When she prescribes the favored weight-loss drug Wegovy, Dr. Angela Fitch sends patients on a quest she likens to “The Hunger Games.”
They may must call drugstores over several days to seek out one with the properly sized first dose. Then they’ll try this again for his or her second dose, and possibly the third. And that is provided that the patient has insurance or the means to afford a drug that may cost greater than US$1,300 a month.
“This will not be for the weak-willed,” said Fitch, who’s president of the Obesity Medicine Association and likewise consults for drugmakers.
Supply problems and insurance complications have made it difficult for people to start out — and stay on — Wegovy and similar medications which might be transforming obesity treatment, based on doctors and patients across the country. They are saying getting the high-demand, injectable drugs requires persistence and a good amount of luck.
People starting on Wegovy must take injections of regularly increasing strength before they reach the so-called maintenance dose that they stay on.
The drug’s maker, Novo Nordisk, says that demand has forced it to limit the availability of those smaller, initial doses within the U.S. The corporate is also warning those taking one other weight-loss drug, Saxenda, to expect difficulty filling prescriptions “for the rest of 2023 and beyond.”
One other drugmaker, Eli Lilly, has said it expects tight supplies until 12 months’s end for its diabetes treatment Mounjaro, which is also prescribed for weight reduction.
Finding Wegovy can develop into a part-time job for patients, said Dr. Diana Thiara, medical director of the load management clinic on the University of California, San Francisco.
Thiara said some wind up driving 45 minutes or more to get prescriptions filled, a barrier for hourly staff who cannot leave their job and for people without cars.
“It’s always patients who’re a little bit bit more privileged, capable of take off from work to go make those drives,” Thiara said.
One in every of Fitch’s patients, Mike Bouboulis, has taken Saxenda, Mounjaro or Ozempic, a Novo diabetes drug with the identical lively ingredient as Wegovy, since around 2019. It became much harder for him to seek out the drugs up to now 12 months, after their popularity exploded.
Refilling a prescription involved calling five to seven pharmacies.
“All of them know what you are calling for, they usually all have the identical answer: `I do not know. We’ll see tomorrow,”‘ said the 35-year-old small business owner who lives outside Boston.
Pharmacy technician Lizzy Nielsen used insider knowledge to start out Wegovy earlier this 12 months.
She often checked drug wholesalers’ supply lists, refreshing her screen each morning, after which ordering Wegovy for her pharmacy as soon as she saw it in stock.
“I used to be really lucky … because that is when it was like beginning to be always back-ordered,” the 42-year-old West Springfield, Massachusetts, resident said.
While patients have needed to cope with shortages of many medications up to now 12 months, those taking weight-loss drugs can face coverage complications too.
The federal Medicare program for people age 65 and older doesn’t cover obesity medicines, but some privately run Medicare Advantage or Medigap plans do, based on Novo. Coverage from Medicaid programs for individuals with low incomes varies.
Doctors and patients say many insurers have stopped covering Ozempic and Mounjaro outside their approved use for diabetes. Some insurers and employers don’t pay for Wegovy.
Novo Nordisk even offers a form letter on its Wegovy website to assist doctors request coverage.
Bouboulis, the Boston-area resident, said his insurer stopped covering Mounjaro earlier this 12 months. He then tried switching back to Ozempic but found that also was not covered.
He’s taking low doses of leftover Ozempic until he can find coverage.
“I do know the insurance firms don’t desire to pay, but between (them) and the pharmaceutical industry, they need to seek out some sort of nice middle ground because these medications, they will save people’s lives,” said Bouboulis, who has lost around 80 kilos since he began taking them.
Employers and insurers that do pay for the weight-loss treatments often require patients to get pre-approval or to first try other strategies like weight loss program and exercise.
Some require patients to indicate they’ve lost 5 per cent of their body weight after six months on the drugs in an effort to proceed coverage. Supply problems make that onerous, Thiara noted.
“Lots of patients usually are not staying on it consistently because they can not get it,” she said.
Dr. Laura Davisson estimates that lower than 30 per cent of her patients with insurance through an employer or a person plan have obesity medicine coverage.
Davisson directs a weight-loss program in West Virginia, a state that consistently ranks as having certainly one of the best obesity rates within the country. The state’s Medicaid program doesn’t cover Wegovy, but neighboring Pennsylvania’s does.
“For me, it’s either they’ve coverage through insurance, or they are not taking it,” she said. “Nobody can afford it.”
Coverage may improve over time, because it has with other obesity treatments like bariatric surgery.
About 46 per cent of enormous U.S. employers cover obesity medicines like Wegovy, based on the advantages consultant Mercer. One other 18 per cent are considering it. Mercer’s experts say employers are still attempting to study how the added cost will affect them and what other support patients may have.
Dr. Deborah Horn says she thinks supply problems and coverage will eventually smooth out, nevertheless it may take a pair years. She noted that the FDA may soon approve Mounjaro to treat obesity, which could improve coverage.
Drugmakers are also developing other weight-loss medications, including easier-to-take pills.
Within the meantime, more patients are realizing that they will get medical help for his or her disease and haven’t got to administer it on their very own, said Horn, an obesity medicine expert at UTHealth Houston.
“I feel like that is the start of the change in obesity care, where we are going to see every 12 months higher and higher medications coming to market and other people getting their disease under control,” she said. “We’re just within the hard part … without delay.”