Christine, a North Carolina resident who started using Mounjaro in 2022, recently learned that her primary care physician would no longer prescribe semaglutide medications because of the insurance hassle. She posted a TikTok about her experience as one of many people nationwide who have begun to report difficulty in getting these medications to fight diabetes and obesity.
“Basically, I have been using the service Mochi to prescribe for me but since it has a monthly fee I decided I would ask my PCP to provide at my physical yesterday, which we had discussed last year,” she wrote in a private message on Facebook about struggles in getting the group of medications known as GLP-1 agonists.
“She told me that their clinic is no longer able to prescribe the meds bc of the admin burden of dealing with them – insurance, supply issues, etc.”
The doctor did prescribe because she has a prior authorization through year end, she wrote, adding “it’s just infuriating bc like, okay, just adding another layer to accessing these things. And more expense.”
Many purchasing difficulties
When we wrote about the prices of Ozempic, Mounjaro, Wegovy and similar medications a year ago, we documented the many difficulties people were having buying these medications. It seems to have gotten worse, not better. The list prices for these drugs are in the high hundreds and low thousands of dollars for a month’s supply. And as they have gained popularity, drug shortages have compounded their inaccessibility. Patient-consumers are finding that “shopping” is inevitable.
(Note: Medical professionals and laypeople are increasingly acknowledging that terms like “obesity” and “overweight,” and the use of Body Mass Index (BMI) in healthcare are stigmatizing and contribute to discrimination. Many insurers and providers still use these terms in official diagnoses and terms of coverage, though, so we will be using them throughout this piece for the sake of clarity.)
Christine, who wrote on condition that we not use her full name, went on: “I currently have two active scripts and PAs, one for wegovy and one for zepbound. I am on day 38 of waiting for zepbound to be in stock. CVS mail order discharged both scripts due to lack of supply. I did get 3 months of wegovy yesterday at a local CVS, my zepbound script is at Walmart bc I trust their waitlist process over cvs….
“Nobody can get it, really. A lady at work started it and gave up after a month of Mounjaro. My brother has found a sweet spot weirdly with the hospital pharmacy in Des Moines. But everyone is hunting. I am planning to get build up a zepbound supply before switching bc I do not want to go back and forth.”
Hard to find
It can be hard to find a doctor who will prescribe for weight loss, we learned, but a diabetes diagnosis can bring a prescription. Yet having a prescription doesn’t mean you have access to the medications: They seem to be in short supply. The names of the medications include Ozempic and Wegovy (semaglutide), Mounjaro and Zepbound (Tirzepatide), Saxenda and Victoza (liraglutide), Trulicity (dulaglutide) and others.
While all these GLP-1 agonists are FDA approved and some have been on the market for almost a decade, only two actually have weight loss as their “on-label” usage: Wegovy and Saxenda. (These also both require the diagnosis of at least one comorbidity such as hypertension or elevated cholesterol.) The rest may be prescribed “off-label” for weight loss — a practice the FDA notes is common but up to the discretion of a healthcare provider.
While manufacturers have put out statements saying they don’t condone such off-label uses of these Type-2 diabetes drugs, their sales and profits on these drugs have skyrocketed as their weight loss potential has become more widely recognized. Wegovy has been in high demand because it is on-label, but a shortage has meant that more people are turning to Ozempic and others for their off-label use, leading to a cycle of exacerbating shortages.
New research showing that these medications can also have a positive effect on heart attack risk and kidney disease have increased the demand, and sparked a new conversation about whether the benefits are broader than originally thought.
Then, the money
Once you have a prescription, the next obstacle is insurance coverage — unfortunately, many people may find that they do not. Most private insurers do not cover these drugs for off-label weight loss use. The two that are approved on-label — Wegovy and Saxenda — have a better chance at coverage. People with a pre-diabetes diagnosis may also be able to get coverage for a number of these medications. It depends on your plan.
Even though Christine has an obesity diagnosis, when she started last year, she paid out of pocket for Mounjaro because its use for weight loss is off-label. Her insurance does cover Wegovy, but even then, her high deductible plan means that she would still be paying the drug retail price out of pocket for a few months until she reaches the deductible amount.
Each individual will need to determine what is actually covered and consider the pros and cons of moving ahead under a high-deductible plan. Our resources on finding out true costs, appealing an insurance denial, and appealing a bill may be helpful.
