Resurgence of Traditional Weight Loss Medications: Limited Access to Zepbound and Wegovy
Discover the resurgence of older weight loss medications as Zepbound and Wegovy remain out of reach for many These affordable pills offer a reliable alternative, with different side effects, and without the need for injections Overcoming insurance battles and shortages, prescriptions for these drugs are on the rise
Christy Nguyen experienced the onset of menopause at the same time as the Covid-19 pandemic, which led to unwanted weight gain. By the age of 56, she had gained 30 pounds in just two years and felt desperate to find a solution for weight loss. Despite trying WeightWatchers and the keto diet, she was unable to shed the weight and hoped to stop taking her prescribed medications for high blood pressure and cholesterol.
Compounded versions of semaglutide typically come in multidose glass vials, and patients draw their own doses into syringes.
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Nguyen embarked on a 15-month exploration of a new group of medications, including Ozempic and Wegovy, known as GLP-1 receptor agonists. Despite their growing popularity, obtaining these medications can be challenging due to insurance obstacles and limited availability. Consequently, like many others, Nguyen resorted to taking an older weight loss prescription drug instead. Dr. Jody Dushay, Nguyen's physician at Beth Israel Deaconess Medical Center, noted that an increasing number of patients encounter difficulties in obtaining GLP-1 medications.
Dushay stated that older weight-loss medications offer several advantages. They are generally more affordable, less likely to be in short supply, have different side effects compared to Wegovy and similar drugs, and are available in pill form rather than requiring injections.
According to data from Epic Research exclusively provided to CNN, prescriptions for older weight-loss medicines have also increased, although to a lesser extent than newer drugs like Wegovy.
Battling insurance and shortages
Nguyen's journey with weight loss medication began in spring 2022, when she was initially prescribed Wegovy by a previous doctor. However, despite meeting the qualifications based on her body mass index of about 35, the cost of the medication exceeded $1,000 per month and was not covered by her insurance. As an alternative, her doctor prescribed Ozempic, a sister drug approved for type 2 diabetes, which contains the same key ingredient, semaglutide, but at generally lower doses. Ozempic is commonly used off-label for weight loss purposes.
Nguyen, a resident outside of Boston, found a three-month stock of Ozempic for $900 on a website that enabled her to purchase the medication from Canada. She reported losing 10 pounds during the course of those three months.
Jaap Arriens/NurPhoto/Getty Images
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"It wasn't incredibly fast," Nguyen remarked. "But it was enough to give me a sense of relief that I had found something that was effective."
However, after three months, Nguyen realized that it wasn't feasible for her to continue paying such a high cost for the medication out of her own pocket. At that juncture, a new alternative had become available: Mounjaro, a medication similar to Ozempic which is approved for type 2 diabetes. The manufacturer, Eli Lilly, provided a coupon to reduce the copays for some patients, and this assistance enabled Nguyen to obtain the medication for about a year.
She lost an extra 10 pounds and believes she could have shed even more weight if the medication had not started to run low on higher doses, causing her to remain on a lower dose for a longer period than expected. Despite this, Nguyen expressed relief in finally finding something that was effective in quieting the "food noise" that had previously made weight loss difficult.
Nguyen expressed a newfound sense of neutrality towards the topic, adding that the introduction of new medications gave her a sense of satisfaction in the way medicine was addressing weight loss. "It's like suddenly being acknowledged and understood for the first time," Nguyen said, "especially when obesity is discussed as a medical condition rather than mere laziness."
Then the Mounjaro coupon program ended, and Nguyen was left without access to the medicines yet again.
Im not fat enough
Nguyen's doctor attempted to prescribe Saxenda, an older medication from the same GLP-1 class, after the initial prescription was denied by her insurance company because her BMI did not fall in the morbidly obese category. According to the US Centers for Disease Control and Prevention, obesity is defined as a BMI of 30 or higher, and Saxenda, along with other GLP-1 medications, is approved for individuals with a BMI of at least 30, or with a BMI of 27 and at least one weight-related condition such as high blood pressure.
An Ozempic (semaglutide) injection pen is seen on a kitchen table in Riga, Latvia on 06 August, 2023. (Photo by Jaap Arriens/NurPhoto via Getty Images)
Jaap Arriens/NurPhoto/Getty Images
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The CDC categorizes a BMI of 35 to 40 as "class 2 obesity," and 40 and above as "class 3," also known as severe or, previously, "morbid" obesity.
"I said, If you want me to become morbidly obese, I suppose I'll come back and speak to you in about a year, because I'll probably be there by then," Nguyen stated. "I guess I'm not fat enough or something."
After stopping Mounjaro, Nguyen regained approximately 80% of the 20 pounds she had lost over the course of 15 months, gaining it back at a rate of about one pound per week from August to November. She described the rate at which she gained the weight back as alarming.
She was referred to Dushay, an endocrinologist at Beth Israel and an assistant professor of medicine at Harvard Medical School, who specializes in obesity and type 2 diabetes. They began discussing potential options for treatment. This conversation is common for Dushay and her patients, as the rise in popularity of new drugs like Ozempic has led to more people seeking weight loss treatment, only to encounter barriers when trying to access the medications.
Dushay commented, "There's this underlying belief that I should be able to handle this by myself, which doesn't apply to many other chronic illnesses and is a misconception for various reasons." She also mentioned the rise in popularity of new medications, saying, "I believe it has enabled people to seek medical treatment for their condition, as they would for diabetes or high blood pressure."
On Tuesday, Sept. 26, 2023, injection pens are being produced at the Novo Nordisk A/S facilities in Hillerod, Denmark. The injectable drugs Ozempic and Wegovy, belonging to the GLP-1s medicine class, manufactured by Novo, have been causing significant impacts on the stock market, affecting the producers of various products, from snacks to alcoholic beverages.
