By Leanna Coy, FNP
New weight loss medications are in high demand. With approximately 70% of adults in the United States either overweight or obese, images of celebrities and videos on social media show people experiencing marked weight changes have boosted the profile of Ozempic and other medications like it. Despite the popularity and apparent benefits of these medications, their use for weight loss is frequently off-label, as most are only approved to treat diabetes. Recently, Medicare announced it will begin covering these medications for more than just diabetes. This shift could be a potential game changer for many people seeking to use these medications for weight loss. But are they worth it?
What Are the New Weight Loss Medications
Ozempic is in a class of drugs called glucagon-like peptide-1 receptor agonists (GLP-1s). This class of drugs first came to the market in 2005 with Byetta for the treatment of diabetes. Users of Ozempic experienced weight loss as a positive side effect. The weight loss was substantial enough that Novo Nordisk, the manufacturer of Ozempic, created a second drug called Wegovy specifically to treat obesity. Wegovy contains a higher dose of the same active ingredient, called semaglutide, that is in Ozempic.
Currently, the Food and Drug Administration (FDA) has approved only three GLP-1 medications for weight loss: Wegovy, Saxenda (liraglutide), and Zepbound (tirzepatide). Tirzepatide is different because it is a combined glucose-dependent insulinotropic polypeptide (GIP) and GLP-1.
How These Medications Work
GLP-1 is a hormone produced by the pancreas that reduces blood sugar and helps to regulate insulin. When someone eats, their blood sugar level increases. The GLP-1 hormone causes the body to produce more insulin, which brings down blood sugar. For people with diabetes, this helps keep their blood sugar controlled. The GLP-1 medications simulate the hormone naturally produced in the body.
The GLP-1 medications help with weight loss by decreasing appetite. This is because the medication slows down the movement of food from the stomach through the intestines. This slowing makes you feel fuller more quickly and for longer periods. Generally, when people feel full, they eat less and will experience weight loss.
What are the Risks and Side Effects
Like any medication or supplement, there is a potential for risks and side effects. The most common side effects of the GLP-1 medications relate to the slowing of the digestive process. Common complaints caused by this slowing include bloating, constipation, nausea, vomiting, diarrhea, abdominal pain, and acid reflux.
The most serious risk with the GLP-1 medications is a specific form of thyroid cancer called medullary thyroid carcinoma. Anyone with a family history of this cancer must avoid using these drugs. A second significant risk is gastroparesis. This is when the regular emptying of the stomach slows too much and can completely stop. Gastroparesis can become quite painful, with nausea and vomiting. In serious cases, gastroparesis can cause malnutrition, dehydration, and changes in blood sugar.
Why are the Medications So Hard to Get
Since the pandemic, there have been major shortages of many prescription medications. Everything from blood pressure medications to cancer treatments are in short supply. The GLP-1 medications are in the same shortage category. Add in the popularity of using the medicines for weight loss, and the shortage is exponentially worse. The demand for Ozempic alone increased by 152% from 2022 to 2023. With the requests for weight loss medications remaining high, this shortage will likely be around for a while.
The second issue with the weight loss medications is insurance coverage. Under current laws, Medicare is prohibited from covering drugs for weight loss. Medicare Part D can cover GLP-1 prescriptions for other purposes, such as diabetes. However, even with diabetes, these medications are not typically the first prescribed. Other than Wegovy, Saxenda, and Zepbound, other well-known GLP-1 medications not FDA-approved for weight loss include Ozempic, Victoza, Trulicity, and Mounjarao. These GLP-1 medications only received approval for the treatment of diabetes. Any use of these medications for weight loss is off-label.
When the FDA approves a medication, it bases the approval on research regarding the risks and benefits of long-term use for a specific condition. When a medication is prescribed for different purposes, it is considered off-label use. When medications are used off-label, insurance is more likely to deny coverage for them. Most insurance companies, including Medicare and Medicaid, require any off-label medication use to be documented in a comprehensive FDA-approved medication list. If the off-label of a specific medication is not on the list, you will be hard-pressed to get insurance to cover the cost. And the cost of these medications is substantial.
|
Estimated GLP-1 Costs Per GoodRx* |
||
| FDA Approved for Weight Loss | ||
| Cost Range from Low to High | ||
| *Wegovy (semaglutide) | $1313 | $1619 |
| Saxenda (liraglutide) | $1311 | $1498 |
| Zepbound (tirzepatide) | $1032 | $1118 |
| Only Approved for Diabetes | ||
| Ozempic (semaglutide) | $947 | $1014 |
| Trulicity (dulaglutide) | $845 | $1218 |
| Rybelsus (semaglutide) | $947 | $1078 |
| Victoza (liraglutide) | $801 | $1113 |
| Mounjaro (tirzepatide) | $1044 | $1271 |
| Estimates listed as of 4/14/24 on GoodRx.com – MONTHLY COSTS | ||
| *Wegovy is the only GLP-1 approved for the treatment of cardiovascular risks. | ||
The latest research shows that some GLP-1s have additional benefits beyond blood sugar control and weight loss. Wegovy was the first weight loss medication to receive FDA approval for use to reduce cardiovascular risks in adults with cardiovascular disease and obesity. Additionally, studies show improved cardiovascular health with better control of blood pressure and cholesterol levels. Lower risk of heart failure, stroke, and kidney disease are also benefits. The evidence of the cardiovascular improvements is leading some cardiologists to begin prescribing the medications.
With the high demand, these medications are challenging for the average person to obtain due to cost and supply issues. The market for weight loss medications shot up 72% more than anticipated in 2023. With that kind of demand, it is unclear how long the drug shortages will continue to make these medications difficult to obtain. The greater challenge will still be the cost. However, ongoing research on these medications may give more grounds for insurance companies to cover the medications.
Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533252/
https://www.goodrx.com/classes/glp-1-agonists