Demand for Ozempic, Wegovy, Zepbound and Mounjaro has skyrocketed this year as news of the drugs’ dramatic weight loss results surface. But many people looking to get one of these once-weekly injectable drugs find themselves struggling for access.
Patients face barriers to obtaining prescriptions and obtaining insurance coverage. The price is a concern. Without a manufacturer’s coupon or insurance, Wegovy costs $1,350 for a month’s supply, according to its manufacturer, Novo Nordisk. For weight loss, Zepbound costs more than $1,000, according to manufacturer Eli Lilly.
Pharmaceutical companies are also scrambling to produce enough of these drugs to keep up with demand, leading to shortages.
The result is the rise of an industry of so-called compounding pharmacies that sell knockoff versions of these weight loss drugs: the compound semaglutide (as a replacement for Ozempic or Wegovy) and the compound tirzepatide (as an adjunct to Mounjaro and Zepbound ).
A recent warning from the US Food and Drug Administration (FDA) focused on the potential dangers of the compound semaglutide, with the agency citing reports of unexpected health problems in people using the drug.
That’s a risk many people are willing to take in their weight loss pursuits.
When insurance won’t cover Vegov, despair can set in
Sunny, 50 (full name withheld for privacy), has always had a hard time keeping her mind calm when it comes to food. “I find it hard to overeat,” she says.
Obesity runs in her family. Her mother lost 100 pounds twice in her life, but gained it back.
Sunny slowly gained weight while carrying and raising her three children, reaching a body mass index (BMI) of 45. Her doctor put her on Contrave, a weight-loss pill that combines bupropion (an antidepressant) and naltrexone (a drug used to treat opioid and alcohol use disorders). Contrave costs about $100 a month.
“It helped me control my thoughts about food by suppressing those cravings and impulses in the brain,” Suni says. “But it stopped working.”
She was ready to try again when her doctor wrote her a prescription for the semaglutide drug Wegovy. As the FDA explains, semaglutide is a GLP-1 receptor agonist, a drug that mimics a natural hormone called GLP-1 that is released in the gastrointestinal tract in response to eating. GLP-1 causes the body to release insulin, which lowers blood sugar levels and interacts with the brain to curb appetite and signal satiety.
The FDA approved Wegovy in 2021 for obese or overweight adults who have at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol.
Just then, Sunny hit a wall. Because she doesn’t have a weight problem other than obesity, her insurance wouldn’t cover Vegov.
“I felt so defeated. I continued to gain weight. I felt like I was out of control and I needed something to get me back in control,” she says.
Sunny works at a hospital where she heard about a cheaper alternative to Wegovy, the compound semaglutide, available through a nurse who told Sunny she was reselling it from a pharmacy. Several colleagues were having success taking the medication, so Sunny decided to go for it, buying a month’s supply for less than $300.
“I understand that there is a risk. I know it could be anything,” Suni says. “I feel hopeless. I feel like the weight gain is bigger than me and I’ve realized that I need medication to help me.”
Since she started taking the compound in March, Sunny has lost 12 pounds and has seen a dramatic decrease in her appetite, which had once controlled her.
“When I use weight loss drugs, I can feel the difference between my brain telling me I’m hungry and my actual stomach telling me I’m hungry. I know I eat out of anxiety and boredom, and there are many psychological reasons why I eat, but I can tell the semaglutide patients apart,” she says.
CONNECTED. Risks to avoid when buying weight loss drugs online
Is combined semaglutide and tirzepatide legal?
There are approximately 7,500 licensed compounding pharmacies in the United States, according to the American Pharmacists Association (APhA). These pharmacies mix, modify, or combine FDA-approved drugs with different ingredients for people with special needs, such as individuals who may be allergic to a particular dye in a brand-name drug.
If there is a shortage of the drug, compounded versions become legal in the United States. In May 2023, the FDA placed both Ozempic and Wegovy on its shortage list, legalizing complex versions of the drugs.
The FDA recognizes that compounded medicines can fill an important need. But compounded drugs aren’t regulated by the FDA, which means there’s no guarantee that drugs purchased from pharmacies, even those sold by legitimate businesses, are what they claim to be.
Novo Nordisk says it does not sell its patented semaglutide for compounds, raising questions about exactly what goes into the complex versions. No generic form of semaglutide exists, although compounded drugs are often marketed as such.
Novo Nordisk announced in June that it was taking legal action against medical spas, weight loss or wellness clinics and pharmacies that sell questionable compound or so-called generic versions of semaglutide, citing “potential safety concerns.”
According to the FDA, the compounded versions of Ozempic and Wegovy may replace pure semaglutide with salt-based forms that have not been shown to be safe and effective in clinical trials. The FDA says it has received reports of “adverse effects” from people taking compound semaglutide.
Pharmacies that sell compounded semaglutide sometimes also include vitamins such as B12 to allegedly promote weight loss, a claim for which there is no solid evidence, the Mayo Clinic says.
Experts say the combination semaglutide and tirzepatide is too risky
Giuliana Simonetti, co-director of the Comprehensive Weight Management Program at the University of Utah in Salt Lake City, says it’s “absolutely insane” that insurance companies often deny coverage for injectable weight-loss drugs to obese people. even for patients who have used these drugs to control prediabetes. He understands what drives people to look for alternatives.
But, he says, there’s no way to know exactly under what conditions compounded drugs are made, and that anyone who buys compounded drugs from a questionable source could be at risk of using drugs that pose safety risks and aren’t even sterile.
“I tell my patients very clearly not to get complicated options. I feel their pain and despair, but I tell them not to do it because it is a dangerous practice,” he says.
Dr. Andrew Craftson, director of the Weight Navigation Program at Michigan Medicine in Ann Arbor, believes strongly in the value of drugs like semaglutide and understands why people struggle to afford them. She points out that obesity is highly stigmatized and undertreated.
“There’s this sense of urgency that pushes people to make rash decisions,” he says. “They feel like, ‘This is there now, I should have been on it yesterday.’
But without FDA oversight, Dr. Craftson says compounded options are too risky. “The problem is that there is this inherent conflict of interest,” he adds of providers who may be willing to compromise security for profit.
In addition, he says, people who buy cheap weight-loss drugs usually don’t get nutritional counseling to ensure they’re staying healthy when they drastically cut calories.
“Food as medicine is an important ingredient here,” says Craftson. “Anyone can lose 800 calories a day on Twinkies, but that doesn’t mean they have to.”
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