Prices vary: Sticker prices we have seen range around $900 to $1,300 every four weeks. But the actual prices can be much less, as The New York Times reported in late 2023: “Net prices, the revenue divided by the number of prescriptions in their analysis, appear to be around $700 every four weeks for Wegovy, or about $650 less than the list price; about $300 for Ozempic, or nearly $650 less than the list price; and approximately $215 for Mounjaro, or about $800 less than its list price.”
If insurance won’t cover it, then it’s on to the world of patient assistance programs and coupons. Some will cover and some won’t. The patient assistance programs are typically run by the manufacturers, and will have limitations (only 6 months, maybe) or coverage restrictions (no one on a government-run insurance program, like Medicaid, Medicare or TriCare for military personnel). We have read of people who started with a patient assistance program, and then had to quit because they couldn’t afford it.
To find these, Google “patient assistance programs” and the name of your medication.
While Medicare does cover “obesity care” like screening and counseling, drugs for weight loss are explicitly prohibited, thanks to a 2003 law establishing the Medicare Part D prescription drug benefit.
Medicaid offers a bit more leeway. According to a recent survey by Bloomberg News, 10 states have “broad coverage” for weight loss drugs: California, Kansas, Minnesota, Wisconsin, Michigan, Pennsylvania, Virginia, Delaware, Rhode Island and New Hampshire. Six states offer “limited coverage”: New Mexico, Louisiana, Tennessee, Georgia, South Carolina and New Jersey. Connecticut is set to begin covering obesity drugs through Medicaid in July 2023.
Shifting landscape
With the shifting landscape, people are having a hard time getting the medications.
“Please fix the Ozempic shortage immediately!” one X-Twitter user wrote.
Another wrote: “Since Ozempic is trending… STOP TAKING IT FOR WEIGHT LOSS!!! There is a shortage because you lazy ppl are taking it & it’s hard for actual diabetics to get it. I’ve had to wait for my refills multiple times because the pharmacy is always out. And I know I’m not the only one.”
Another: “What’s happening is they’re rotating – when Ozempic is on shortage, docs prescribe Mounjaro. When Mounjaro is on shortage, docs prescribe Zepbound. Eventually one comes back in stock while the others are in demand. Cycle repeats”
The Wall Street Journal reported on gray-market substitutes purporting to stand in for the GLP-1 drugs in shortage conditions.
Another view
Another view came from B., a 50-year-old woman from Chicago who discussed her experiences on condition that we not use her full name.
“My NP suggested Ozempic to me, just before Wegovy had hit the market,” she wrote in a message on Facebook. “No one knew the word semaglutide yet.
“Even though I wasnt pre-diabetic, she ‘coded’ my that so insurance would cover it. It was an explicit discussion we had and I was happy to try it.
“I could not care less about weight loss, but I was intrigued by the opportunity to bring my inflammation down.
“In early 2023, I walked up to refill my Ozempic and overheard a woman being told her Wegovy was out of stock indefinitely. Sure enough, 3 months later, CVS was out of Ozempic. I heard word of mouth to try Costco and that kept my prescription filled through early 2024.
“First time, I tried to refill Ozempic in February, CVS Caremark denied it. My assumption was that they would only cover it for folks with diabetes ‘proper.’ Makes sense especially if there are challenges with access. My husband has type 2 diabetes and I know the importance for his health.
Lower weight, less inflammation
“In my experience, being on Ozempic did reduce my weight 16%. Great help in my inflammation. What I didn’t anticipate and have loved is that the lower appetite and slower digestion had erased getting ‘hangry’ and the ‘food noise’ of feeling the meal is urgent.
“In short, being on Ozempic has been a mood stabilizer, which makes it far easier to focus on other parts of my health. We grossly misunderstand what these drugs do when we write them off as weight loss drugs. The shift in digestion and appetite change our whole system for the better.
“Because I got on the medication just before the wave of wider mainstream knowledge, I have had MANY conversations busting the myths of semaglutides. I am thrilled that better understanding the chemistry of obesity is helping medical professionals recognize that a person’s weight is bigger than, ‘eat less, move more,’ that obesity is not a moral failing.
“These drugs are lifechangers… and the hype about them is really fucking annoying. Anything that helps people actually understand the sea change is great.
“Soooooooo much misinformation on how they work. Like the folks who think I will lose a few pounds and go off it.”
Another view
Not everyone is having trouble.
G., 47, an accountant, in Columbia, Mo., wrote: “I haven’t experienced any shortages and I’m still on a very slow ramp-up schedule (up to 1.7 mg starting next month). I thought it would be a lot harder for me to get it – maybe because I’m in a mid-size town vs a larger populated one?”
