William Simpson
Over the past year and a half, Tandra Cooper Harris and her husband, Marcus, who have diabeteshave difficulty filling prescriptions for medications needed to control blood sugar.
Without Ozempico or a similar drug, Cooper Harris suffers fainting spells, becomes too tired to care for her grandchildren, and struggles to earn extra money by braiding her hair. Marcus Harris, who works as a cook at Waffle House, needs Trulicity to prevent swelling and bruising in his legs and feet.
The couple’s doctor tried to prescribe similar drugs, which mimic a hormone that suppresses appetite and controls blood sugar by increasing insulin production. But these are also often out of stock. Other times, insurance through the Affordable Care Act marketplace burdens the couple with a long approval process or an out-of-pocket cost they cannot afford.
“It’s like I’m having to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.
Supply shortages and insurance obstacles for this powerful class of medications, called GLP-1 agonists, have left many people suffering from diabetes and obesity without the medications they need to stay healthy.
One root of the problem is the very high prices set by drug manufacturers. About 54% of adults who took a GLP-1 medication, including those with insurance, said the cost was “difficult” to afford, according to KFF survey results released this month. But it is patients with the lowest disposable incomes who are hardest hit. These are people with few resources who struggle to see doctors and buy healthy food.
In the United States, Novo Nordisk charges about $1,000 for a monthly supply of Ozempic, and Eli Lilly charges a similar amount for Mounjaro. Prices for a month’s supply of different GLP-1 medicines range from $936 to $1,349 before insurance coverage, according to 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, according to KFF survey.
O “outrageously loud“The price has “the potential to bankrupt Medicare, Medicaid and our entire health care system,” wrote Sen. Bernie Sanders, an independent from Vermont who chairs the Senate Health, Education, Labor and Pensions Committee. USA, in a letter to Novo Nordisk in April.
High prices also mean that not everyone who needs the medicines can get them. “They are already at a disadvantage in many ways and this is just one more,” 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 plans or are on public assistance programs like Medicaid or Medicare.
Many drug manufacturers have programs that help patients start and maintain medications for little or no cost. But these programs have not been reliable for drugs like Ozempic and Trulicity due to supply shortages. And requirements by many insurers that patients receive prior authorization or try cheaper drugs first increase delays in care.
By the time many of Rahman’s patients see her, their diabetes has not been controlled for years and they are suffering from serious complications, such as foot injuries or blindness. “And this is the end of the road,” Rahman said. “I have to choose something else that’s more affordable and not as good for them.”
GLP-1 agonists – the category of drugs that includes Ozempic, Trulicity and Mounjaro – were approved for the first time to treat diabetes. Over 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 only grows as the benefits of medicines become evident.
In March, the FDA approved the Wegovy weight loss medicine, a version of Ozempic, for treat heart problems, which will likely increase demand and spending. Up to 30 million Americans, or 9% of the US population, are expected to take a GLP-1 agonist by 2030, financial services company says JP Morgan estimated.
As more patients try to get prescriptions for GLP-1 agonists, drugmakers are struggling to produce enough doses.
Eli Lilly is asking people to avoid using its medicine Mounjaro for cosmetic weight loss to ensure sufficient supplies for people with health problems. But the drugs’ popularity continues to grow despite Side effects such as nausea and constipation, driven by its effectiveness and celebrity endorsement. In March, Oprah Winfrey released a one-hour special on the ability of medications to aid weight loss.
It may seem like everyone is taking this type of medication, said 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 people as you think,” she said. “There just aren’t any.”
Even when drugs are in stock, insurers are clamping down, leaving patients and healthcare providers to navigate a tangle of ever-changing coverage rules. State Medicaid Plans vary in their coverage of weight loss medications. Medicines will not cover drugs if they are prescribed for obesity. AND commercial insurers are restricting access due to the cost of medicines.
Healthcare providers are creating care plans based on what is available and what patients can afford. For example, Cooper Harris’s insurance company 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.
One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust prescriptions for all 18 patients she saw due to issues with drug availability and cost, she said. One patient, insured by a high-deductible teachers’ retirement health plan, was unable to take a GLP-1 agonist, Addison said.
“Until she reaches that deductible, this is not a medication she can use,” Addison said. Instead, she administered insulin to her patient, which is priced at a fraction of the cost of Ozempic but does not provide the same benefits.
“Those patients who are on a fixed income are going to be our most vulnerable patients,” Addison said.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the main operational programs of the KFF — the independent source of research, polls and journalism on health policy.
