- FDA News
by Skippack Pharmacy
Wegovy-Mounjaro-Ozempic-Saxenda Shortage: Impact on Patients
“All included Telehealth Weight Loss Program. Just sign up with your email and have access to physician counseling, Daily Diet Plan, Daily Exercise Plan, and Semaglutide/ B12 Injections. All for just $749 per month, no insurance accepted.” You may have seen this on a TV ad.
About 42% of American adults are obese, according to the CDC. For years, people have been trying different methods and medications to perfect weight loss and in 2023, a new trend has been getting a lot of attention.
While many of these medications are beneficial to millions around the world, currently, access has been limited to them due to the amount of people who have been prescribed these medications for a variety of indications.
8 of 10 calls we receive at the pharmacy the past few months in regards to seeing if we have a product in stock has been in regards to one of these medications. Throughout the last year, many patients have been prescribed Wegovy, Mounjaro, Ozempic, or Saxenda with the hopes of helping them lose weight. With many of these on backorder or on short supply, what is everyone supposed to do?
There is always the traditional diet and exercise program many are already working on but many patients want to expedite weight loss in addition to changing lifestyle.
What is Semaglutide vs Tirzepatide vs Liraglutide?
Wegovy and Ozempic are both Semagulatide which are glucagon-like peptide (GLP-1) receptor agonists. Semaglutide lowers blood sugar by stabilizing amounts of insulin released, making patients feel fuller by slowing down stomach emptying. These effects also work to help patients taking semaglutide to lose weight. Semaglutide was first brought to the market as a non-insulin treatment for Type 2 Diabetes to lower blood sugars, lower cholesterol, and overall prevent adverse cardiac events such as heart attack and stroke.
Once it was discovered that weight loss was a side effect of semaglutide, many providers began to prescribe it as a medication for patients who are overweight or obese.
In a study conducted by The New England Journal of Medicine, it was found after 68 weeks of using a once-weekly semaglutide injection there was a mean body weight change of about 15% in conjunction with diet and exercise.
Novo Nordisk manufactures both Ozempic and Wegovy. However, there are a few differences between the two.
Ozempic is FDA-approved for the treatment of type 2 diabetes. In the US, the FDA has approved Ozempic for this indication to help prevent serious cardiovascular events such as heart attacks or strokes in people with type 2 diabetes and cardiovascular disease. Wegovy on the other hand is FDA-approved as a weight-loss treatment. The dosages of the drugs are also different, Ozempic starts at a 0.25 mg dose as well as 0.5 mg, 1 mg, up to 2 mg dose. Wegovy on the other hand has a 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg dose. Wegovy has the stronger doses because of the intention for weight loss with the drug.
Other than that the medications are very similar. Patients are prescribed to take a once-a-week injection. Each pack has enough for four doses, enough for the whole month. Then after they are finished all the injections for that package they move up to the next dosage. Sometimes patients on Ozempic stay at the 0.5 mg dose but it varies from patient to patient.
Mounjaro is Tirzepatide. Mounjaro is the first of its kind that targets to hormones that regulate blood sugar levels and help patients lose weight (GLP-1 and GIP (gluoce-dependent insulinotropic peptide). Mounjaro is FDA approved to improve blood sugar levels in adults with type 2 diabetes in addition to diet and exercise. Currently, it is not FDA approved for weight loss; although it is prescribed for such off-label by many prescribers, and in review by the FDA for this indication. Mounjaro works by increasing insulin sensitivity, slowing the digestive system and decreasing appetite (also causing patients to lose weight). It is also taken once a week and can be used in addition to insulin. The injection starts with 2.5mg doses weekly and can go up to 15mg weekly.
Saxenda is Liraglutide. Saxenda was the first GLP-1 agonist injectable that was FDA approved over 10 years ago for weight loss; however, since its approval the newer once weekly injectables have become more popular.
Why is there a shortage?
The influx of prescriptions for these medications has increased due to patients taking the drug for weight loss purposes. With an uptick in ads, trends such as those on TikTok, and celebrity endorsements, many of these weight loss medications have been common amongst many Americans looking for an option to improve their health by losing weight. By no means, is there anything wrong with taking these medications with a consultation and benefit-risk analysis with your healthcare provider; however, it is always important to be educated about the medication prior to starting it in today’s landscape knowing where you can get it not just this month but going forward should you choose to start it.
A downside to taking this medication occurs when the patient stops taking these injections is many patients end up gaining the weight the drug helped them lose. The shortage of these drugs is predicted to continue through the end of the year and possibly further. The same applies to the other medications mentioned in this post, as well.
Why is this a Concern?
Ozempic is a medication for the treatment of type 2 diabetes and now with the surge in prescribing of the medication for other health reasons, patients with type 2 diabetes are having difficulty getting the medication they have taken for a while or are supposed to be starting. Another concern becomes that patients may start one of these medications this month and may end up in the same position next month and struggle to find it.
If you have troubles after this and are just starting the medication, we suggest you speak to your physician/provider prior to starting the medication until the shortage issue resolves. If after searching “everywhere” you are not having luck, speak to your provider as they may have alternatives or be able to assist.
Does Skippack Pharmacy have these medication in stock?
Unfortunately, no. At the moment our pharmacy is unable to procure Wegovy, Ozempic, Mounjaro, or Saxenda at a cost from our wholesalers that allows us to fill the medication without losing money. Umm, what’s this mean? Can you give me an example?
Example: Ozempic RX sent in for a patient for a 1 month supply
Cost of drug to pharmacy from wholesaler: $935.77
Reimbursement from insurance company: $878.10
GER/DIR processing fee from insurance company: $19.20
Labor/supply/processing cost to fill prescription: $12.00
Patient’s copay: $0.00
Net loss: $88.87
So where does that $88.87 get made up? It doesn’t, that is the amount we would lose each time we filled this prescription for 1 patient each month.
And that’s not where it ends. Insurance companies are known to audit high cost drugs (especially if they find a loop hole). If a drug is prescribed off-label (i.e. only FDA approved for type 2 diabetes but patient is using it for weight loss), the insurance company would recoup the full amount back from us.
We had the choice…are we going to invest a net $80-$100 loss or potentially losing the entire amount every month for every patient or keep our doors open. We decided the latter. Many independent pharmacies like ours cannot get volume discounts or rebates from manufacturers that many chain and grocery store pharmacies can get. They also have many other sources of revenue that can make up for losses if that were to occur.
With plummeting reimbursements from insurance companies to levels where the amount the insurance reimburses us is lower than the amount we purchase the drug for; we currently cannot get these injectables until change happens.
One thing is for sure, we don’t leave our patients hanging so if you have a prescription for one of these medications, here are some tips that can help.
- If your insurance has a “mail order” option, you can call the mail order company to see if they have the medication in stock and see if they can mail it to you.
- Call a grocery store pharmacy near you to see if they have it in stock (i.e. Wegmans, Giant, ShopRite, etc.)
- Call a chain pharmacy near you (i.e. Walgreens or CVS) if they do not have it in stock at that specific location, ask if they can check their central system to see which store nearest to them has it in stock.