We recognize that access to AOMs can vary. In this section, we discuss how to obtain these medications, considering factors like geographic location, insurance coverage, and income. We also address the cost implications, including insurance considerations, discount programs, and total expenses, to help you understand the financial aspect of AOM treatment.
Access: Prescriptions from Licensed Healthcare Providers
FDA-Approved GLP-1 Medications (Prescription / On Label)
The only way to access FDA-approved GLP-1 medications (i.e., Wegovy, Zepbound, Saxenda) is by obtaining a prescription from a licensed healthcare provider (Kubala, 2023). Patients obtain prescriptions via either online or in-person provider appointments. In-person consultations can be with primary care physicians, endocrinologists, and nurse practitioners, and these providers can work at general health practices or specific weight loss clinics. During the appointment, the licensed healthcare professional evaluates the individual, makes a decision on the need and health/safety of taking the medications, and determines a treatment plan that works best for the individual.
Individuals can also obtain prescriptions for approved GLP-1 medications through some approved telehealth service companies. With this route, individuals meet virtually with US-licensed medical providers for evaluation and treatment determination (Kubala, 2023). Examples of telehealth services that help with accessing these medications, as consolidated by Healthline, are as follows:
PlushCare | Weight loss guided by doctors and compatible with numerous insurance providers
Sesame | Telehealth platform giving virtual and in-person visits
Noom Med | Initially began as a subscription app for tracking eating and exercise habits. Offers an add-on to a psychology-based weight loss app
Ro Body | Personal coaching (1-on-1) and weight loss medications
Calibrate | Drives sustainable behavior and lifestyle changes through coaching and education
LifeMD Weight Care | Weight management via at-home metabolic testing and ongoing support from licensed health care professionals
Everlywell Weight Care+ | Weight loss membership program with at-home testing
Finally, as of 2023 Weight Watchers, the long-time weight management and fitness program company made popular with their points program, now offers access to GLP-1s via their WW clinic (weightwatchers.com).
Prevalence of Off-Label GLP-1 Use and Compounded GLP-1s
Note: this section gives an unbiased view of how people access GLP-1s. Consult a licensed healthcare practitioner for access to and use of Anti-Obesity Medications.
Recently, Americans have started to access GLP-1 medications “off-label” - meaning they are using the medication for a non-approved purpose - for weight loss (Wehrwein, 2023). This off-label use is especially true of Ozempic (semaglutide), the FDA-approved Type 2 diabetes medication (T2DM), given its research-proven effectiveness in reducing weight. Social media platforms and celebrity influencers popularized off-label Ozempic use (Han et al., 2023). A recent study by the health system Baylor Scott & White Health showed that the proportion of patients prescribed GLP-1s (approved for diabetes) without diabetes increased from 6% in 2018 to 27% in 2022. Although these patients still require a prescription from a healthcare professional, it demonstrates the growing popularity of prescribing off-label GLP-1s for weight loss even for individuals. Although the media widely reports the popularity of off-label GLP-1 use, no full study of off-label medication use has been published to date.
Finally, as mentioned in the trends section, patients are getting access to compounded GLP-1 medications. Compounded GLP-1s are custom-made by specialty pharmacies, not the same and/or tested as the branded medications, and only prescribed because of the FDA declaring a shortage for the branded medications (GoodRx, 2023). The FDA does not regulate compounded medications and compounded medications may contain ingredients from unregistered manufacturers.
Access: Filing and Receiving the Prescription
Patients fill their GLP-1 prescriptions in a variety of ways, including via pharmacies or direct-to-consumer options.
Pharmacy: traditional pharmacies, such as Walgreens and CVS, fill the prescriptions in person and through the mail
Direct to Consumer: given the high demand in the evolving market for GLP-1s, companies in the industry are sending the prescriptions directly to consumers (Collins, 2023). A few examples of this are as follows:
LillyDirect | Eli Lilly, the maker of Mounjaro and Zepbound, has created their LillyDirect website to send prescriptions directly to patients. The website shares a few benefits to patients from using LillyDirect
Gives patients an option to obtain required pharmacy services with online and home delivery
Allows patients to skip going to the pharmacy by having their healthcare provider send the prescription to LillyDirect pharmacy solutions to fill
Ro | Ro offers weight loss Rx online, which prescribes and delivers to qualified patients. According to their website, they also provide on-demand provider coaching and support
Premier Weight Loss | According to their website, Premier Weight Loss is an Indianapolis-based weight loss clinic that consults and provides personalized patient treatment plans. Their weight loss program includes options for direct access to Ozempic, Mounjaro and other brand name medications, cutting out the pharmacy and saving patients money
Supply Chain Issues: Trouble Finding GLP-1 Medications and Strategies for Addressing
The increase in demand for GLP-1 medications has resulted in unexpected and wide-spread shortages (Collins, 2023). The demand grew faster than the production forecasts of the major pharmaceutical manufacturers, and supply challenges are leading to global shortages (McCarthy & Cretella, 2023). Supply challenges are predicted to last through 2024 according to the UK, and the FDA has kept GLP-1s such as Ozempic and Wegovy on their shortage list (Mahase, 2024). In response to the ongoing challenge, telehealth company RO created a tracker to track shortages and find GLP-1 medication supply. Check out the constantly maintained tracker here!
