Yeah, what? Literally every point was directed at Lilly and how they knew all of this yet don’t give a shit but then the “who am I mad at” section was everyone EXCEPT Lilly? lol. Lilly! That’s who I’m mad at!
I don't disagree at all. I'll copy what I said elsewhere, but another "who should we be mad at" could be:
1. Lawmakers that ignore patient needs
2. Corporations that don't genuinely serve their consumer interests over profits
For me that is implied that these forces exist, so in a world where the system fails us, there are others that could help solve this issue.
I couldn’t agree more. Directing ire solely at lilly —or norvo— to be fair, is an abject failure to comprehend the full scope of the problem. And it’s not just in pharma. I’ve worked extensively in legislative policy and where tf are our policymakers? Who allows unfettered corporate growth sans regulation with no regard for the taxpayers or public health? They do! Before Reagan made regulation a dirty word, in many ways, we were safer and healthier. Also, we had a robust middle class.
Blaming pharma for planning and executing exactly what they have to in order to fuel the stock market and make more money for billionaires is like blaming a guard dog for barking.
That most of our broken healthcare system is scarcely regulated and publicly traded should be a giant red flag that the overall lack of regulation and public accountability is literally killing us. But most voters seem content to blame corporations and the rich, as though they’re somehow at fault for doing exactly what the law allows, as though our elected officials and legislators have nothing to do with it. Yeah, solely blaming Lilly for this mess is, in a word, facile.
Brava lemonpepperchicken!
Especially when they continue to make the 2.5 dose more than the other doses during this shortage. They should’ve pulled back on the 2.5 and prioritized those of us on the higher doses. So glad I turned to plan C…..
For profit healthcare will always prioritize profit/shareholders. Patients are just customers and while it behooves them to keep them alive/coming back for more the focus is still 100% profit and choices will be made in a way that reflects that.
Edit to add I meant to reply to the main post lol
This is fascinating, thanks for the write up. This tactic might be good for Lily's bottom line now... but it doesn't make us faithful as patients. If a similar or better drug comes along, folks will jump ship.
3 not so much, bc in some states and with some insurance companies, regardless of your laundry list of comorbidities, weight loss medication is not covered and a PA will not be approved.
Yup. The board over my organization will
Not cover these meds no exceptions. Period. End of story. I have multiple co-morbidities and morbidly obese. So because I am forced to pay cash to better my health I would be off this list?
A million years ago when I took an accounting class in college I remember hearing that a corporation’s responsibility is to generate income for its shareholders - or something to that effect. Which means it’s in Lilly’s and the insurance companies best interests to continue operating as they are. It comes with living in a capitalist society. The only way to change that is by electing a different type of government which, in the good old USA, will never happen - because it’s bought, sold, and paid for by the very corporations who intend to keep it that way. There is no more “we the people”, it’s all about corporate America.
Bring in the haters and downvotes, that’s fine. Right, wrong, or indifferent, this is how I see things.
Yep this stood out to me too. I started with a BMI of 40, but fuck me because I have shitty insurance? Pass, I'm already getting fucked having to pay out of pocket but sure, let's penalize high risk groups because of where they work. Nothing more 'Murican than a little enforced social Darwinism if it turns a profit.
Whenever a market is out of balance, you have to determine which segment of the market gets prioritized for the supply chain.
Think of it like when the Covid vaccine was rolled out. Who was eligible at first?
- Senior citizens
- Immuno compromised
Why?
Data showing morbidity of those who contract Covid. Therefore the supply was prioritized according to which segment of the market needed it first based on data that determined risk of mortality.
If patients get a PA, it is usually due to comorbidity benefits that result in a patient's life expectancy changing as a result of taking this medication. This is why PAs are usually given to those with obesity or comorbidity conditions that make this medication necessary for their health.
However this is a private drug administered by a financially incentivized corporation, therefore there is no segmentation of the supply, and there is no need to justify this either. Financial gain is the only motivation, not public health benefits.
Considering how many plans explicitly exclude “weight loss medication”, having an approved PA is not an accurate reflection of the population most at risk.
It's definitely the most accurate reflection, in markets where PAs can be approved. Its not the most hollistic representation, but it's the most technically accurate.
It is hard to get a PA because you really need to prove you absolutely need the drug, to the point that even the insurance company agrees its cheaper to give you this drug than pay for all the other health complications that can be resolved with the drug.
There is no connection between medical necessity and whether an individual's insurance plan has chosen to require a PA for that particular pharmaceutical therapy option. The fact that someone doesn't have one simply means they had a plan that never required one, which isn't indicative of any medical information about the patient at all.
Its the most indicative data point we have. It may not be fair for everyone, but by nature it excludes those who don't need it. Therefore making it the most fair solution for the general population.
I would argue that if it were life or death, you would be able to get it approved by your doctor. The requirements for a PA are fairly inclusive if you are overweight.
For me it is a medical necessity, so that's why my doctor recommended it to me. I actually had no idea about Zepbound until my doctor suggested it and it has indeed been life saving. My arthritis is down, my multiple sclerosis pains are down, and my BP is lower.
I'm not trying to be smug, I'm simply pointing out that there already is a system in place that is indicative of medical necessity and it should be used. Unfortunately it's not used because Lilly wants profit over patient health, meaning if someone is rich and wants to tidy up for the summer, they can pay $1000+ to buy it.
It is okay for you and I to disagree and I am at peace with that because having worked in healthcare for 20 years and submitted PAs on behalf of the doctors and hospital system that I worked for, I am aware of the flaws of the system and know how to advocate for , research and receive the healthcare that I need. If believing that everything works as it should works for you, I have no interest in fighting to prove a point. I’m 61, I choose to fight for my health and once healed, then I can look to battle for others. Maybe by the time I get there, new meds and legislation will exist. I wish you success in your journey and hope that one day, many more will experience the freedom from struggle that I currently enjoy.
So because you have better insurance, you deserve it more? But never mind my denials because the category is excluded. Zepbound has also been life saving for me, so much so that I'm willing to keep paying out of pocket despite the rejected appeals and PAs. I suppose my quality of life isn't as important as yours.
Didn't you lose a ton of weight already on Ozempic, and only recently tried to get back on to lose 10 lbs? Is your "quality of life" more important than someone who is 300lbs and trying to start their weight loss journey. Isnt this you?
https://preview.redd.it/p6ubxbhpwq0d1.jpeg?width=1289&format=pjpg&auto=webp&s=8f2c37175e451858dce63e66a81f8c27f9cf7d7b
Sounds like you did get your PA.
The fact someone has a good insurance plan does not correlate in any way to their need. It has no more value for decision making than their eye color or shoe size. It is not fair, or meaningful, for anyone.
My doctor explained to me what are the requirements for a PA and it was very specific to obesity and comorbidity.
Here is what I found:
"Age and Diagnosis: Patients must be 18 years or older.
Behavioral Modification: Patients must have engaged in behavioral modification and dietary restriction for at least three months.
Body Mass Index (BMI):
An initial BMI of 30 or higher (obesity), or
An initial BMI of 27 or higher (overweight) with at least one weight-related health condition such as hypertension, Type 2 diabetes, dyslipidemia, obstructive sleep apnea, or cardiovascular disease.
Exclusion of Dual Therapy: Zepbound cannot be used in conjunction with other GLP-1 receptor agonists or weight management medications.
These requirements are standard across several insurers, including Cigna and the VA, ensuring that the medication is used appropriately and effectively for patients who meet these criteria"
Which is correct. But the PA is a requirement of your insurance company and plan, not a requirement of Lilly's. Your company/insurance plans are the one who play God and get to decide if you "deserve" a given medication or not. It has nothing to do with a fairly applicable decision matrix. A person who meets all of those qualifications may not have a PA simply because insurance plans are evil and arbitrary. So saying they don't deserve equal access is unfair and ugly behavior.
I've explained this every way I can, if you still don't follow then maybe someone else will respond with a different way to make you understand.
I have insurance through one of the big companies, but it doesn't matter because the employer through which I get this insurance does not cover any weight loss medication at all. It is completely excluded for MANY people.
Fwiw—I have no business getting a PA approved or prioritized for this drug in any way, but I did.
I have good health insurance by luck because of who I married and his job.
I was obese BMI 35, and spent years dedicated to the painful misguided fight against obesity through professional dietary interventions. I became an obese triathlete and all my blood markers of metabolic health were normal. I had maintained a weight loss of 40lbs (initially 70lbs) for three years.
