With the rise in popularity of drugs like Ozempic, Wegovy, and Mounjaro that some use for weight loss, they remain out of reach for many people.
The reason is the cost of medications, which can run to more than $1,000 per month without insurance coverage.
Patients may not have it [insurance] coverage, and so, if they choose to use it, they often pay out of their own pockets,” Dr. Veronica Johnson, an obesity medicine specialist at Northwestern Medicine, told ABC News. Costs can range from $1,000 to $1,500 a month.”
Ozempic and Mounjaro are both approved by the FDA to treat type 2 diabetes, but some doctors prescribe them “off-label” for weight loss. Wegovy is FDA-approved for weight loss for people who are obese or overweight.
Drug insurance coverage varies, depending on everything from a person’s medical diagnosis to where they live and their insurance plan.
Ozempic, Wegovy, and Mounjaro for weight loss are not covered by most Medicare and Medicaid programs.
“Health insurance providers are working to ensure that the right medications are prescribed to the right patients at a reasonable cost,” Health Insurance Plans of America, a trade association of health insurers, told ABC News in a statement, adding: “Evidence…suggests that patients may not be able to Maintain weight loss once you stop taking the medication.
Among people whose insurance does not cover the drug, some resort to an alternative option, finding a cheaper brand-name version at a compounding pharmacy.
Tina Straw of Ohio told ABC News that she opted to use a compounding pharmacy when her insurance company refused coverage.
She said, “I was like, ‘OK, I can be paid $1,200 a month for a year, but I can’t…be paid $1,200 a month indefinitely’.” “I’m planning on, you know, I hope to retire soon.”
Instead of paying $1,200 a month, Straw said she pays about $300 a month for the generic semaglutide.
Semaglutide is the active compound that Ozempic and Wegovy are made of, while Mounjaro contains a compound called tirzepatide.
Compounding pharmacies create their own compounds of semaglutide or terzipatide using raw ingredients.
“A combination pharmacy is a pharmacy that takes the ingredients of a drug and mixes them together to make a drug,” Dr. Carter, executive director of the National Association of Pharmaceutical Boards, told ABC News. “Patients [use compound pharmacies] If they need a specific drug that isn’t on the market, or if they need a drug that doesn’t have a specific ingredient that’s inactive because of an allergy or something else.”
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Some medical experts say there are risks associated with obtaining semaglutide through this route because compounds can be altered and it is not clear in many cases where the drugs are obtained from.
“It can be combined with something else that hasn’t been tested or safe, so in general, it’s not really recommended,” Johnson said of the use of combination pharmacies.
The FDA said that while the drugs are eligible for combination due to shortages, combination versions “pose a greater risk.”
“Combination drugs pose a greater risk to the patient than FDA-approved drugs because combination drugs do not undergo pre-market review by the FDA for safety, efficacy, or quality,” the agency said in a statement. “The FDA’s combination program aims to protect patients from poor-quality combination drugs, while preserving access to legally marketed combination drugs for patients.”
The National Association of Boards of Pharmacy says many combination pharmacies are safe and regulated by states.
of these drugs [used for weight loss]”My concern is when you buy these combination products online,” Carter said.
MORE: Woman says Ozempic helped her lose weight while she was trying to conceive
Experts say people who want brand-name drugs should check insurance coverage every few months because coverage can change.
Eli Lilly, the maker of Mounjaro, said in April that he expects the drug to be approved by the US Food and Drug Administration for weight loss as early as the end of the year.
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