctor put him on Ozempic, which helped him lose about 20 pounds. His A1C dropped to 6.8%. This is still in the diabetic range, but much closer to normal, which is just under 5.7%.
When Mitchell recently went to pick up his refill, an automated message told him there would be a delay in picking up his standard 1-milligram injection pen because of a nationwide shortage. The three other pharmacies in town told him the same thing: they were out of that dose.
He was able to get his doctor to write a prescription for a lower dose, but that meant he would have to double the injections. It also confused his insurance company, which initially refused to pay for the drug. The pharmacy then said he would have to pay $1,000 to get a two-week supply. His co-pay is usually $5.
After negotiating with the insurance company, Mitchell was able to cover the pen, but since he’s doubling up on injections, they will last him half as long as usual.
He is not sure what will happen when this pen runs out. He’s worried he’ll have to plead his case to his insurance company again.
All this meant hours of extra work to get what should have been a routine medication refill. Mitchell wanted to know why she suddenly had to jump through so many more hoops, and an Internet search turned up stories of celebrities using the weight-loss drug. Mitchell was furious.
“My goal at 39 is to try to put off insulin dependence as long as possible. I don’t want to suffer the same fate as my father,” he said.
“I guess I’m just mad at not just the celebrities, but anyone who would use this, and especially knowing there’s a shortage. This information is out there,” he said.
Every winter, millions of Americans end the year with tighter belts, leading to another annual ritual: the New Year’s resolution to lose weight.
Nearly 1 in 4 Americans vowed to live healthier in 2022, making it the #1 New Year’s resolution. One in 5 said they wanted to lose weight, according to the user data website Statista.com.
Despite these good intentions, the burden continues to pile up. More than 2 in 5 Americans were classified as obese, with a BMI over 30, between 2017 and 2020, according to the U.S. Centers for Disease Control and Prevention—more than a 10% increase from 1999-2000.
Until recently, people struggling to lose weight could count on only limited help from their medicine cabinets.
Three pills approved by the US Food and Drug Administration, resulted in an average weight loss of about 5% to 10% of total body weight in clinical trials.
In 2014, Saxenda, or liraglutide, ushered in a new era. Taken as a daily injection, it became the first in a class of drugs developed to treat diabetes to receive FDA approval for weight loss.
It belongs to a family of relatively new drugs that mimic the effects of an appetite-regulating hormone called GLP-1. These drugs work by stimulating the release of insulin, which helps lower blood sugar. They also slow the passage of food through the intestines.
“It leaves you feeling full almost all the time,” Mitchell said of the GLP-1 agonist he takes, Ozempic. “You don’t want to eat.”
Ozempic, or semaglutide, is the more potent cousin of liraglutide. Instead of a daily injection, semaglutide is given once a week. The FDA approved it for diabetes in 2017 under the brand name Ozempic and for weight loss as Wegovy in 2021.
Wegovy became a smash hit, fueled by celebrity mentions and social media posts showcasing remarkable before-and-after transformations. On Twitter, Elon Musk credited Wegovy about his own recent weight loss.
Studies have shown that the drug can help people lose an average of 10% to 15% of their original weight – a significantly greater amount than with previous drugs.
But soon after Novo Nordisk began selling Wegovy, it ran into shortages when a Brussels-based company hired to fill the syringes was cited by the FDA for quality problems. Production of the drug has been halted and the shortage, which was supposed to be resolved this year, continues.
Wegovy should be taken for both weight loss and weight maintenance. Studies show that once people stop using it, all the pounds lost can come back.
“There have been a number of patients who have started taking Wegovy who have not been able to continue it,” said Dr. Kimberly Gudzune, medical director of the American Board of Obesity Medicine.
“So, as a result of not being able to get Wegovy, many doctors started prescribing Ozempic off-label for the treatment of obesity,” she said.
As a result, many of these injectable GLP-1 mimics have now fallen into short supply.
“It’s really snowballed,” Gudzune said, and people with diabetes like Jeremy Mitchell are now struggling to find their medication.
Gudzune, who also treats people with diabetes, said the shortage has changed her practice. She sent prescriptions to pharmacies electronically, which is fast and reduces errors. But she can no longer do that for these injectables.
“As a group, we’ve had to go back to actually giving people paper prescriptions because then they can actually call and take them from pharmacy to pharmacy to pharmacy so they can find places that actually have drugs that they can is distributed,” she said.
Gudzune said the shortage is especially hard on lower-income people, who don’t necessarily have the funds or time to visit or call a bunch of pharmacies to find their medicine.
Novo Nordisk, which makes both Ozempic and Wegovy, said in a statement that it was experiencing intermittent supply disruptions of some doses of Ozempic “due to a combination of incredible demand coupled with general global supply constraints.”
While it acknowledges that some health care providers may be prescribing Ozempic off-label for people who want to lose weight, the company “does not promote, suggest or encourage the off-label use of our medications.”
As for Wegovy, Novo Nordisk said it has taken steps to ramp up production. It expects to add a second contract manufacturing facility in the first half of 2023. The current syringe filler has restarted production and expects to add a second facility later in the year.
Novo Nordisk said it is on track to have all Wegovy doses available by the end of the year.
“We are asking healthcare providers to delay starting new patients on Wegovy until we confirm wider availability at the pharmacy level,” Nicole Araujo, senior manager of corporate communications, wrote in an email.
Gudzune said he follows that lead. When people ask about weight loss drugs, she tells them to wait to start taking them until the tension subsides.
“The excitement around these drugs right now is a bit of a double-edged sword, so I’m glad people are excited and feel they have an option to treat their obesity that would really make a difference,” she said.
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