Both new patients and existing patients are impacted by the lack of supply. While the manufacturers work to resolve their production issues to meet demand, providers have been leveraging a few strategies (Whitley et al., 2023):
Alternative Dosing Strategies: lowering the dose amount per injection or spreading out the time between injections
Interchanging GLP-1 Medications: using multiple GLP-1 medications in your treatment based on availability. There are several studies underway to test the effectiveness of this strategy
These strategies are not the recommended treatment and providers/patients may choose to restart their preferred GLP-1 medications following resolutions to the supply chain issues.
In addition to the above provider-based strategies, patients continue to seek their alternative strategies for access. In response, there are social media sites, telehealth clinics, and other clinics that claim to have either commercial GLP-1 medications or compounded medications available to purchase. As mentioned in the section on the “compounding” trend, patients need to realize that compounded GLP-1s are not approved medications and the production sources may be unknown (NCBI).
Cost
The total patient costs of using GLP-1 medications can be broken down into a few key categories, including healthcare provider consultation costs, ongoing provider programs/visits, and medications. These costs can vary significantly depending on the service provider chosen, the medication prescribed, and the patient's ability to use insurance. For this section, we focus on data on the expected cost range for GLP-1 medications 100% out-of-pocket and with insurance coverage.
Out-of-pocket List Prices
Due to the high demand and brand protection of the GLP-1 anti-obesity medications, the average per-month price per patient is typically around $1,000 and can cost even more (Reuters). Example list prices are as follows:
Wegovy ($1,349 per month): research by Peterson-KFF showed the list price of one month of Wegovy (15mg) as $1,349 per month as of August 2023 (Krutika Amin & 2023, 2023)
Zepbound ($1,059.87): Eli Lilly announced the FDA approval of Zepound (Tirzepatide) for Obesity or Overweight treatment sharing the list price of $1,059.87 (Thompson, 2023)
Discount Coupons
List prices do not indicate the typical patient cost due to insurance coverage and discounts. The manufacturers provide discounts via savings programs (“savings cards”) or patient coupons. These discounts can lower the net price by a large percentage of the list price, and here are a few examples by medication:
Wegovy: maximum $225 coupon for a 28-day supply for up to a year if the patient's insurance plan covers Wegovy OR maximum $500 per 28-day supply if their insurance plan does not cover it (https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html)
Zepbound: patients that have insurance covering Zepbound may be eligible to pay as low as $25 for a 1 or 3-prescription with a savings card; patients with insurance not covering Zepound may pay as low as $550 for a 1-month supply (https://www.zepbound.lilly.com/coverage-savings)
Insurance
Private US insurers are still determining if they will cover the cost of weight loss drugs, and the coverage and cost-sharing details are varying across plans (Ortaliza et al., 2023). Insurers typically do not cover weight loss medications as they still consider them as cosmetic rather than medical treatments (Green & Taddei-Allen, 2023). Under current law, Medicare does not cover anti-obesity medications. The story for employers is very similar - although many cover GLP-1 medications for diabetes treatments, there is still uncertainty, and a range of answers to coverage for obesity treatment (Leo & Mandowara, 2023).
As indicated in the above sections, insurance coverage helps lower the list price of GLP-1 medications substantially. The total savings depend on the type of insurance coverage: a few examples of patient costs with insurance coverage, found on a blog on the Dignity Weight Center’s website, are as follows:
Patient on Wegovy with Blue Cross Blue Shield: $35 per month
Patient on Zepbound with United Health Care: $140 for a 90-day supply
Coverage and amount of coverage will vary patient-by-patient and plan by plan.
Additional Cost Considerations
Finally, the cost range estimates reflect patients in the US purchasing FDA-approved anti-obesity medications. Outside of the US, the per-patient list cost is between 5 and 10 times less than it is in the US, according to research by Peterson-KFF (Twitter et al., 2023). Further, online telehealth providers marketing compounded and/or commercially viable GLP-1s are claiming to offer lower prices. Given the high costs, supply shortages, pharmacy vs. direct-to-consumer channels, and compounded medications available, patients need to research their options and confirm what’s best for them with their healthcare provider.
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