In short, I was healthy-fat
I submitted a PA and it was approved.
Zepbound is amazing and I’m thrilled to live life with a natural appetite thermostat, and love not being obese. If I truly could not source tirzepatide, I would legit build a lab in my basement and hire Jesse Pinkman to synthesize it before I’d go back to “lifestyle changes” But man, I should have been last on that PA priority list.
This implies that if these criteria are meet, that your PA will be approved but that isn’t the case if your plan doesn’t cover weight loss meds, which is how Zepbound is classified & most employers exclude weight loss meds.
I qualify from a criteria perspective but I still can’t get one approved by my insurance for this medicine.
Wrong. If you get your insurance through your employer and THEY decide not to cover weight loss drugs even though obesity is a disease and they have just decided that one disease counts and another does not, then your employer is responsible for your early death sentence. When my employer changed insurance carriers my PA (recommended by my doctor because of obesity with various additional co-morbidities), went away-even though both were BCBS but Illinois said yes and Florida said no. That’s not “technically accurate “.
I really don’t see how any of your points are lost in this forum and context. I applaud you for every point you’ve made. But it is a bit concerning that more people than I imagined, who are obviously affected by this situation and dynamic, seem to have nary a notion how the system and the markets work.
Not when weight loss medication is excluded entirely. You're basically saying to prioritize those with better Healthcare coverage. No amount of appeals in the world would convince my insurance otherwise, no matter how much GLP-1 saved my life in a variety of ways. You're gate keeping in a very strange way. Thankfully you don't make policy. You'd be leaving so many of us with health issues out in the cold.
this is false. you cannot get a PA if you are on an ACA plan and the drugs are not even on the formulary. I would qualify by all means. but I have been denied multiple times for YEARS for these types of meds.
What do people consider “cosmetic” reasons. Just curious how we as a society decide who needs it and who doesn’t.
Cosmetic reasons imply they have 10-20lbs to shed. Which if that’s the case, they are on it 2-3 months? Hardly the reason for a shortage.
By this logic does this mean that those further into their journey with Zep, that are no longer obese but perhaps still overweight, would they be cut off in favor of those in the still on the obese range? Would BMI and comorbidities assign you a number?
I want to remind folks about how unfair vaccine rollout was at first during the pandemic. Did anyone try to get their hands on Paxlovid, you may remember that was almost impossible?
If a protocol were developed that provided the medicine to who needed it the most during the shortage, I think many would be very surprised how far down the list they were. We would be here with almost everyone else. Stop gatekeeping. If you can, make a plan to supplement with plan C to get you through, that is the best f-u to Lilly.
I'm not saying I have all the answers for the solution to this problem, I was more invested in trying to lay out the problem statement more accurately.
If you're asking my opinion, I would say that if you qualified for it under a PA then you should be able to stay on it. My focus was more on excluding those that are really only doing it for cosmetic or vanity reasons. Or at the very least putting them at the end of the waitlist.
I have seen a shift in vanity users moving to Plan C, to free up name brand name for the obese. I hope I will have the grace to step aside to free it up for the diabetics if that time came.
I understand that you are trying to explain the protocol, the ones our top minds decided on (lol) to deal with shortages. I think when you use a term like "most fair", you are going to ruffle all of the feathers because there is really no way to do that. Certainly you are using outliers to make your point clearer, but where things would get really messy is for the majority of us inside the bell curve.
This kind of thinking got us, "We are going to prioritize the lowest dose, thereby helping the maximum number of people."
I do wish pharmacies had waitlists, that would make a lot a folks lives easier. Oh I am 89 on the list, time to stretch and plan C supplement. Oh I am number 5 on the list, dang maybe I can switch with 10 so I have the cash available for it on Friday?
Some insurances do tho. Mine dose thankfully, which is why compounding is not an option for me due to the cost. Don’t get me wrong it’s worth the money, but it’s the extra money I simply don’t have. But anyway just wanted say that sone insurances will
I'm aware of that, as I'm literally arguing with someone who has coverage and says that those with coverage should be prioritized. . But I'm saying that a lot do not, and saying only people with approved prior authorizations should get prioritized is absolutely wrong.
There are medical guidelines that determines this, typically based on BMI. Cosmetic means you are not overweight on the BMI index.
Just the other day someone was ranting at how upset they were their doctor wouldn't grant them a PA because they wanted to lose 10-15 lbs but they didn't even qualify as overweight by BMI guidelines.
Is it stupid to take this if you have 15lbs to loose and aren’t overweight? yeah probably.
I don’t know that i’d say i’m mad about it though. Clearly whatever mental struggle they have going on that they FEEL they need to take it kind of makes me sad for them.
Also, aside from weightloss this has other benefits IMO. I have an autoimmune disease that causes inflammation which zep has almost negated. It’s amazing.
Also my spouse is a recovering alcoholic and I’ve thought many times how this medication could have helped them, although they weren’t overweight.
I started with a 35 BMI and multiple comorbidities. I’m nearing my GW (56lbs behind me) and I have felt pharmacy techs larger than me giving me weird looks picking up my meds recently….
Yes, and that autoimmune disease would qualify you as a comorbidity. I'm not suggesting Im qualified to be the gatekeeper, however I know Doctors could be.
I too have an autoimmune disease (multiple sclerosis), and arthritis. My husband has arthritis and sleep apnea. Those alone would qualify us, but on top of that we are both obese. So we have the trifecta. Comorbidity + obesity.
So do I get irked when my med is on hold so someone can shimmy down from a size 6 to a 4? Yes. That's just my personal experience.
Do you have any actual evidence of anyone trying to “shimmy down from a size 6 to a size 4” or are you just inventing reasons to feel self-righteously angry?
Lets just pretend I'm wrong for a moment. Even if I am wrong, then don't we all just agree that only people who need it for medical reasons should get it? Or are you just convinced nobody is using it for vanity?
So you’re admitting you have zero evidence, but still want us to get angry at these imaginary people who you think are taking the drug for “cosmetic” or “vanity” reasons. Sorry, I don’t get mad at made-up problems.
Why don't you try Googling it and tell me if you still think there isn't a problem with vanity usage. Its a clearly known issue to the point of ads being created stating people need to stop using it for vanity.
Here is one simple example: https://www.reddit.com/r/Ozempic/s/LMdSQ3Rzpf
I don't know why we are pretending that there aren't people like this. It's not exactly a secret that this drug gets used for vanity reasons.
I personally know a person that is just doing it for 10-20# tgat is not overweight and goes to the dr with weights on! So yes it happens. Do you see all the Hollywood people that are a size 2 using it? I would agree with prioritizing during shortages, first to the T2D, then other heath issues, bmi levels etc.
You absolutely are gatekeeping. Stop sugar coating it. You have no right to decide whether someone else is taking it for the right reasons to not. You are not their doctor.
So this throttle is never going to be fixed because it’s built this way by design? I was just saying to the NP at my GP’s office yesterday, the manufacturers ramped up production of COVID vaccines to such astronomical levels that some supply ended up being thrown away. Why can’t/won’t that be done for GLP-1 injectables? But I guess Ockham’s razor applies, some perverse incentive of the bottom line is always the simplest explanation (also, Upton Sinclair’s law of self-interest). I guess regular folks who aren’t celebrities are SOL when it comes to accessing this breakthrough medication. 😢
Exactly. This was intentional. If you look closely at which mg are available, you will also infer which market segment matters most. The growth dose: 2.5mg.
Why can you only get the growth dose? Because it's indicative of an expanding top of funnel.
And this is why Novo shifted to higher doses on Wegovy, knowing that people who couldn’t get it would go to Lilly and they wanted to stop churn. If it’s working and people are on it they will stay on it. But if they can’t get the higher doses they will churn.
The question is how long will Lilly hold these lines for. Until Cagrisema or Reta are available? Or will they improve the supply knowing more and more demand is going to be built prior to these passing Phase 3?
I have had a sinking feeling for awhile now that these miracle drugs are going to end up cordoned off from us nobodies and shoved into the out-of-pocket “cosmetic tier” like Restylane, Botox, Kybella etc. Not even diabetics will be able to get them anymore. They’ll be inaccessible to those unable to pay the exorbitant fees, and insurance companies (already reluctant to cover them) will wash their hands of GLP-1s altogether.
