These new weight-loss drugs look promising, but there's more to the story

These new weight-loss drugs look promising, but there’s more to the story

Retail prices for liraglutide (Saxenda) and semaglutide (Wegovy) injection pens are approximately $1,700 per month for uninsured patients in the United States. It’s just over $20,000 a year.

The formulations of these drugs for type 2 diabetes also have high prices, although they are significantly lower. The retail price of Ozempic (the version of semaglutide for people with type 2 diabetes) and Moonjaro (the brand name of tirzepatide) is around $1,100, or about $600 less per month.

With Johnson’s insurance, her co-payments have been $50 a month. She covers half of it with a savings card provided by the manufacturer.

“I’m incredibly lucky to have good insurance as well as the finances to cover the higher co-pay if I needed to,” she said.

Some insurance companies do not cover certain GLP-1 agonists. For example, Medicare and most insurance companies won’t cover Wegovy, according to GoodRx. An app called Calibrate offers personalized coaching and access to doctor-prescribed GLP-1 agonists for $1,649 per year or $138 per month. This is in addition to the cost of medications, but on its website, Calibrate claims to work with users’ insurance companies to cover them. It also guarantees weight loss of 10% or more. (Calibrate did not respond to a request for comment at the time of publication.)

Regardless of the cost, new Wegovy prescriptions have been temporarily discontinued. Novo Nordisk, the maker of Wegovy and Ozempic, had to change its production schedule in the face of a shortage of its third-party supplier’s needle pens used to administer the drug. In order to continue to serve patients already taking Wegovy, Novo Nordisk is currently only producing the two highest doses, 1.7mg and 2.4mg, and the company said it hopes to be able to meet growing demand. of Wegovy by the second half. of 2022.

Due to the shortage of Wegovy and the fact that the price of Ozempic is much lower, some patients have asked their doctors for off-label prescriptions of the type 2 diabetes drug. However, Dr. Jason Brett, director Novo Nordisk’s medical affairs executive for diabetes and obesity, insists that healthcare providers should not prescribe the drugs interchangeably.

“The active pharmaceutical ingredient is the same, semaglutide, but they have different doses, they have different dose escalation schedules, and they have different devices,” he said.

It’s not clear if you need to take them indefinitely to maintain weight loss

When Johnson took Saxenda, she was better able to manage her diet without having to deal with constant hunger. But then his weight started to plateau. Even when she took the highest dose of the drug, her appetite returned, so she stopped taking the weekly injection. Soon she returned to her maximum weight.

“After I stopped taking it, I stopped doing a lot of things that I should have done, like tracking my food and weighing myself regularly. And within weeks I was back to full strength,” a- she said, “If you don’t change your behavior, then it’s just a short-term solution, isn’t it?”

She then tries Wegovy. However, due to the shortage of low-dose versions of the drug, she may be more likely to experience nausea as a side effect. Her doctor has prescribed her anti-nausea medication just in case, and she notes that there are “not many options.”

Wharton thinks these drugs allow people to make healthy lifestyle changes – but, as with any other chronic disease of the mind or body, people with obesity-related health issues are likely to have still need some form of treatment.

“The drug does not melt fat. All of this allows you to change your behavior,” Wharton said. “But since we know it is a chronic medical biological disease, patients can never stop the drug, as with any other drug for any other chronic disease.”

Wharton also thinks the idea that people can or should be weaned off medication is actually counterintuitive and harmful.

“It’s like telling someone with schizophrenia to just practice not hearing voices,” he said. “But, of course, if you have a patient with schizophrenia and you take their medication away, what ultimately happens? The voices return.

Duke has a different perspective. She thinks that while her obese and/or prediabetic patients can take liraglutide and semaglutide, that doesn’t necessarily mean they’ll need a prescription for life.

“I’m not in favor of people continuing to take drugs they don’t need,” she said. “If someone can sustain their loss because they’ve learned to manage their diet, exercise, really help their body reprogram their insulin sensitivity response, I love to see that. J would like to at least see patients have the option of decreasing their dose in the future or coming off completely.

When she has someone on obesity medication who decides they are ready to conceive, Duke lowers their dose.

“It’s important because they can’t continue taking this drug during pregnancy,” she said. Wegovy should be discontinued at least two months before a planned pregnancy, for both men and women, due to risk of fetal harm, according to prescribing information. For Ozempic, the anti-diabetic formulation of the same molecule, the FDA says it should only be used during pregnancy if the potential benefits outweigh the risks, which may include fetal abnormalities and miscarriages. (High blood sugar from diabetes can also increase the risk of birth defects, stillbirths, and pregnancy complications, and insulin is considered the safest drug to reduce this risk.)

“I had a patient who was on one of these drugs for most of the pandemic. When they were ready to start a family, we quit so that by the time their pregnancy test was positive, they had stopped taking medication.

They are not intended for those with short-term weight loss goals

If the low blood sugar around these drugs has you wondering if this new class of drugs might be the answer to your short-term plan to shed a few pounds before an upcoming wedding, experts say these drugs aren’t for you. .

Anti-obesity drugs aren’t for those who might be able to change their behaviors on their own, Wharton said.

“If someone wants to lose 10 pounds, they can do it with behavioral changes. They can exercise more or eat better. If you need to lose 10 pounds, I’m not talking to you,” he said. he said, “But treating chronic obesity is a matter of neurological science, not a matter of behavioral science as everyone would like.”

In the same way that Johnson’s relief from taking liraglutide gave him insight into his constant hunger, GLP-1 treatments are providing the medical community with insight into how obesity works. Wharton hopes the chronic advent of these drugs will help de-stigmatize obesity among doctors, clarify that it is a treatable health condition, not a character flaw.

“The fact that these drugs work in the brain, where the disease lives, makes it much clearer that there’s a biology attached to it,” Wharton said. “The more we believe it’s a biological medical condition – and we come to understand because the drugs work – the more we can recognize that it’s not that person’s fault.”

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