By Renuka Rayasam, KFF Health News
For the past yr and a half, Tandra Cooper Harris and her husband Marcus, each of whom have diabetes, have struggled to fill prescriptions for the medications they need to regulate their blood sugar.
Without Ozempic or an analogous drug, Cooper Harris suffers from fainting spells, is just too drained to maintain her grandchildren and struggles to earn more money braiding hair. Marcus Harris, who works as a cook at Waffle House, needs Trulicity to maintain his legs and feet from swelling and bruising.
The couple's doctor has tried to prescribe them similar medications that mimic a hormone that suppresses appetite and regulates blood sugar by increasing insulin production. But these, too, are sometimes out of stock. In other cases, their insurance through the Affordable Care Act burdens the couple with a lengthy approval process or costs they’ll't afford.
“It's like I have to jump through hoops to survive,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.
Due to provide shortages and insurance hurdles for this powerful class of medicine, generally known as GLP-1 agonists, many diabetics and obese people should not have access to the medicines they should stay healthy.
One of the causes of the issue is the very high prices set by drug manufacturers. About 54% of adults who had taken a GLP-1 drug, including those with insurance, said the price was “difficult to afford,” in line with KFF survey results published this month. But it’s the patients with the bottom disposable income who’re hit hardest. These people have few resources and may hardly go to the doctor or buy healthy food.
In the US, Novo Nordisk charges about $1,000 for a month's supply of Ozempic, and Eli Lilly charges an analogous amount for Mounjaro. Prices for a month's supply of varied GLP-1 drugs between 936 and 1,349 US dollars before insurance coverage, in line with the Peterson-KFF Health System Tracker. Medicare spending on three popular diabetes and weight-loss drugs – Ozempic, Rybelsus and Mounjaro – reached $5.7 billion in 2022, up from $57 million in 2018, in line with Research by KFF.
The “outrageously high“The high price tag has the potential to bankrupt Medicare, Medicaid and our entire health care system,” Senator Bernie Sanders (I-Vt.), chairman of the Senate Health, Education, Labor and Pensions Committee, wrote in a letter to Novo Nordisk in April.
The high prices also mean that not everyone who needs the drugs can get them. “They're already disadvantaged in some ways and that is just another excuse,” said Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia. Many of Rahman's patients, including Cooper Harris, are underserved, have high-deductible health insurance plans or rely on government assistance programs such as Medicaid or Medicare.
Many drug manufacturers offer programs to help patients start and stay on medications at little or no cost. But these programs have not been reliable for drugs like Ozempic and Trulicity due to supply shortages. And many insurers' requirements that patients prior approval or the first attempt with less expensive drugs leads to delays in treatment.
By the time Rahman's patients come to see her, their diabetes has been untreated for years and they are suffering from serious complications such as foot wounds or blindness. “And that's the top of the road,” Rahman says. “I even have to search out something else that’s more cost-effective and never pretty much as good for them.”
GLP-1 agonists – the drug category that includes Ozempic, Trulicity and Mounjaro – were initially approved to treat diabetes. In the past three years, the Food and Drug Administration has approved rebranded versions of Mounjaro and Ozempic for weight loss, causing demand to skyrocket. And demand is only growing as more and more of the drugs' benefits become apparent.
In March, the FDA approved the weight loss drug Wegovy, a version of Ozempic, for Treating heart problemswhich is likely to increase demand and spending. Up to 30 million Americans, or 9% of the U.S. population, are expected to take a GLP-1 agonist by 2030, according to the financial services company JP Morgan estimates.
More and more patients are trying to get a prescription for GLP-1 agonists, but pharmaceutical manufacturers are struggling to produce enough doses.
Eli Lilly urges people to avoid its cosmetic weight-loss drug Mounjaro to ensure adequate supplies for people with health problems. But the drugs' popularity continues to rise despite side effects such as nausea and constipation, thanks to their effectiveness and celebrity endorsements. In March, Oprah Winfrey hosted an hour-long special on the drugs' ability to help people lose weight.
It may seem like everyone in the world is taking this class of drugs, says Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But it's not as many individuals as you'd think,” she says. “There just aren't any.”
Even when the drugs are in stock, insurers crack down, leaving patients and health care providers to navigate a tangle of constantly changing insurance rules. State Medicaid plans vary of their range of weight reduction medications. Medicare doesn’t cover the prices of medication after they are prescribed for obesity. And Commercial insurers restrict access due to the cost of the medication.
Health care providers piece together treatment plans based on what's available and what patients can afford. Cooper Harris' insurance, for example, covers Trulicity but not Ozempic, which she said she prefers because it has fewer side effects. When her pharmacy ran out of Trulicity, she had to rely more on insulin instead of switching to Ozempic, Rahman said.
On one day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust prescriptions for all 18 patients she was treating because of issues with drug availability and cost, she said. One patient, covered by a high-deductible teachers' pension plan, couldn't afford a GLP-1 agonist, Addison said.
“Until she meets that deductible, it's just not a drug she will be able to use,” Addison said. Instead, she prescribed her patient insulin, which is priced at a fraction of the cost of Ozempic but doesn't offer the same benefits.
“The patients on a fixed income will be our more vulnerable patients,” Addison said.
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