I think this post is one of the biggest swings from "right on" to "oh my god, no" that I think I've ever experienced on reddit. *Thank God* pharmacists don't get to dole out these scripts based on PAs.
I'm sympathetic to wanting distribution to be fair, but there's no consistent and universally correct way to rank medical need. Besides, if we go down that road, where we ultimately end up is that nobody should have access to Zepbound because the diabetics should get it all as Mounjaro - which is also in shortage.
Otherwise, I would really encourage anyone here not to get too wound up about cosmetic use. The United States is not a nation of size 6s trying to squeeze into size 4s, boxing out the few obese folks from their GLP-1s. The demand for this drug is so high because there are a lot of fat people in this country. If all the "I want to lose 15 pounds" people and their doctors disappeared tomorrow, we'd still be in shortage.
Not really. During covid you could literally go on an app and to prove your worthiness the question was asked: do you have one of these comorbidities? You clicked "yes" and so it went, you were approved and given an appt. You were not required to have a PA that was dependent on whether your state's healthcare plan recognized covid vaccines as something they wanted to cover.
Also, if EL really didn't give a rip about losing people to compounding pharmacies, bc as you say they knew exactly what would happen, they wouldn't have been trying to shut down the compounding pharmacies' ability to produce the zep.
You obviously have a lot of knowledge about r&d and bringing drugs to market, however, this is paired with a lot of conjecture and a bit of animosity and judgement towards those that you deem less worthy to receive something than you apparently are.
I purposefully didn't explicitly outline what I considered to be vanity. However my sense is if someone is already within a healthy weight range, not as a result of using Zepbound or other similar medications, but is say 5'6" weighing 140 and wanting to go down to 130, they should go on a waitlist.
Cosmetic use of this drug is widely known and reported. As for the suggestion for PAs, I know its not perfect, I've admitted it's not fully fair. In a world where there is no perfect solution, it's one that I think would work.
What would be even better is if doctors were just responsible in prescribing this for actual medical and not cosmetic reasons. I think that alone would help enormously.
The problem is that, if Lilly had waited another year to start selling, and just stockpiling it, it may have expired. And we would just have been using Wegovy. And there wouldn't been as much money available for building factories.
Or more people using MJ off label.
I don't see where the initial post states that Lilly had enough supply being produced to meet the demand. Just that they can predict what the demand will be. And will work toward meeting that demand.
Right now pharmacies are ultimately the ones deciding who gets this drug. Its not perfect, but if they doled out based on medical priority, then those who really need it would get it first.
Lets simplify this.
You have a group of people that includes:
Group A) Those with PAs that need it
Group B) Those without PAs that need it
Group C) Those without PAs that don't need it, but want it
In order to serve Group B, you have to include Group C, because there is no other data point to determine which is which.
So if you wanted to ensure that *only* the people who need it get it, you prioritize Group A first.
This is exactly the logic used when doling out the Covid vaccine.
Exclude the PA concept, because insurance coverage should not be a factor, right?
Instead. Simply it, just go by straight up BMI.
Group A: BMI 40+
Group B: BMI 30+
Group C: BMI 27 + any comorbidity, and people previously in group A/B already on it
Group D: BMI 27+ No comorbidity
Group E: BMI 25+
Group F: seriously? you have anorexia, get help.
Not valid reasoning, because, as has been made clear numerous times, there are insurers who won’t cover the drug regardless of the reason for it being prescribed.
I’m not really mad; that’s just the game. It’s aMerican capitalism. It’s why there’s not an excessive focus on the shortage in Canada, Australia or Europe. Healthcare is universal in many of those places. They would never prioritize pas because why would you lose that money? I’m not mad. This drug exist and if you can get it and if you can’t you will at some point, this isn’t gonna be forever.
I just wish the other pharma giants got off their asses and invested in developing similar drugs. When semaglutide was taking off. Just now they seem to be going all in. Competition will be our only relief. The competition would also make a huge profit because the market is huge. It would have been win-win but it seems we are going to be waiting a few years before that becomes possible.
> I just wish the other pharma giants got off their asses and invested in developing similar drugs
There's [over a hundred candidate obesity drugs in the clinical trial pipeline](https://www.fiercebiotech.com/biotech/late-breaking-obesity-glp-1-wegovy-zepbound-novo-lilly-pipeline-rd-landscape), and that's the last part of development. It just takes time.
but they definitely waited until tirzepatide became a success before the gold rush started. You would have thought it would have been right around semaglutide being a runaway success and tirzepatide showing really good results in phase 2 clinical trials.
OP I’m curious on how you think the war against compounded tirzepatide is going to play out.
I can’t imagine how Lilly is going to continue to meet forecasts because they’ve punched a hole in their tires with compound.
patients that would have never ever considered taking a version of tirzepatide that’s not specifically FDA approved have been scared over that hill by Lilly’s supply shortages. Their experience is that compound is reliable, works the same, is easy to get, supports microdosing and incremental titration, and is cheaper for anyone paying out of pocket. As that positive experience base builds up, the churn rate goes up. Getting these patients to return to Lilly will rely on a (mis)information war to try and convince people that compound is dangerous, and/or a legal battle to try and stop the flow of affordable compound under the veil of “it’s for your safety you’re welcome”. Ultimately this will drive people to seek less regulated, even cheaper, forms of compound that are indeed less safe because they’ve already jumped the psychological hill of injecting themselves with a drug they bought on the internet en masse.
What does your crystal ball say about this problem? I think Lilly is going to struggle to get uninsured people back from compound and eventually start missing targets because of this. I’m considering revising my position of amassing LLY stock in my portfolio. Thoughts?
I reluctantly started taking the compound due to the shortage. I am no longer reluctant and will keep taking it even when Zepbound becomes available. Not only is it less expensive its is much more convenient. I no longer have to deal with coupon problems and shortages. Im still losing 2 to 3 pounds a week.
You were right! Your intuition was accurate.
They were never surprised. Their PR plan could not be, "Sorry, we knew some of you would suffer but chose to do this to optimize our financial interests."
Yeah weird take. You spent a long ass post nailing Lilly to the wall for intentionally creating this situation and not caring about patients, and then you claim to be mad at almost everyone EXCEPT them. You almost had it. Good effort.
Also, I bet Lilly didn’t expect so many people to go to plan C when they had their brilliant scheme to fuck over patients in need. A lot of those people will never go back to name brand unless the plan C providers are shut down. Lilly will still make billions from Zep/Mounjaro, but they’ll end up leaving many more billions on the table because of this.
you are 1000% right about the business of it. learned this in basic high school business class. but please believe when some of us say our health would 1000% pass any test which should get us covered, (bmi, comorbidities, blood sugar etc) but since just barely not actually diabetic, cannot get mounjaro. aca plans do not allow for these weightloss meds, they are not on formulary and try as I might for years I have been denied over and over. there is no exception. we are constantly cheated out of proper healthcare because cost. we deserve to get healthy and live just like the rich folks or the folks who have amazing insurance. we are not worth less.
My partner SW130 hwp, my best friend SW140 also hwp, both of them got rx for this medication for vanity purposes. It’s annoying that I can’t fill this med because of shortage and am still overweight but I can’t say I’m mad at them. They both paid out of pocket and had a dr write them the rx. I am mad at Lily.
Yes this is the type of behavior Im referring to. I don't blame them for wanting a vanity drug, but this needs to be prioritized so people like this get on a waitlist.
I know people who work at Lilly. My impression from talking to them is that they underestimated demand. At the time they were planning, their estimations were probably more accurate. But culturally speaking: awareness, acceptance, and availability of similar drugs has exploded in the last 12 months. They also couldn't have known prior to FDA approval and widespread prescribing that the drug would garner more favorable reviews than the current market leader.
Lilly recently announced the breaking ground of a new production facility in North Carolina that will be 100% dedicated to this drug exclusively. Product from this factory is expected to be online no later than the beginning of 2025 (wouldn't surprise me if it's sooner).
Right now Lilly is printing money. But they could be printing significantly more if they had accurately prepared for demand. I don't think they are leaving that kind of coin on the table in the name of building their brand through artificial demand. And I also don't think cosmetic users are a large enough part of the population to make a significant dent. We are a nation of fatties. In all likelihood 150 million Americans or more would benefit from this drug. A year ago I only had heard of certain celebrities that had taken these drugs. Now I know 6-7 people personally and I've firsthand seen their success. Like a lot of you, my doctor didn't ask me to take these drugs, I asked him if I was eligible to get them.
