Tag: ozempic

Can’t Get Your Weight Loss Meds? Here’s What You Can Do! 

woman holding face in distress

If it hasn’t become obvious to you, it will soon—medicine is a mess. Let’s start with getting your medications. Many of us are aware that since the COVID lockdowns started, there have been supply chain issues affecting our food, our home supplies, our clothing…you name it. Medicine is no exception.

Whether it’s getting the ingredients to make the medications, getting the employees to work at the manufacturing sites, getting the medications distributed to pharmacies, or getting the employees needed to write and dispense the medications—it’s very clear that things are not working right. As a result, especially when it comes to popular injectable weight loss medications, the supply of appropriate dosages of specific medications remains a moving target.

So what are you supposed to do? You’ve finally found a solution that has led to excellent weight loss, and right smack in the middle of your rising success, the rug is pulled out from under you. How?

A coupon expires. Your pharmacy doesn’t have your medication in stock or doesn’t have the dose you need due to shortages. Your insurance company suddenly decides not to cover your medication that was previously approved…

These are frustrating times for both patients and their physicians, I assure you, but do not give up the fight! Here are some ways to navigate through the shark-infested waters.

What To Do If Your Pharmacy Does Not Have Your Dose

1. Pharmacy Shop 

Just because your regular pharmacy doesn’t have what you need, it does not mean that another one nearby will have the same issue. Call around and when you find a pharmacy carrying your dose, have your physician call it into that pharmacy. Although this isn’t always a long-term solution, it will at least keep you moving forward in the right direction. We have found that smaller, more local pharmacies seem to have better supplies than the larger conglomerates, which really surprised us.

2. Take the Available Lower or Higher Dose

Although this is not ideal, it is an option. When it comes to injectable weight loss medications, results are dose-dependent. This means that if you choose the lower dose, your weight loss might slow down or stop altogether. You should, however, maintain your weight loss.

If you have been on your current dose for 4 weeks, and the next higher dose is available, it is preferable to step up to the higher dose instead of going back down. I never advise skipping ahead past the next dose you are on, however, because the side effects are much worse.     

3. Consider the Compounded Version of the Medication

When it became clear that there was an issue with the national supply of semaglutide (commonly known as Ozempic & Wegovy), the FDA approved the production of semaglutide by compounding pharmacies. A compounding pharmacy creates custom medications from base ingredients for patients. Rather than providing a pre-mixed formula, the compounding pharmacist begins with base drugs, combining and preparing them to fit the individual patient’s needs.

Although it is still a little pricey, compounded semaglutide is about a ¼ to ½ the cost of the uncovered pharmaceutical price depending on your dose, and what the prescribing physician’s office charges. You can discuss this option with your physician, or call a compounding pharmacy and see which local physicians are writing the medication. With compounding pharmacies, remember that each state has different rules as to how they write and/or dispense these medications.

There is a very similar story with tirzepatide (marketed as Mounjaro for Diabetes, and recently FDA-approved as Zepbound for weight loss).  Since the beginning, there has been the usual supply chain problem with tirzepatide as well. The FDA again approved compounding pharmacies to create a supply, which can be found at some physician’s offices, however, it is much more expensive than semaglutide.

What To Do If Your Coupon Runs Out Or You Lose Coverage

1. Check Out a Pharmaceutical Website

For Ozempic and Wegovy, go to Ozempic.com or Wegovy.com. On these sites, they will calculate the cost of the medication and coverage for you after having you answer just a few questions. Make sure you scroll all the way to the bottom, however, because it may say “covered” but the cost to you at the bottom of the paragraph can be anywhere from $25 to $1200 plus. 

2. Contact Your Insurance Company

If you’ve had excellent weight loss on Mounjaro for example (whose coupon is iffy right now), you can connect with an advocate from your health insurance company and see what your options are.  Sometimes they will cover a different medication, or require a letter from your physician’s office detailing your success. At our office, we have had physician-to-physician conversations with the medical director of a plan and successfully advocated for our patients to continue or obtain coverage for a medication that has worked for them. When it comes to success on a medication, no doesn’t always mean NO.

3. Consider the Compounded Version of the Medication

As detailed above, compounded semaglutide is about a quarter to half the cost of the uncovered pharmaceutical price depending on your dose, and what the prescribing physician’s office charges. You can discuss this option with your physician, or call a compounding pharmacy and see which local physicians are writing the medication. Compounded tirzepatide is about twice as expensive as semaglutide, but is available as well. 

