For the past year and a half, Tandra Cooper Harris and her husband, Marcus, who both diabeteshave had difficulty filling their prescriptions for the medications they need to control their blood sugar.
Without Ozempic or a similar drug, Cooper Harris suffers blackouts, becomes too tired to care for her grandchildren, and struggles to earn extra money braiding her hair. Marcus Harris, who works as a cook at Waffle House, needs Trulicity to keep his legs and feet from swelling and bruising.
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 too are often out of stock. Other times, their insurance through the Affordable Care Act marketplace imposes a lengthy approval process on the couple or fees they can’t afford.
“It’s like I have to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Ga., east of Atlanta.
Supply shortages and insurance hurdles for this powerful class of drugs, called GLP-1 agonists, have left many people with diabetes and obesity without the medications they need to stay healthy. health.
One of the causes of the problem is the very high prices set by drug manufacturers. About 54% of adults who took a GLP-1 drug, including those with insurance, said the cost was “difficult” to afford, according to KFF poll results released this month. But it is patients with the lowest disposable income who are hit hardest. These are people with few resources who have difficulty seeing doctors and purchasing healthy foods.
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 monthly supply of different GLP-1 drugs 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 a KFF study.
The “outrageously high” price has “the potential to bankrupt Medicare, Medicaid and our entire health care system,” wrote Sen. Bernie Sanders, independent of Vermont, who chairs the U.S. Senate Health Committee, education, work and pensions. in a letter to Novo Nordisk in April.
High prices also mean that not everyone who needs these drugs can get them. “They’re already at a disadvantage in many ways and this is just one more aspect,” said Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper Harris, are underserved, on high-deductible health plans or on public assistance programs like Medicaid or Medicare.
Many drug manufacturers offer programs that help patients start and continue their treatment at little or no cost. But these programs are unreliable for drugs like Ozempic and Trulicity due to supply shortages. And many insurers’ requirements that patients receive prior authorization or try less expensive drugs first add to delays in care.
By the time many of Rahman’s patients see her, their diabetes has gone untreated for years and they are suffering from serious complications like foot injuries or blindness. “And that’s the end of the road,” Rahman said. “I have to choose something else, more affordable and less good for them.”
GLP-1 agonists – the class of drugs that includes Ozempic, Trulicity and Mounjaro – were first approved 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 is only increasing as the benefits of these drugs become clear.
In March, the FDA approved the weight loss drug Wegovy, a version of Ozempic, for treat heart problems, which will likely 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, financial services firm JP Morgan has estimated.
As more patients try to get prescriptions for GLP-1 agonists, drugmakers are struggling to produce enough doses.
Eli Lilly urges people to avoid taking its medicine Mounjaro for cosmetic weight loss to ensure sufficient supplies for people with health problems. But the popularity of these drugs continues to grow despite Side effects such as nausea and constipation, driven by their effectiveness and celebrity support. In March, Oprah Winfrey released a one-hour special on the ability of medications to help with weight loss.
It may seem like everyone is taking this class of drugs, said Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But there are not as many people as you think,” she said. “There just aren’t any.”
Even when drugs are in stock, insurers take tough action, leaving patients and health care providers navigating a maze of ever-changing coverage rules. State Medicaid plans vary in their coverage of weight loss medications. Medicare will not cover medications if they are prescribed for obesity. And commercial insurers are tightening access because of the cost of drugs.
Health care providers develop care plans based on what is available and what patients can afford. For example, Cooper Harris’ insurer covers Trulicity but not Ozempic, which she says she prefers because it has fewer side effects. When her pharmacy no longer had 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 18 patients she saw because of issues with drug availability and cost, she said. One patient, insured by a teachers’ retirement plan with a high deductible, couldn’t afford to take a GLP-1 agonist, Addison said.
“Until she gets to that deductible, it’s just not a medication she can use,” Addison said. Instead, she put her patient on insulin, which is price capped at a fraction of the cost of Ozempic but doesn’t provide the same benefits.
“Patients who are on a fixed income will 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 major operating programs of KFF — the independent source for health policy research, polling and journalism.
Grub5