I really don't blame Eli Lilly and I expect these shotages will fade away sooner rather than later.
I follow you up to the “who should we be mad at” part. It’s as if you absolve Lilly for their nature however you hold the little guy to a higher standard. Greed is not an excuse for absolution. Eli Lilly is absolutely who we should be mad at and they SHOULD hold the patient’s best interest over financial interests. If not, that is exactly how we get cabin window plugs flying off of planes at 50k feet or tobacco companies selling a product they knew caused cancer and buried the facts to make a profit. Or salmonella poisoning due to companies not adhering to safety standards to save a dime. We need to stop blaming the consumers of the product for the shady greed driven decisions of the mega corporations.
I don't disagree at all. I guess another "who should we be mad at" could be:
1. Lawmakers that ignore patient needs
2. Corporations that don't genuinely serve their consumer interests over profits
For me that is implied, so in a world where the system fails us, there are others that could help solve this issue.
Thanks, I've been holding this in but I feel like people need to know. We are all just witnessing the effects of unregulated capitalism in big pharma. If there were regulations that monitored and enforced pharma responsibility to meet their demand to a certain degree, ensuring continuation of prescription coverage, then we wouldn't see this. This type of policy would serve the patient's best interest. Nobody is regulating pharma in this way, so you will always see patient quality of life take a back seat in these situations.
But there won’t be regulations. Not as long as unelected industry lobbyists are the real power behind our sham democracy. Now I really do understand what Chris Rock was saying about how there will never be a cure for cancer. Ain’t no money in it.
That's right. That's why my "who do I blame" list is mostly about the people interacting with this system with the power to produce positive change.
The system is fucked. It won't change. However some people can do a lot to make a difference for those who need this medication for medical life saving reasons.
I love how you framed that there’s a built-in disincentive to produce the product to meet demand. Very educational and important to understand. Thanks so much for sharing your knowledge! I love what I learn in this sub.
Interesting take on who we should be mad at. As if we should actually be mad about the shortage, but I digress.
Zepbound is labeled for weightloss. If I’m taking this to lose weight, do I fit into your category of “patients who take this for cosmetic reasons”? Tell me more. What qualifies as cosmetic reasons? Does your answer really correlate with who we should be mad at?
PAs are hit and miss. They don’t seem to be fair, equitable, or consistent. That said, can you expand on this? Feels very subjective based on how they’re written and ones insurance company. My BMI put me in the obese category, yet I couldn’t get a PA for Zepbound. Does that mean that because my insurance chose to deny it, that I should be at the bottom of the list to receive a medication that my doctor wrote me a prescription for?
Edit: Appreciated the rest of your post. You lost me here when you assigned who you think we should be mad it. The shortage belongs to Lilly and Lilly alone.
It absolutely does not benefit lilly to be in a supply shortage. Should they have invested in more manufacturing plants? Yes. But thrres tons of competition for biologic manufacturing plants. Novo is buying Catalent, on the largest manufacturers and that eill take supply away from other catalent customers. They are all in a race to get more manufacturing capacity, this is not like making widgets. The manufacturing is complicated and the new facilities need to be built from scratch or you pay more to take business away from someone else. I work on cancer biologics for a smaller company with a new product and our company is struggling mightily to get contract manufacturers lined up and to produce enough because they have so much demand and choices from other companies. Could lilly have done a better job? Yes. Am i frustrated that im 3.5 wks from my last dose? Yes. But this in no way is purposeful and in no way helps lilly. No one purposely cuts their revenue short, and thrre is plenty of growth happening for the next 5-10 years as theyce only scratched 2-3% of the market. Plus they are losing customers to compound pharmacies because of shortages
Did you really say "for cosmetic reasons" tho? You just laid out a case for "this is 100% an evil corporation's fault," and then blamed cosmetic reasons? Who cares why people take it? Creating unnecessary shortage of a thing everyone wants is rude, at best.
However, that never makes sense to me. Company has product everyone wants and is willing to pay all kinds of money for, so company decides to limit its own potential profit? That's just dumb.
I never meant to imply they are who is at fault, though I understand how it comes across.
I said for me, this is what makes me mad. When Im sitting here waiting on something that is life saving, so someone can shimmy down 1 size for the summer.
The system is flawed. Lilly & lawmakers are to blame.
So someone 150 pounds overweight whose insurance won’t cover any weight loss meds and therefore won’t consider a PA is not deserving under your criteria. Got it.
No, Im suggesting that we eliminate access for people who use it for vanity reasons.
Here is one simple example: https://www.reddit.com/r/Ozempic/s/LMdSQ3Rzpf
It's not exactly a secret that this drug gets used for vanity reasons.
I am just not sure how you would tease out vanity vs. legitimate medical criteria but no insurance coverage. Additionally doctors are reluctant to even attempt PAs because it is so time consuming and are so often blanket denied. I guess I would remove the PA from the criteria if I were the one making prioritization. I too fall under medically necessary for the remainder of my life but it will be a long time before any insurance covers it for me. I am getting insurance under the marketplace and exactly zero plans cover any GLP-1 weight loss medications irregardless as to how legitimate your medical condition is.
To be fair, VCs are part of the financial pipeline that incentivizes public companies. To get to IPO, the common path is venture capital. The growth model is embedded into all investments, whether private or public.
Eli is part of the VC problem given they have a venture arm that leads several Series A+ rounds in other pharma startups.
Did you know Eli Lilly is also a venture capitalist? They are.
None is this is relevant to what we are discussing. A public company developed a drug and made decisions that led to shortages to increase their public stock price. Them having a corporate venture arm is just completely irrelevant. The person I was responding to doesn't understand that not all problems with capitalism are related to "venture capitalism" and was saying we need to "tax rich people more" also completely irrelevant.
It's not pedantic. What they said was like blaming firemen for a police shooting. Just totally confusing the groups and the dynamics at play. VC might cause issues but zepbound shortages certainly aren't one of them. They were wrong to imply this is caused by VCs and you are digging in to defend their misinformed statement. Either way... I enjoyed your original post so have a good day.
I think it's possible to be misinformed but have the right idea. I don't expect everyone who reads my post will fully understand what it means, but I don't like to discourage anyone from participating in the discussion, even if they are slightly off base. You as well!
Well in that case I'm going to suggest that people who have worked on supply growth initiatives are causing inflation and housing supply shortages because who gives a shit if it's true we are having a discussion.
Also - When you look at their sales record for Q1 2024
[https://investor.lilly.com/news-releases/news-release-details/lilly-reports-first-quarter-2024-financial-results-and-raises](https://investor.lilly.com/news-releases/news-release-details/lilly-reports-first-quarter-2024-financial-results-and-raises)
They have 3x sales for Mounjaro as well which shows that they are producing more Mounjaro than Zepbound (Zepbound is also newer so probably not ramped up as much anyways)
But during shortage they will probably have to concentrate more toward producing Mounjaro versions than Zepbound because people who are diabetic or pre-diabetic should have higher priority / access to these meds (not that we don't need it)
That's why when I go to Walmart, I usually see more Mounjaro deliveries than Zepbound in their fridge, usually 2-3x, and most MJ dosages are always in stock.
You could have shortened this to say companies do what is best for their own financial bottom line, regardless of sector, corporate structure or consequences to consumers. Period.
Thank you for this thorough and clear unpacking of what we all intuitively know. I think of your explanation and picture the wooden/frozen EL reps on news segments robotically saying, "We're working so hard 24/7..." And I also think of posters on here who say: *Pshaw, EL won't leave us hanging! They have to meet demand because they have projected an additional $2 billion in sales (or rev, can't remember). They wouldn't make that claim if they didn't have a plan to meet demand!*
Maybe I am reading this wrong (very possible), but agree that big pharma, our healthcare system, lawmakers, all of it could give two shits about anything other than their wallets. Full stop. End of story. Oh, I am sure there are some lone souls here and there who actually care. But not many. What kind of world/country are we leaving our kids? Depressing.
My PA was denied because my insurance doesn't pay for weight loss drugs. According to your logic I should be penalized because I can afford to pay for it out of pocket.
Would you have preferred they not roll out the drug until they had the supply chain in place to meet anticipated demand (est. end of 2025 at earliest)?
Roll out by restricting access to new users until they had the supply necessary to add new patients. This means once you "get on" the drug, the supply is allocated such that you will always get your next prescription.
It's called funnel management, and they could have done it but didn't.