4. Look On GoodRX and See Which Pharmacies Offer the Lowest Cost Alternative

If you are not familiar with the GoodRx app, this would be a good time to download it to your phone. GoodRx searches local pharmacies and finds you the best out-of-pocket price for your medication.  With the injectables, this might still be extremely high, but it gives you the option to compare prices.

5. Consider a Different Medication That Is Less Expensive

Although injectable weight loss medications give excellent results, they are not the be-all and end-all. As an obesity medicine physician who has been in the field for over 16 years, I know that injectables offer more options, but not necessarily better results. There are alternatives to injectables that are similarly safe and effective:

  • Phentermine: Phentermine has been around since the 1950s and is a great medication to help with hunger and metabolism. It works by decreasing hunger at the level of the hypothalamus and increasing metabolism through a slight increase in heart rate. We check metabolic rates in our office and phentermine is always my first choice for those with low metabolism because it is the only medication that addresses both issues. This is a great choice for menopausal women for this reason. 
  • Diethylpropion: Diethyl is similar to phentermine in function but is short-acting. Phentermine will last about 12 hours, whereas Diethyl works for only a 4-6 hour window. It is great for those who snack in the late afternoon or evening hours because it won’t keep you up.  
  • Contrave: Contrave is Wellbutrin plus Naltrexone, which attacks hunger and the hedonic (or addiction) pathway simultaneously. Unfortunately, it is not covered by many insurance plans and has a heavy pill burden (two tabs twice daily, taking four weeks to step up to the complete dose). I will use Contrave for patients who have depression because Wellbutrin helps this piece, with the added benefit of the addiction component. It pales in comparison to the weight loss seen with the above two medication categories.
  • Topamax (Topiramate): Topiramate is a medication that has been studied for Binge Eating Disorder (BED) and is found to be very helpful. It is also very inexpensive which is a huge plus. We are not sure how it works other than through the dopamine or “addiction pathway”. It is dosed once or twice daily but must be titrated slowly because it can cause word-finding problems and brain fog at higher doses.
  • Vyvanse (Lisdexamfetamine): Many have heard of Vyvanse as a medication used for Attention Deficit Disorder (ADD), but it is also an excellent drug to effectively treat BED and has recently been indicated for this use. It is well tolerated and used once daily in the a.m. It can be expensive, however, if not covered by insurance.
weight loss medication pricing chart for injectables and other more affordable options

All in all, the shortage and cost issues with injectables are not going to end any time soon. The best thing you can do to stay healthy is to lose weight and maintain it. There are four pillars to Obesity Medicine, only one of which is medicine. Start focusing on non-pharmaceutical alternatives such as herbs, supplements, and the healing properties of certain foods. There are also medications out there that are less expensive and readily available. Remember that injectables are not the only answer and we’ve been without them for a long time! 

Want to learn more? Join me Live on Facebook every month and check out our YouTube channel for the replays!

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A Comparison of Tirzepatide (Zepbound) vs. Semaglutide (Ozempic/Wegovy) from a Weight Loss Expert

balancing rocks on a beach with background imagery of weight loss injectable medications, nutrition and cost of weight loss medications

Zepbound by Eli Lilley was recently the first GLP-1/GIP medication FDA-approved for weight management. Although this is exciting, is this really a new drug, or just a “repurposing” of an existing drug? Let’s find out.

Medications for Weight Loss vs. Diabetes 

Zepbound (or Tirzepatide) is the exact same medication that is found in the popular medication approved for diabetes called Mounjaro. Mounjaro was found to have 22.5% weight loss at the highest dose vs. placebo in patients taking it for diabetes which is remarkable. This is almost 8% higher than GLP-1s alone. The problem Eli Lilley has is this: 22.5% weight loss will reverse most type II diabetes and put a company specializing in drugs for diabetes out of business. For this reason, Tirazepide was remarketed as Zepbound and eventually approved by the FDA for weight management. 

Interestingly, Novo Nordisk did the same thing with Semaglutide. It was released in 2014 as Ozempic, a once-weekly injectable used for type II diabetes only. In 2021, Semaglutide was approved for weight loss under the trade name Wegovy. At the highest doses, Semaglutide boasts a 15% weight loss compared to placebo which doubles previous injectables but is still not as good as Tirzapetide.

The approval of Zepbound for weight loss is great news for patients because there is now a pathway forward for coverage of this medication for those without diabetes who need weight management. Many of my patients have found success on Mounjaro through their coupon program, which was rapidly withdrawn recently. This answers the question, “What do I do now?”