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Due to persistent shortages of Mounjaro, Ozempic, and Wegovy along with insurance denials and various other reasons, Dushay and other healthcare professionals have been resorting to using older prescription medications for weight loss, such as phentermine, metformin, and bupropion, both on and off-label.
For Nguyen, Dushay prescribed bupropion, originally approved by the US Food and Drug Administration in 1985 and recognized as the brand-name antidepressant Wellbutrin. Additionally, it is approved for smoking cessation and, in 2014, the FDA also approved it for weight loss in conjunction with another drug, naltrexone, as Contrave.
"Dushay suggested trying it for individuals struggling with afternoon or evening snacking or dealing with strong cravings for sweets. He believes that, similar to its effectiveness in aiding smoking cessation by reducing cravings, this could be the primary way it helps."
"In November, Nguyen shared that after a week on bupropion, she felt it may have finally halted the continuous weight gain she had been experiencing since losing access to Mounjaro."
Older weight-loss drug prescriptions rise
The prevalence of weight-loss prescriptions among overweight adults has more than doubled since 2017, as indicated by data from Epic Research analyzing millions of electronic health records. In the span of just one year, from 2022 to 2023, the data reveals a 25% increase in prescription rates.
The largest upticks in prescription rates are seen for semaglutide and tirzepatide, the generic names for Ozempic and Wegovy (semaglutide) and Mounjaro and Zepbound (tirzepatide). However, there have also been noteworthy increases in the prescription rates of older medications.
Wegovy (semaglutide 2.4mg)
Courtesy Novo Nordisk
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According to Epic's data, the prescription rate for bupropion increased by 29% between 2017 and 2023. Additionally, the prescription rate for phentermine, FDA-approved in 1959, increased by 34%. The analysis focused on adults classified as overweight who received prescriptions for any medications in a given year and the rates at which they were prescribed a weight-loss drug.
Prescription rates for newer medications have surged in the past year, with Semaglutide nearly doubling and tirzepatide rising by 141%. Semaglutide, approved as Ozempic for type 2 diabetes in 2017 and for chronic weight management as Wegovy in 2021, has seen significant growth. Similarly, tirzepatide, marketed as Mounjaro for type 2 diabetes in May 2022 and for weight loss as Zepbound last month, has experienced a substantial increase in prescriptions.
Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine, expressed concern that not everyone has insurance coverage for the new medications. As a result, patients are forced to rely on older medicines for weight management, highlighting the financial barriers that some individuals face in accessing these newer treatment options.
Older medications can be highly effective, but finding the right one for each individual is crucial. For instance, Phentermine can raise heart rate and blood pressure, making it unsuitable for those with cardiovascular disease.
Notably, Phentermine was once part of the fen-phen combination, which caused severe heart valve issues in certain patients. While the other medication in the combination, fenfluramine, was withdrawn from the market in 1997, the FDA did not request the removal of Phentermine.
The medicine was approved in 2012 in combination with topiramate as the weight-loss drug Qsymia. However, clinical trials showed that Qsymia and Contrave did not result in as much weight loss as the GLP-1 class, and these medicines were not commercially successful.
On April 17, 2023 in Los Angeles, California, a photo illustration shows boxes of the diabetes drug Ozempic resting on a pharmacy counter. Originally approved by the FDA to treat Type 2 diabetes, Ozempic, also known as semaglutide, has seen an increase in demand in recent months due to its weight loss benefits. This surge in demand has led to shortages, with some doctors prescribing Ozempic off-label to treat obesity. (Photo illustration by Mario Tama/Getty Images)
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Some individuals find the newer medications less attractive simply due to their novelty. After losing about 70 pounds over four years through a lifestyle program with Dushay, sixty-two-year-old Henry Benson expressed his reluctance to try Wegovy and similar medicines, citing concerns about potential side effects such as nausea, vomiting, and constipation, especially during the initial stages of treatment.
He also mentioned, "The drug is still relatively new, so we lack knowledge about its potential long-term side effects. After considering all of this, I decided that it just wasn't the right choice for me."
He and Dushay opted for metformin, a generic drug that was approved in 1994 for type 2 diabetes. He has already lost an additional five pounds and hopes to discontinue the medication after shedding another 15 pounds, planning to maintain his weight loss without the aid of medication. Additionally, he pointed out that he has successfully ceased taking other medications, such as statins, as a result of changes in his diet that led to a decline in his cholesterol levels.
Physicians welcome new tools such as GLP-1s, but their expanded use may have drawbacks, according to Dr. Zhaoping Li, a professor of medicine and chief of the Division of Clinical Nutrition at the University of California, Los Angeles. "While people are losing weight, they are also losing a significant amount of muscle," which is particularly concerning for older patients, said Li. "Another significant concern is that people are consuming so little that they are at risk of malnutrition and vitamin deficiencies. So, it is not a guaranteed improvement for everyone."
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Additionally, with the introduction of Zepbound from Eli Lilly, patients like Nguyen are optimistic about improving their access to it. Dushay stated that approximately 75% of her insurance coverage requests for the drug, priced at over $1,000 per month even with a discount compared to Wegovy, have been denied. While Wegovy has seen improved coverage after being on the market for a longer period, it is currently in short supply, especially in lower doses.
Just like it did for Mounjaro, Lilly is providing a coupon to reduce the out-of-pocket expenses for some patients. Nguyen's insurance denied coverage, but with the savings card, she is able to pay $550 per month. She intends to utilize this as she begins with lower doses of Zepbound and, once she reaches a higher dose, she may consider switching to Wegovy, which is covered by her insurance. Nguyen administered her first injection of Zepbound last week.