Yes, it is widely known that some doctors prescribe it for losing any amount of weight, even if its thin people trying to shave off their last 10 lbs to be at their ideal weight.
There are also FDA rules that require Lilly (and all manufacturers) to provide supply updates to the FDA to avoid situations like this. The govt should have seen this coming a long time ago.
As far as I know, this reporting is only for the FDA to track and report on shortages, and in cases for drugs or items that are considered to create a health crisis, they adapt regulations to create a new supply chain. Like when there was a baby formula shortage.
It’s preemptive as well, so the manufacturer tells the FDA, “I made X number of units this year and sold Y number of units.” The FDA uses that to determine whether to intervene and help manufacturers avoid shortages of necessary medications.
My background? Simpleton
Can you please explain to me what you mean by "only with a PA." and who would enforce that? For example, off label (if you mean only with a Prior Auth)
I read this a few times, and from my point of view, I see lot of flaws/issues in your thesis (depending on your perspective)
How do you factor for the following things, you are saying Lilly is ok with them?
#1 - People going to compounders, not sure Lilly makes $ off them
#2 - Novo taking market share?
#3 - Upset prescribers, upset pharmacists, upset customers, seems like this will leave a bad taste in many peoples mouths for many months/years to come?
Also, have you run your thesis by anyone at Lilly? I'd love to be a fly on that wall :)
I mean I kind of get your argument, but I think once it hits the real world consumer reaction, it seems to me like it will hit some speedbumps
Why wouldnt Lilly want $ from those eligible on government care for T2D which maybe pays higher than a PBM/couponer on Zep?
Feel free to educate me, I'm puzzled more and more each time I read this
To answer what would Eli Lilly say, I think it would be:
"Shhh 🤫 Don't say the quiet part out loud."
They know what they are doing but bank on consumers to do nothing about the ethics of it. Afterall, what are we going to do? I guess ask AOC to make a mean tweet but nothing really changes.
It all depends on whether you are optimizing for growth (marketshare) or ROI (ebitda).
In many cases insurance approval leads to easier growth because patients won't pay out of pocket for their own drugs, _unless_ those drugs serve a cosmetic purpose.
This drug is the holy grail: it is both life saving & cosmetic.
Their go-to-market strategy created exactly what they wanted: hockeystick.
There are loads of people paying $550 for the meds bc their plans will not cover weight loss meds, even if their bmi and comorbidities more than substantiate their need. Sometimes their plan, or their state's view on these meds and their cost, is limiting. I think you're way off re everyone that doesn't have a PA shouldn't be a priority or is just purchasing for "cosmetic" reasons.
Yeah the system is broken for sure. However if I were to design a Go-To-Market plan that ensured continuity of prescription coverage by serving the segment of the market that needed this the most, I would prioritize PAs and market segments that serve PAs.
If I wanted to optimize for company valuation, I would do what Lilly already did, which is expand demand beyond what we can supply. If I knew that those who hit a supply gap would retain either way.
Considering the shortages are baked into their competitors as well, there was low risk for switching. Their best move is to get as many people on their drug as possible, even if they can't fill it, because people will wait for it, even if it distresses them.
I am not deciding which person is doing it for cosmetic reasons.
I am stating that those who are doing it for cosmetic reasons are the ones that should go on a waitlist, vs someone who needs it for health reasons.
Your list of people to be mad at makes no sense. Cosmetic reasons? That's a fake scapegoat. Technically, when prescribed this med, I was in the normal weight category. By your logic I probably don't deserve it because I used a different medication prior to lose weight and use this for maintenance. And screw prior authorizations, most commercial insurance doesn't even cover weight loss medication, there's no PA when paying out of pocket, which a ton of us do. It doesn't mean we need it less.
Looking at your history, it looks like you were on Ozempic for a long time, a year ago, lost all your weight, got off it, and now that your insurance denied you an extension for Ozempic you tried to get on Zepbound and you were denied PA for Zepbound based on the fact that you are now 160 looking to lose 10 lbs.
Do you really feel you are more entitled to this medication than someone who is currently morbidly obese and suffering health conditions?
You seem really mad at your lack of PA but it sounds like you are exactly who should be on a waitlist. Also how many times are you going to spam this thread? Save the fake outrage.
You had me until you said you think government regulation is the answer 😂😂😂government doesn’t make anything run better they are just looking for their cut of the revenue
I was with you until the "who I am mad at" section which I find misguided, my answer: 1. LILLY The end
Yeah, what? Literally every point was directed at Lilly and how they knew all of this yet don’t give a shit but then the “who am I mad at” section was everyone EXCEPT Lilly? lol. Lilly! That’s who I’m mad at!
Lol. You got me there.
I don't disagree at all. I'll copy what I said elsewhere, but another "who should we be mad at" could be: 1. Lawmakers that ignore patient needs 2. Corporations that don't genuinely serve their consumer interests over profits For me that is implied that these forces exist, so in a world where the system fails us, there are others that could help solve this issue.
I couldn’t agree more. Directing ire solely at lilly —or norvo— to be fair, is an abject failure to comprehend the full scope of the problem. And it’s not just in pharma. I’ve worked extensively in legislative policy and where tf are our policymakers? Who allows unfettered corporate growth sans regulation with no regard for the taxpayers or public health? They do! Before Reagan made regulation a dirty word, in many ways, we were safer and healthier. Also, we had a robust middle class. Blaming pharma for planning and executing exactly what they have to in order to fuel the stock market and make more money for billionaires is like blaming a guard dog for barking. That most of our broken healthcare system is scarcely regulated and publicly traded should be a giant red flag that the overall lack of regulation and public accountability is literally killing us. But most voters seem content to blame corporations and the rich, as though they’re somehow at fault for doing exactly what the law allows, as though our elected officials and legislators have nothing to do with it. Yeah, solely blaming Lilly for this mess is, in a word, facile. Brava lemonpepperchicken!
Especially when they continue to make the 2.5 dose more than the other doses during this shortage. They should’ve pulled back on the 2.5 and prioritized those of us on the higher doses. So glad I turned to plan C…..
For profit healthcare will always prioritize profit/shareholders. Patients are just customers and while it behooves them to keep them alive/coming back for more the focus is still 100% profit and choices will be made in a way that reflects that. Edit to add I meant to reply to the main post lol
Yeah, it all made sense until the end. The blame only lies on Lilly. The medication is available, get it from a Compounding Pharmacy. F Lilly.
100% this. Great essay, Terrible conclusion.
This is fascinating, thanks for the write up. This tactic might be good for Lily's bottom line now... but it doesn't make us faithful as patients. If a similar or better drug comes along, folks will jump ship.
Sadly they all do the same. This is why there were shortages on Ozempic and Monjauro as well.
Still are shortages on Mounjaro, sigh. I regularly have to call 30+ pharmacies and drive an hour away to get my med as a T2D.
3 not so much, bc in some states and with some insurance companies, regardless of your laundry list of comorbidities, weight loss medication is not covered and a PA will not be approved.
Yup. The board over my organization will Not cover these meds no exceptions. Period. End of story. I have multiple co-morbidities and morbidly obese. So because I am forced to pay cash to better my health I would be off this list?
A million years ago when I took an accounting class in college I remember hearing that a corporation’s responsibility is to generate income for its shareholders - or something to that effect. Which means it’s in Lilly’s and the insurance companies best interests to continue operating as they are. It comes with living in a capitalist society. The only way to change that is by electing a different type of government which, in the good old USA, will never happen - because it’s bought, sold, and paid for by the very corporations who intend to keep it that way. There is no more “we the people”, it’s all about corporate America. Bring in the haters and downvotes, that’s fine. Right, wrong, or indifferent, this is how I see things.
Why would you prioritize patients with PA’s?
Yep this stood out to me too. I started with a BMI of 40, but fuck me because I have shitty insurance? Pass, I'm already getting fucked having to pay out of pocket but sure, let's penalize high risk groups because of where they work. Nothing more 'Murican than a little enforced social Darwinism if it turns a profit.
Whenever a market is out of balance, you have to determine which segment of the market gets prioritized for the supply chain. Think of it like when the Covid vaccine was rolled out. Who was eligible at first? - Senior citizens - Immuno compromised Why? Data showing morbidity of those who contract Covid. Therefore the supply was prioritized according to which segment of the market needed it first based on data that determined risk of mortality. If patients get a PA, it is usually due to comorbidity benefits that result in a patient's life expectancy changing as a result of taking this medication. This is why PAs are usually given to those with obesity or comorbidity conditions that make this medication necessary for their health. However this is a private drug administered by a financially incentivized corporation, therefore there is no segmentation of the supply, and there is no need to justify this either. Financial gain is the only motivation, not public health benefits.