Cost of Tirzepatide vs. Semaglutide

The price for Tirzepatide without coverage can run as high as $ 1,400-$ 1,500 per month which is prohibitive for most users. Compounding pharmacies have been approved to offer Tirzepatide due to a shortage at about half the cost, and are offered at some weight loss practices but supply has remained a moving target. If insurance companies choose to cover (which has yet to be determined), the cost will likely be considerably less and may just involve a copay. It is important to understand that plans have to opt into covering weight loss medications, so it is important to review coverage of this class with your insurance company and ask about the topic during open enrollment. 

Semaglutide is considerably cheaper. It is still high if not covered for brand (about $1,000- $1,200) however, compounded is much less – usually $300- $ 500 per month.  

Note: If you find these drugs for much cheaper and there is not a physician involved in your treatment, I would be very leery of the safety and efficacy of what you are purchasing. It is also important to have a nutrition plan involved with regular check-ins. These medications are very powerful and at high doses many patients forget to eat which can be very dangerous. There are several pop-ups appearing on the streets and online. I have seen some real disasters from the programs. Please watch for the signs and stay away. 

How to Get a Hold of Weight Loss Medications like Tirzepatide and Semaglutide

Accessibility of Tirzepatide and Semaglutide have been moving targets. We are at an unprecedented time in medicine, with weight management drugs being among the worst when it comes to shortages at varying doses. This is a real problem for this class, because you must work up on these drugs slowly. If you start and stop and restart at a high dose (because that is the only one you have access to) you will get very sick. I don’t see any of these supply issues ending any time soon, unfortunately, and it has become a real factor in prescribing these drugs to our patients.  

How Does Tirzepatide Work Differently From Semaglutide for Weight Loss? 

Semaglutide (Ozempic and Wegovy) and Tirzapatide (Mounjaro and Zepbound) are all medications that fall under the category of GLP-1 receptor agonists. This class of medications has been around since 2005. Today, we have a significant amount of data to prove both class safety and efficacy. 

GLP-1 receptor agonists promote fullness by triggering GLP-1 receptors (fullness receptors) in the brain and the gut. They also decrease gastric emptying (how fast the food moves through your stomach) which also causes fullness.

Tirzapetide (Mounjaro and Zepbound) also contains a GIP receptor agonist in addition to a GLP-1 receptor agonist. We do not know much about the GIP receptor, other than being told it is also a receptor that promotes satiety. Through my patients, I have also found that it helps addictions to food, gambling, alcohol etc. in addition to boosting mood which I did not expect. This is good when there is ample supply, but bad when one has to start and stop a dose due to supply issues. This definitely plays a role in my prescribing practices. 

Balancing Weight Loss Success with Supply Chain Challenges

Injectable AOMs (anti-obesity medications) have been a wonderful addition to my weight loss practice, however, the supply chain issues are a game changer.  When there is ample supply I will use them, but I will always have a backup plan. When there isn’t, I will stay with the old tools that worked great before, during, and after the media frenzy and chaos with this class of medications. I have seen patients do very well with weight loss and an overall sense of well-being with injectables, only to suffer greatly when the supply dwindles. There has been a complete lack of empathy from both the pharmaceutical industry and insurance companies on these issues, leaving both patients and physicians stumbling to find a resolution. 

The approval of Zepbound could be great for patients if it is covered by the insurance companies and that coverage remains. Again, this is a great class of medications to help with weight loss! There is a risk of starting them however for both physicians and patients, as there is no guarantee month to month that patients will have their refills.  

Want to learn more? Join me Live on Facebook every month and check out our YouTube channel for the replays!

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The Health Crisis of Obesity: Understanding and Overcoming a Modern Disease

obese person measuring themselves around the waist

Recently, I was out having dinner with some friends and my phone started blowing up. 

 “Are you catching this piece on 60 Minutes about obesity?”

“60 Minutes is talking about Wegovy – you have to watch!”

This piece is an excellent commentary on the issues of obesity, and how medications can help treat this disease. That said, I am very disappointed that the focus was just on one medication, and not on the vast complexities of obesity. There are 4 pillars of obesity medicine that play a role in lasting weight loss: nutrition, exercise, behavioral modification, and medical management (which includes disease reversal).  

As I’ve stated before it’s important to look at who is paying for the piece and what is the angle. Let’s take a deeper dive into answering these questions, and how we could have made this more beneficial for the millions of folks fighting obesity in America and throughout the world.

Obesity IS a Disease!

Let me start by saying that I know and respect Dr. Carol Apovian and Dr. Fatima Cody-Stanford.  In fact, I fought side by side with them ten years ago in my leadership position with the OMA (Obesity Medicine Association) to convince the AMA (American Medical Association) to recognize obesity as a disease and we won! What’s amazing to me is ten years later, we are still trying to convince society that obesity is in fact a disease. Why is this?  