R., who lives in Charlotte, N.C., wrote: “It’s been erratic. I’ve learned to call my Cvs a couple of weeks before i run out to check their supply. Then i have time to call around as needed. It may help that i am on the highest dose of Ozempic 2 mg.
“In the fall, my doctor switched me down to 1 mg since I could find that. And I went to an out of network pharmacy so it was $45 vs $25. But I haven’t run out.”
Widespread concern
There’s endless conversation on Reddit and on Tiktok and Facebook about the shortages. And endless advice.
Reddit has this warning from the mods at the top of the Ozempic subreddit: “For people claiming that they are buying medication on websites for an extreme discount, please be wary of these sites. Often these will look like legitimate accounts, but they are not. Reddit accounts can be bought and sold and they will use legitimate looking accounts to steer you towards scam websites. Lots of harmful counterfeit Ozempic out there right now. If it seems too good to be true, it is.”
There is commentary that seems ill-informed and cautionary, and some that is sales-y and upbeat. There are an astounding number of offers selling GLP-1’s — and of course, social media is the last place you should be thinking of buying.
Social media is never a good place to get medical information. But as experts in crowdsourcing, we can tell you: Some of this information is very good. For example, when we were writing about the shortages of Adderall and similar ADHD medications, people kept saying “try hospital pharmacies” or “try Costco” or “try mom-and-pop pharmacies, instead of CVS and the other biggies.”
We hear a lot of that on social media, too, these days, about finding GLP-1’s.
There are a large number of companies offering online services — Mochi, HenryMeds, Push Health, Sequence, Weightcare, Emerge, ReflexMD, Alanmeds.
Some people suggested GoodRX. We are aware that sometimes the GoodRX predicted savings coupons are not accepted at some pharmacies, or the prices change.
Every time I did a search for this topic online, new purveyors sprung up. The social media conversation about what’s good, what’s bad, and what’s so-so is vibrant. (We do not make recommendations on whether any of the on-line services are reliable.)
If you think it looks like the Wild West, you’d be right. Also if you hesitate to buy prescription medications from someone with a TikTok account, you’d be right.
Do your homework, and be thoughtful. Also this is a good time to reflect on how broken our healthcare system is: If a medication for diabetes cannot be obtained because of money, that’s a big problem.
Search tool
The telehealth company Hims and Hers, seeing the chaos in the marketplace, made a free tool that is supposed to help people find these medications. It was launched on May 29, and it’s not clear to us how well it works. It’s supposed to be free for everybody, but of course it seems likely that they will be using it to collect data.
Meanwhile, some suppliers are selling compounded versions of these medications — a version that is put together at a compounding pharmacy from raw materials, rather than the versions that are made and sold as injection pens by the manufacturers, approved by the Food and Drug Administration.
One is Hims and Hers, offering a month’s supply of the compounded weight-loss medication (not the brand name) for $199 — hundreds of dollars less than brand name medications. They say they also will prescribe brand-name medications, but the site shows that Wegovy and Ozempic are out of stock, while the compounded semaglutide is in stock. (Big surprise.) Hims and Hers says Ozempic prices start at $1,899 a month, and Wegovy starts at $2,599 a month.
Hims and Hers, of course, began with telemedicine prescribing of medications for erectile dysfunction, and then moved on to medications for baldness and acne, among other things.
“Typically, the Food, Drug, and Cosmetic Act prohibits compounding drugs that are just copies of commercially available medications. However, drugs that are in shortage are not considered by the U.S. Food and Drug Administration (FDA) to be commercially available,” Bruce Gill writes over at Quartz. “Wegovy and Eli Lilly’s weight loss drug Zepbound are both currently in shortage due to increased demand, according to an FDA database. Because of this, compounders are allowed to buy semaglutide and tirzepatide from drug ingredient makers to compound it into injectable formulations.”
Many are said to quit
Meanwhile, Blue Cross Blue Shield Association released a study saying that 30% of patients stopped using GLP-1 medications within the first month and “58% of patients discontinue use before reaching a clinically meaningful health benefit.”
“According to the study conducted by BHI, most GLP-1 prescriptions came from primary care providers, but patients who received their prescriptions from an endocrinologist or obesity medicine specialist were more likely to stick with the treatment. Those who saw their doctor more often, regardless of provider specialty, were also more likely to continue with the treatment — emphasizing the need for greater care management.
“BHI data indicates that patients facing the greatest socioeconomic barriers to health care, such as cost, transportation and language barriers were less likely to continue treatment, as were adults under age 35. But patients with coexisting conditions like peripheral vascular disease and diabetes — and particularly those with three or more such conditions— were more likely to continue.”
