CLOCK: A look at the cost of diet drugs
As drugs like Ozempic, Wegovy, and Mounjaro used by some for weight loss experience a surge in popularity, they remain out of reach for many people.
The reason is the cost of medications, which can exceed $1,000 a month without insurance coverage.
“Patients may not have it [insurance] coverage, and then, if they choose to use them, they often pay out of pocket,” Dr. Veronica Johnson, an obesity medicine specialist at Northwestern Medicine, told ABC News. “And the costs can be anywhere between $1,000 to $1,500 dollars a month”.
Both Ozempic and Mounjaro are approved by the US Food and Drug Administration for the treatment of type 2 diabetes, but some doctors prescribe them “off-label” for weight loss. Wegovy is FDA approved for weight loss for obese or overweight people.
Insurance coverage for drugs varies depending on everything from a person’s medical diagnosis to where they live and their insurance plan.
Ozempic, Wegovy and Mounjaro are not covered for weight loss under most Medicare and Medicaid programs.
“Health insurance providers work to ensure that the right drugs are prescribed to the right patients and at an affordable cost,” America’s Health Insurance Plans, a trade association of health insurance companies, told ABC News in a statement. , adding, “Evidence … suggests that patients may not be able to maintain their weight loss once they stop taking the drug.”
Among people whose insurance doesn’t cover drugs, some are turning to an alternative option, finding a cheaper off-brand version at a compound pharmacy.
Ohio’s Tina Straw told ABC News she opted to use compound pharmacy when her insurance company denied coverage.
“I was like, ‘OK, I can make $1,200 a month for a year, but I can’t… make $1,200 a month indefinitely,” she said. “I’m thinking about, you know, retiring early.”
Instead of paying $1,200 a month, Straw said he’s paying about $300 a month for a generic semaglutide compound.
Semaglutide is the active compound that Ozempic and Wegovy are made of, while Mounjaro contains a compound called tirzepatide.
Compound pharmacies create their own semaglutide or tirzepatide compounds using the raw ingredients.
“A compound pharmacy is a pharmacy that takes drug components and mixes them together to make a drug,” Dr. Al Carter, executive director of the National Association of Boards of Pharmacy, told ABC News. “Patients [use compound pharmacies] if they need a specific drug, it’s not available in a market, or if they need a drug that doesn’t have a specific inactive ingredient due to allergy or something else.”
MORE: People Describe Real-Life Side Effects of Popular Injectable Weight Loss Drugs
Some medical experts say there are risks associated with taking semaglutide via that route because the compounds can be altered and in many cases it’s not clear where the drugs come from.
“It could be combined with something else that’s not tested or safe, so in general it’s really not recommended,” Johnson said of the use of compound pharmacies.
The FDA said that while the drugs are eligible for compounding due to shortages, compounded versions “pose a higher risk.”
“Compound drugs pose a greater risk to the patient than FDA-approved drugs because compound drugs do not undergo FDA premarket review for safety, efficacy, or quality,” the agency said in a statement. “The FDA’s compounding program aims to protect patients from poor-quality compounded drugs while preserving access to legally marketed compounded drugs for patients.”
The National Association of Boards of Pharmacy states that many compound pharmacies are safe and are regulated by states.
“Of these drugs [used for weight loss]where I would worry is when you buy these compound products online,” Carter said.
MORE: Woman Says Ozempic Helped Her Lose Weight While Trying to Get Pregnant
Experts say people who would like to take the drug’s brand names should check their insurance coverage every few months because coverage could change.
Eli Lilly, the maker of Mounjaro, said in April that it expects the drug to be approved by the FDA for weight loss as early as the end of the year.
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