It’s never a bad idea to follow the money. As stated in this 60 Minutes piece, the case has been made and won that obesity is a complicated, multifactorial disease that contributes to at least 13 cancers and hundreds of diseases. Many of these conditions are treated with more medications that further weight gain, causing more obesity-related diseases (ORDs). Before you know it, you are on seven medications to “treat” or “control” these ORDs! 

There are a few problems with this piece that I’d like to point out here. 

Problem #1:  Why Don’t We Use the Language Disease Reversal? 

In this piece, which was sponsored by Novo Nordisk (makers of Wegovy, and several other medications used to treat diabetes and other conditions), we keep hearing how we must “manage” or “control” ORDs. Isn’t that interesting? Follow the money. 

It’s true that obesity is complicated, but we now have plenty of proof that a 5-10% weight loss can reduce and in many cases reverse obesity-related diseases. Unfortunately, these same drug companies that make the AOMs (anti-obesity medications) make the meds to treat obesity-related diseases. What a conundrum. 

Problem #2: The “Magic Drug” Phenomenon

Here we go–the war on drugs. There are several classes of anti-obesity medications (AOMs) available including the GLP-1s which have been all over the news lately. Some of these include Wegovy (by Novo Nordisk), Ozempic (which is the same as Wegovy), and Mounjaro (by Eli Lilley).

There is tons of money to be made by whoever can control the obesity market, yet still stay in the game with the meds that treat obesity-related diseases. I’m a minimalist, and my job as an Obesity Medicine Physician is to get folks healthier and reverse as many diseases as possible through weight loss. I like and use all three of the medications listed above. If I can use one drug to get a patient off six, and there is ample supply, I will do it. Up until now, however, Wegovy has not had ample supply. Coincidentally, just before this 60 Minutes piece came out, I received a letter and visit from my Novo Nordisk rep informing me that suddenly the problem was fixed. Well, we will see–this has been an on-and-off problem for all of these medications (GLP-1s) for a long time.  

So back to the “magic drug” phenomenon. Let’s assume everyone has an ample supply.  That does not mean that you can take Wegovy and go eat whatever you want, not exercise, drink too much alcohol, stay up late, caffeinate too much and lose 50 pounds like your friend did. In fact, I will argue that you will be the one writing nasty comments on my Instagram account about how the drug made you sick and that no one should take it.  

The point is, you need to have a sufficient nutrition plan in addition to healthy eating behaviors, adequate sleep, and exercise. If you take this class of drugs (GLP-1s), you must also know how to titrate the medication appropriately (with the help of an experienced doctor) to minimize any side effects. This 60 Minutes piece doesn’t show everything that’s involved in experiencing success from taking this drug. It only shows you one woman who took it and lost weight, and another that didn’t and is still struggling. 

Let me let you in on a secret…shh, don’t tell anyone…THERE IS NO MAGIC DRUG. You must manage the other components of your life to benefit from the prolonged weight loss anti-obesity medications have to offer. There is no way around it. Sorry (hands up emoji).  

Problem #3: It’s About Shame and Genetics. Period. 

Oh did I hear about this one!   

Obesity is complicated. VERY complicated.

Genetics plays a role, as does shame for some folks, but there are a number of other factors that contribute to obesity: 

  • Environmental factors (Epigenetics)
  • Produce that is genetically modified
  • Meat and poultry that is fed with all sorts of bad stuff
  • Our increased use of technology and decrease in overall movement
  • The fact that healthy food is more expensive, and that much of the fast food and shelf-ready food offered to us is addictive
  • Psychosocial issues like childhood poverty, neglect, and abuse that formulate dysfunctional eating behaviors early in life
  • Untrained physicians and other providers who lack empathy even though many of them struggle with their own weight
  • Lockdowns during the pandemic where the average American gained 50 + pounds

The list goes on…

Finally, top it with medications for obesity-related diseases that cause further obesity as previously mentioned and there you have it–the hot mess that we have been calling the obesity epidemic for over 30 years.  

It’s complicated for sure, but fixable, very fixable! But not with a magic pill or drug alone. 

If you’re struggling with your weight, find an obesity medicine physician in your area and get expert help. If your insurance will not cover it, lobby your employer to provide benefits. Don’t give up the fight! You may start hopeless but you will leave victorious. And if you’re in the Central New York area, come see me! The Medical Weight Loss team would love to help you.

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