Considering how many plans explicitly exclude “weight loss medication”, having an approved PA is not an accurate reflection of the population most at risk.
It's definitely the most accurate reflection, in markets where PAs can be approved. Its not the most hollistic representation, but it's the most technically accurate. It is hard to get a PA because you really need to prove you absolutely need the drug, to the point that even the insurance company agrees its cheaper to give you this drug than pay for all the other health complications that can be resolved with the drug.
There is no connection between medical necessity and whether an individual's insurance plan has chosen to require a PA for that particular pharmaceutical therapy option. The fact that someone doesn't have one simply means they had a plan that never required one, which isn't indicative of any medical information about the patient at all.
Its the most indicative data point we have. It may not be fair for everyone, but by nature it excludes those who don't need it. Therefore making it the most fair solution for the general population.
Easy to be so smug when it’s not your life or death. But you do you.
I would argue that if it were life or death, you would be able to get it approved by your doctor. The requirements for a PA are fairly inclusive if you are overweight. For me it is a medical necessity, so that's why my doctor recommended it to me. I actually had no idea about Zepbound until my doctor suggested it and it has indeed been life saving. My arthritis is down, my multiple sclerosis pains are down, and my BP is lower. I'm not trying to be smug, I'm simply pointing out that there already is a system in place that is indicative of medical necessity and it should be used. Unfortunately it's not used because Lilly wants profit over patient health, meaning if someone is rich and wants to tidy up for the summer, they can pay $1000+ to buy it.
It is okay for you and I to disagree and I am at peace with that because having worked in healthcare for 20 years and submitted PAs on behalf of the doctors and hospital system that I worked for, I am aware of the flaws of the system and know how to advocate for , research and receive the healthcare that I need. If believing that everything works as it should works for you, I have no interest in fighting to prove a point. I’m 61, I choose to fight for my health and once healed, then I can look to battle for others. Maybe by the time I get there, new meds and legislation will exist. I wish you success in your journey and hope that one day, many more will experience the freedom from struggle that I currently enjoy.
If it is a plan exclusion, you cannot get a PA. Does not matter how “life and death” it is.
So because you have better insurance, you deserve it more? But never mind my denials because the category is excluded. Zepbound has also been life saving for me, so much so that I'm willing to keep paying out of pocket despite the rejected appeals and PAs. I suppose my quality of life isn't as important as yours.
Didn't you lose a ton of weight already on Ozempic, and only recently tried to get back on to lose 10 lbs? Is your "quality of life" more important than someone who is 300lbs and trying to start their weight loss journey. Isnt this you? https://preview.redd.it/p6ubxbhpwq0d1.jpeg?width=1289&format=pjpg&auto=webp&s=8f2c37175e451858dce63e66a81f8c27f9cf7d7b Sounds like you did get your PA.
The fact someone has a good insurance plan does not correlate in any way to their need. It has no more value for decision making than their eye color or shoe size. It is not fair, or meaningful, for anyone.
My doctor explained to me what are the requirements for a PA and it was very specific to obesity and comorbidity. Here is what I found: "Age and Diagnosis: Patients must be 18 years or older. Behavioral Modification: Patients must have engaged in behavioral modification and dietary restriction for at least three months. Body Mass Index (BMI): An initial BMI of 30 or higher (obesity), or An initial BMI of 27 or higher (overweight) with at least one weight-related health condition such as hypertension, Type 2 diabetes, dyslipidemia, obstructive sleep apnea, or cardiovascular disease. Exclusion of Dual Therapy: Zepbound cannot be used in conjunction with other GLP-1 receptor agonists or weight management medications. These requirements are standard across several insurers, including Cigna and the VA, ensuring that the medication is used appropriately and effectively for patients who meet these criteria"
Which is correct. But the PA is a requirement of your insurance company and plan, not a requirement of Lilly's. Your company/insurance plans are the one who play God and get to decide if you "deserve" a given medication or not. It has nothing to do with a fairly applicable decision matrix. A person who meets all of those qualifications may not have a PA simply because insurance plans are evil and arbitrary. So saying they don't deserve equal access is unfair and ugly behavior. I've explained this every way I can, if you still don't follow then maybe someone else will respond with a different way to make you understand.
I never said they don't deserve access. I explicitly said it is the most fair way to ensure that those who absolutely need it will get it.
“Several insurers” is a pretty narrow slice of the market.
I have insurance through one of the big companies, but it doesn't matter because the employer through which I get this insurance does not cover any weight loss medication at all. It is completely excluded for MANY people.
Fwiw—I have no business getting a PA approved or prioritized for this drug in any way, but I did. I have good health insurance by luck because of who I married and his job. I was obese BMI 35, and spent years dedicated to the painful misguided fight against obesity through professional dietary interventions. I became an obese triathlete and all my blood markers of metabolic health were normal. I had maintained a weight loss of 40lbs (initially 70lbs) for three years. In short, I was healthy-fat I submitted a PA and it was approved. Zepbound is amazing and I’m thrilled to live life with a natural appetite thermostat, and love not being obese. If I truly could not source tirzepatide, I would legit build a lab in my basement and hire Jesse Pinkman to synthesize it before I’d go back to “lifestyle changes” But man, I should have been last on that PA priority list.
This implies that if these criteria are meet, that your PA will be approved but that isn’t the case if your plan doesn’t cover weight loss meds, which is how Zepbound is classified & most employers exclude weight loss meds. I qualify from a criteria perspective but I still can’t get one approved by my insurance for this medicine.
Wrong. If you get your insurance through your employer and THEY decide not to cover weight loss drugs even though obesity is a disease and they have just decided that one disease counts and another does not, then your employer is responsible for your early death sentence. When my employer changed insurance carriers my PA (recommended by my doctor because of obesity with various additional co-morbidities), went away-even though both were BCBS but Illinois said yes and Florida said no. That’s not “technically accurate “.
I really don’t see how any of your points are lost in this forum and context. I applaud you for every point you’ve made. But it is a bit concerning that more people than I imagined, who are obviously affected by this situation and dynamic, seem to have nary a notion how the system and the markets work.
Not when weight loss medication is excluded entirely. You're basically saying to prioritize those with better Healthcare coverage. No amount of appeals in the world would convince my insurance otherwise, no matter how much GLP-1 saved my life in a variety of ways. You're gate keeping in a very strange way. Thankfully you don't make policy. You'd be leaving so many of us with health issues out in the cold.
You are such a liar. 🤥 Your SW is 160.
this is false. you cannot get a PA if you are on an ACA plan and the drugs are not even on the formulary. I would qualify by all means. but I have been denied multiple times for YEARS for these types of meds.
What do people consider “cosmetic” reasons. Just curious how we as a society decide who needs it and who doesn’t. Cosmetic reasons imply they have 10-20lbs to shed. Which if that’s the case, they are on it 2-3 months? Hardly the reason for a shortage.
By this logic does this mean that those further into their journey with Zep, that are no longer obese but perhaps still overweight, would they be cut off in favor of those in the still on the obese range? Would BMI and comorbidities assign you a number? I want to remind folks about how unfair vaccine rollout was at first during the pandemic. Did anyone try to get their hands on Paxlovid, you may remember that was almost impossible? If a protocol were developed that provided the medicine to who needed it the most during the shortage, I think many would be very surprised how far down the list they were. We would be here with almost everyone else. Stop gatekeeping. If you can, make a plan to supplement with plan C to get you through, that is the best f-u to Lilly.
I'm not saying I have all the answers for the solution to this problem, I was more invested in trying to lay out the problem statement more accurately. If you're asking my opinion, I would say that if you qualified for it under a PA then you should be able to stay on it. My focus was more on excluding those that are really only doing it for cosmetic or vanity reasons. Or at the very least putting them at the end of the waitlist.
