If it hasn’t become obvious to you, it will soon—medicine is a mess. Let’s start with getting your medications. Many of us are aware that since the COVID lockdowns started, there have been supply chain issues affecting our food, our home supplies, our clothing…you name it. Medicine is no exception.
Whether it’s getting the ingredients to make the medications, getting the employees to work at the manufacturing sites, getting the medications distributed to pharmacies, or getting the employees needed to write and dispense the medications—it’s very clear that things are not working right. As a result, especially when it comes to popular injectable weight loss medications, the supply of appropriate dosages of specific medications remains a moving target.
So what are you supposed to do? You’ve finally found a solution that has led to excellent weight loss, and right smack in the middle of your rising success, the rug is pulled out from under you. How?
A coupon expires. Your pharmacy doesn’t have your medication in stock or doesn’t have the dose you need. Your insurance company suddenly decides not to cover your medication that was previously approved…
These are frustrating times for both patients and their physicians, I assure you, but do not give up the fight! Here are some ways to navigate through the shark-infested waters.
What To Do If Your Pharmacy Does Not Have Your Dose
1. Pharmacy Shop
Just because your regular pharmacy doesn’t have what you need, it does not mean that another one nearby will have the same issue. Call around and when you find a pharmacy carrying your dose, have your physician call it into that pharmacy. Although this isn’t always a long-term solution, it will at least keep you moving forward in the right direction. We have found that smaller, more local pharmacies seem to have better supplies than the larger conglomerates, which really surprised us.
2. Take the Available Lower or Higher Dose
Although this is not ideal, it is an option. When it comes to injectable weight loss medications, results are dose-dependent. This means that if you choose the lower dose, your weight loss might slow down or stop altogether. You should, however, maintain your weight loss.
If you have been on your current dose for 4 weeks, and the next higher dose is available, it is preferable to step up to the higher dose instead of going back down. I never advise skipping ahead past the next dose you are on, however, because the side effects are much worse.
3. Consider the Compounded Version of the Medication (Applies to Semaglutide Only)
When it became clear that there was an issue with the national supply of semaglutide (commonly known as Ozempic & Wegovy), the FDA approved the production of semaglutide by compounding pharmacies. A compounding pharmacy creates custom medications from base ingredients for patients. Rather than providing a pre-mixed formula, the compounding pharmacist begins with base drugs, combining and preparing them to fit the individual patient’s needs.
Although it is still a little pricey, compounded semaglutide is about a ¼ to ½ the cost of the uncovered pharmaceutical price depending on your dose, and what the prescribing physician’s office charges. You can discuss this option with your physician, or call a compounding pharmacy and see which local physicians are writing the medication. With compounding pharmacies, remember that each state has different rules as to how they write and/or dispense these medications.
What To Do If Your Coupon Runs Out Or You Lose Coverage
1. Check Out a Pharmaceutical Website
For Ozempic and Wegovy, go to Ozempic.com or Wegovy.com. On these sites, they will calculate the cost of the medication and coverage for you after having you answer just a few questions. Make sure you scroll all the way to the bottom, however, because it may say “covered” but the cost to you at the bottom of the paragraph can be anywhere from $25 to $1200 plus.
2. Contact Your Insurance Company
If you’ve had excellent weight loss on Mounjaro for example (whose coupon is iffy right now), you can connect with an advocate from your health insurance company and see what your options are. Sometimes they will cover a different medication, or require a letter from your physician’s office detailing your success. At our office, we have had physician-to-physician conversations with the medical director of a plan and successfully advocated for our patients to continue or obtain coverage for a medication that has worked for them. When it comes to success on a medication, no doesn’t always mean NO.
3. Consider the Compounded Version of the Medication (Applies to Semaglutide Only)
As detailed above, compounded semaglutide is about a ¼ to ½ the cost of the uncovered pharmaceutical price depending on your dose, and what the prescribing physician’s office charges. You can discuss this option with your physician, or call a compounding pharmacy and see which local physicians are writing the medication.
4. Look On GoodRX and See Which Pharmacies Offer the Lowest Cost Alternative
If you are not familiar with the GoodRx app, this would be a good time to download it to your phone. GoodRx searches local pharmacies and finds you the best out-of-pocket price for your medication. With the injectables, this might still be extremely high, but it gives you the option to compare prices.
5. Consider a Different Medication That Is Less Expensive
Although injectable weight loss medications give excellent results, they are not the be-all and end-all. As an obesity medicine physician who has been in the field for over 16 years, I know that injectables offer more options, but not necessarily better results. There are alternatives to injectables that are similarly safe and effective:
- Phentermine: Phentermine has been around since the 1950s and is a great medication to help with hunger and metabolism. It works by decreasing hunger at the level of the hypothalamus and increasing metabolism through a slight increase in heart rate. We check metabolic rates in our office and phentermine is always my first choice for those with low metabolism because it is the only medication that addresses both issues. This is a great choice for menopausal women for this reason.
- Diethylpropion: Diethyl is similar to phentermine in function but is short-acting. Phentermine will last about 12 hours, whereas Diethyl works for only a 4-6 hour window. It is great for those who snack in the late afternoon or evening hours because it won’t keep you up.
- Contrave: Contrave is Wellbutrin plus Naltrexone, which attacks hunger and the hedonic (or addiction) pathway simultaneously. Unfortunately, it is not covered by many insurance plans and has a heavy pill burden (two tabs twice daily, taking four weeks to step up to the complete dose). I will use Contrave for patients who have depression because Wellbutrin helps this piece, with the added benefit of the addiction component. It pales in comparison to the weight loss seen with the above two medication categories.
- Topamax (Topiramate): Topiramate is a medication that has been studied for Binge Eating Disorder (BED) and is found to be very helpful. It is also very inexpensive which is a huge plus. We are not sure how it works other than through the dopamine or “addiction pathway”. It is dosed once or twice daily but must be titrated slowly because it can cause word-finding problems and brain fog at higher doses.
- Vyvanse (Lisdexamfetamine): Many have heard of Vyvanse as a medication used for Attention Deficit Disorder (ADD), but it is also an excellent drug to effectively treat BED and has recently been indicated for this use. It is well tolerated and used once daily in the a.m. It can be expensive, however, if not covered by insurance.
All in all, these issues with injectables are not going to end any time soon. The best thing you can do to stay healthy is to lose weight and maintain it. There are four pillars to Obesity Medicine, only one of which is medicine. Start focusing on non-pharmaceutical alternatives such as herbs, supplements, and the healing properties of certain foods. There are also medications out there that are less expensive and readily available. Remember that injectables are not the only answer and we’ve been without them for a long time!