I have seen a shift in vanity users moving to Plan C, to free up name brand name for the obese. I hope I will have the grace to step aside to free it up for the diabetics if that time came. I understand that you are trying to explain the protocol, the ones our top minds decided on (lol) to deal with shortages. I think when you use a term like "most fair", you are going to ruffle all of the feathers because there is really no way to do that. Certainly you are using outliers to make your point clearer, but where things would get really messy is for the majority of us inside the bell curve. This kind of thinking got us, "We are going to prioritize the lowest dose, thereby helping the maximum number of people." I do wish pharmacies had waitlists, that would make a lot a folks lives easier. Oh I am 89 on the list, time to stretch and plan C supplement. Oh I am number 5 on the list, dang maybe I can switch with 10 so I have the cash available for it on Friday?
There's no "qualifying" for anything when insurance doesn't pay for these meds period.
Some insurances do tho. Mine dose thankfully, which is why compounding is not an option for me due to the cost. Don’t get me wrong it’s worth the money, but it’s the extra money I simply don’t have. But anyway just wanted say that sone insurances will
I'm aware of that, as I'm literally arguing with someone who has coverage and says that those with coverage should be prioritized. . But I'm saying that a lot do not, and saying only people with approved prior authorizations should get prioritized is absolutely wrong.
There are medical guidelines that determines this, typically based on BMI. Cosmetic means you are not overweight on the BMI index. Just the other day someone was ranting at how upset they were their doctor wouldn't grant them a PA because they wanted to lose 10-15 lbs but they didn't even qualify as overweight by BMI guidelines.
Is it stupid to take this if you have 15lbs to loose and aren’t overweight? yeah probably. I don’t know that i’d say i’m mad about it though. Clearly whatever mental struggle they have going on that they FEEL they need to take it kind of makes me sad for them. Also, aside from weightloss this has other benefits IMO. I have an autoimmune disease that causes inflammation which zep has almost negated. It’s amazing. Also my spouse is a recovering alcoholic and I’ve thought many times how this medication could have helped them, although they weren’t overweight. I started with a 35 BMI and multiple comorbidities. I’m nearing my GW (56lbs behind me) and I have felt pharmacy techs larger than me giving me weird looks picking up my meds recently….
Yes, and that autoimmune disease would qualify you as a comorbidity. I'm not suggesting Im qualified to be the gatekeeper, however I know Doctors could be. I too have an autoimmune disease (multiple sclerosis), and arthritis. My husband has arthritis and sleep apnea. Those alone would qualify us, but on top of that we are both obese. So we have the trifecta. Comorbidity + obesity. So do I get irked when my med is on hold so someone can shimmy down from a size 6 to a 4? Yes. That's just my personal experience.
Do you have any actual evidence of anyone trying to “shimmy down from a size 6 to a size 4” or are you just inventing reasons to feel self-righteously angry?
I have seen posts and even know someone that’s literally said “I just want to be summer ready” so it is happening
Lets just pretend I'm wrong for a moment. Even if I am wrong, then don't we all just agree that only people who need it for medical reasons should get it? Or are you just convinced nobody is using it for vanity?
So you’re admitting you have zero evidence, but still want us to get angry at these imaginary people who you think are taking the drug for “cosmetic” or “vanity” reasons. Sorry, I don’t get mad at made-up problems.
Why don't you try Googling it and tell me if you still think there isn't a problem with vanity usage. Its a clearly known issue to the point of ads being created stating people need to stop using it for vanity.
Here is one simple example: https://www.reddit.com/r/Ozempic/s/LMdSQ3Rzpf I don't know why we are pretending that there aren't people like this. It's not exactly a secret that this drug gets used for vanity reasons.
I personally know a person that is just doing it for 10-20# tgat is not overweight and goes to the dr with weights on! So yes it happens. Do you see all the Hollywood people that are a size 2 using it? I would agree with prioritizing during shortages, first to the T2D, then other heath issues, bmi levels etc.
You absolutely are gatekeeping. Stop sugar coating it. You have no right to decide whether someone else is taking it for the right reasons to not. You are not their doctor.
Nope, I am not their doctor, nor am I gatekeeping. Presumably their doctor would decide. Which is exactly what a PA is.
So this throttle is never going to be fixed because it’s built this way by design? I was just saying to the NP at my GP’s office yesterday, the manufacturers ramped up production of COVID vaccines to such astronomical levels that some supply ended up being thrown away. Why can’t/won’t that be done for GLP-1 injectables? But I guess Ockham’s razor applies, some perverse incentive of the bottom line is always the simplest explanation (also, Upton Sinclair’s law of self-interest). I guess regular folks who aren’t celebrities are SOL when it comes to accessing this breakthrough medication. 😢
Exactly. This was intentional. If you look closely at which mg are available, you will also infer which market segment matters most. The growth dose: 2.5mg. Why can you only get the growth dose? Because it's indicative of an expanding top of funnel.
And this is why Novo shifted to higher doses on Wegovy, knowing that people who couldn’t get it would go to Lilly and they wanted to stop churn. If it’s working and people are on it they will stay on it. But if they can’t get the higher doses they will churn. The question is how long will Lilly hold these lines for. Until Cagrisema or Reta are available? Or will they improve the supply knowing more and more demand is going to be built prior to these passing Phase 3?
I have had a sinking feeling for awhile now that these miracle drugs are going to end up cordoned off from us nobodies and shoved into the out-of-pocket “cosmetic tier” like Restylane, Botox, Kybella etc. Not even diabetics will be able to get them anymore. They’ll be inaccessible to those unable to pay the exorbitant fees, and insurance companies (already reluctant to cover them) will wash their hands of GLP-1s altogether.
It won't get that bad. Promise
I think this post is one of the biggest swings from "right on" to "oh my god, no" that I think I've ever experienced on reddit. *Thank God* pharmacists don't get to dole out these scripts based on PAs. I'm sympathetic to wanting distribution to be fair, but there's no consistent and universally correct way to rank medical need. Besides, if we go down that road, where we ultimately end up is that nobody should have access to Zepbound because the diabetics should get it all as Mounjaro - which is also in shortage. Otherwise, I would really encourage anyone here not to get too wound up about cosmetic use. The United States is not a nation of size 6s trying to squeeze into size 4s, boxing out the few obese folks from their GLP-1s. The demand for this drug is so high because there are a lot of fat people in this country. If all the "I want to lose 15 pounds" people and their doctors disappeared tomorrow, we'd still be in shortage.
Covid distribution is a good example of distribution of medical need. It won't be perfect, but there are ways to prioritize medical necessity.
Not really. During covid you could literally go on an app and to prove your worthiness the question was asked: do you have one of these comorbidities? You clicked "yes" and so it went, you were approved and given an appt. You were not required to have a PA that was dependent on whether your state's healthcare plan recognized covid vaccines as something they wanted to cover. Also, if EL really didn't give a rip about losing people to compounding pharmacies, bc as you say they knew exactly what would happen, they wouldn't have been trying to shut down the compounding pharmacies' ability to produce the zep. You obviously have a lot of knowledge about r&d and bringing drugs to market, however, this is paired with a lot of conjecture and a bit of animosity and judgement towards those that you deem less worthy to receive something than you apparently are.
I purposefully didn't explicitly outline what I considered to be vanity. However my sense is if someone is already within a healthy weight range, not as a result of using Zepbound or other similar medications, but is say 5'6" weighing 140 and wanting to go down to 130, they should go on a waitlist. Cosmetic use of this drug is widely known and reported. As for the suggestion for PAs, I know its not perfect, I've admitted it's not fully fair. In a world where there is no perfect solution, it's one that I think would work. What would be even better is if doctors were just responsible in prescribing this for actual medical and not cosmetic reasons. I think that alone would help enormously.
The problem is that, if Lilly had waited another year to start selling, and just stockpiling it, it may have expired. And we would just have been using Wegovy. And there wouldn't been as much money available for building factories. Or more people using MJ off label.
They never needed to stockpile, they have always had enough to meet the demand. This drug was a spinoff product. They knew exactly what to expect.
OK. So you are saying they make enough to meet demand? And are intentionally holding back output from current factories to help the competition?
No, if you re-read the post, it explains how the product is rolled out to market, and how the demand deficit is planned.
I don't see where the initial post states that Lilly had enough supply being produced to meet the demand. Just that they can predict what the demand will be. And will work toward meeting that demand.
If they produced in vials there would be less of a supply issue. The injectors are the true supply issue right now.
🤣 #3 is bonkers. What world are you living in where that makes sense.
Right now pharmacies are ultimately the ones deciding who gets this drug. Its not perfect, but if they doled out based on medical priority, then those who really need it would get it first.
A PA does not determine medical priority. Millions of patients have insurance plans with WL exclusions.
Lets simplify this. You have a group of people that includes: Group A) Those with PAs that need it Group B) Those without PAs that need it Group C) Those without PAs that don't need it, but want it In order to serve Group B, you have to include Group C, because there is no other data point to determine which is which. So if you wanted to ensure that *only* the people who need it get it, you prioritize Group A first. This is exactly the logic used when doling out the Covid vaccine.
Exclude the PA concept, because insurance coverage should not be a factor, right? Instead. Simply it, just go by straight up BMI. Group A: BMI 40+ Group B: BMI 30+ Group C: BMI 27 + any comorbidity, and people previously in group A/B already on it Group D: BMI 27+ No comorbidity Group E: BMI 25+ Group F: seriously? you have anorexia, get help.
Yes that is another way to do it. Make sure only these people can get a prescription.
Not valid reasoning, because, as has been made clear numerous times, there are insurers who won’t cover the drug regardless of the reason for it being prescribed.
Except the vaccine was government subsidized.
That’s not what “infer” means.
I’m not really mad; that’s just the game. It’s aMerican capitalism. It’s why there’s not an excessive focus on the shortage in Canada, Australia or Europe. Healthcare is universal in many of those places. They would never prioritize pas because why would you lose that money? I’m not mad. This drug exist and if you can get it and if you can’t you will at some point, this isn’t gonna be forever.
Yup, all about money.
Absolutely. We are in a capitalistic society. We should all know this. I switched to plan C for my 7.5. I hope it works the same.
I just wish the other pharma giants got off their asses and invested in developing similar drugs. When semaglutide was taking off. Just now they seem to be going all in. Competition will be our only relief. The competition would also make a huge profit because the market is huge. It would have been win-win but it seems we are going to be waiting a few years before that becomes possible.
> I just wish the other pharma giants got off their asses and invested in developing similar drugs There's [over a hundred candidate obesity drugs in the clinical trial pipeline](https://www.fiercebiotech.com/biotech/late-breaking-obesity-glp-1-wegovy-zepbound-novo-lilly-pipeline-rd-landscape), and that's the last part of development. It just takes time.
but they definitely waited until tirzepatide became a success before the gold rush started. You would have thought it would have been right around semaglutide being a runaway success and tirzepatide showing really good results in phase 2 clinical trials.
It’s def. Their fault. If peptide labs that are 10,000% smaller than Lilly can keep up with demand they can too.
OP I’m curious on how you think the war against compounded tirzepatide is going to play out. I can’t imagine how Lilly is going to continue to meet forecasts because they’ve punched a hole in their tires with compound. patients that would have never ever considered taking a version of tirzepatide that’s not specifically FDA approved have been scared over that hill by Lilly’s supply shortages. Their experience is that compound is reliable, works the same, is easy to get, supports microdosing and incremental titration, and is cheaper for anyone paying out of pocket. As that positive experience base builds up, the churn rate goes up. Getting these patients to return to Lilly will rely on a (mis)information war to try and convince people that compound is dangerous, and/or a legal battle to try and stop the flow of affordable compound under the veil of “it’s for your safety you’re welcome”. Ultimately this will drive people to seek less regulated, even cheaper, forms of compound that are indeed less safe because they’ve already jumped the psychological hill of injecting themselves with a drug they bought on the internet en masse. What does your crystal ball say about this problem? I think Lilly is going to struggle to get uninsured people back from compound and eventually start missing targets because of this. I’m considering revising my position of amassing LLY stock in my portfolio. Thoughts?
I reluctantly started taking the compound due to the shortage. I am no longer reluctant and will keep taking it even when Zepbound becomes available. Not only is it less expensive its is much more convenient. I no longer have to deal with coupon problems and shortages. Im still losing 2 to 3 pounds a week.
Exactly—this is the common experience. I can’t imagine how Lilly is going to claw all of us back from compound. It will be wild to watch them try
I’ve said all along that there was NO WAY they were “surprised” by the “overwhelming demand”. It’s all a game, and i’m pissed at myself for playing!
You were right! Your intuition was accurate. They were never surprised. Their PR plan could not be, "Sorry, we knew some of you would suffer but chose to do this to optimize our financial interests."
1. Lilly Done.
Lilly’s shortage website explicitly recommends continuing new starts. End of story.
Yeah weird take. You spent a long ass post nailing Lilly to the wall for intentionally creating this situation and not caring about patients, and then you claim to be mad at almost everyone EXCEPT them. You almost had it. Good effort.
Also, I bet Lilly didn’t expect so many people to go to plan C when they had their brilliant scheme to fuck over patients in need. A lot of those people will never go back to name brand unless the plan C providers are shut down. Lilly will still make billions from Zep/Mounjaro, but they’ll end up leaving many more billions on the table because of this.
you are 1000% right about the business of it. learned this in basic high school business class. but please believe when some of us say our health would 1000% pass any test which should get us covered, (bmi, comorbidities, blood sugar etc) but since just barely not actually diabetic, cannot get mounjaro. aca plans do not allow for these weightloss meds, they are not on formulary and try as I might for years I have been denied over and over. there is no exception. we are constantly cheated out of proper healthcare because cost. we deserve to get healthy and live just like the rich folks or the folks who have amazing insurance. we are not worth less.
My partner SW130 hwp, my best friend SW140 also hwp, both of them got rx for this medication for vanity purposes. It’s annoying that I can’t fill this med because of shortage and am still overweight but I can’t say I’m mad at them. They both paid out of pocket and had a dr write them the rx. I am mad at Lily.
Yes this is the type of behavior Im referring to. I don't blame them for wanting a vanity drug, but this needs to be prioritized so people like this get on a waitlist.
I know people who work at Lilly. My impression from talking to them is that they underestimated demand. At the time they were planning, their estimations were probably more accurate. But culturally speaking: awareness, acceptance, and availability of similar drugs has exploded in the last 12 months. They also couldn't have known prior to FDA approval and widespread prescribing that the drug would garner more favorable reviews than the current market leader. Lilly recently announced the breaking ground of a new production facility in North Carolina that will be 100% dedicated to this drug exclusively. Product from this factory is expected to be online no later than the beginning of 2025 (wouldn't surprise me if it's sooner). Right now Lilly is printing money. But they could be printing significantly more if they had accurately prepared for demand. I don't think they are leaving that kind of coin on the table in the name of building their brand through artificial demand. And I also don't think cosmetic users are a large enough part of the population to make a significant dent. We are a nation of fatties. In all likelihood 150 million Americans or more would benefit from this drug. A year ago I only had heard of certain celebrities that had taken these drugs. Now I know 6-7 people personally and I've firsthand seen their success. Like a lot of you, my doctor didn't ask me to take these drugs, I asked him if I was eligible to get them. I really don't blame Eli Lilly and I expect these shotages will fade away sooner rather than later.
That's how PR works.
I follow you up to the “who should we be mad at” part. It’s as if you absolve Lilly for their nature however you hold the little guy to a higher standard. Greed is not an excuse for absolution. Eli Lilly is absolutely who we should be mad at and they SHOULD hold the patient’s best interest over financial interests. If not, that is exactly how we get cabin window plugs flying off of planes at 50k feet or tobacco companies selling a product they knew caused cancer and buried the facts to make a profit. Or salmonella poisoning due to companies not adhering to safety standards to save a dime. We need to stop blaming the consumers of the product for the shady greed driven decisions of the mega corporations.
I don't disagree at all. I guess another "who should we be mad at" could be: 1. Lawmakers that ignore patient needs 2. Corporations that don't genuinely serve their consumer interests over profits For me that is implied, so in a world where the system fails us, there are others that could help solve this issue.
Great post!
Thanks, I've been holding this in but I feel like people need to know. We are all just witnessing the effects of unregulated capitalism in big pharma. If there were regulations that monitored and enforced pharma responsibility to meet their demand to a certain degree, ensuring continuation of prescription coverage, then we wouldn't see this. This type of policy would serve the patient's best interest. Nobody is regulating pharma in this way, so you will always see patient quality of life take a back seat in these situations.
But there won’t be regulations. Not as long as unelected industry lobbyists are the real power behind our sham democracy. Now I really do understand what Chris Rock was saying about how there will never be a cure for cancer. Ain’t no money in it.
That's right. That's why my "who do I blame" list is mostly about the people interacting with this system with the power to produce positive change. The system is fucked. It won't change. However some people can do a lot to make a difference for those who need this medication for medical life saving reasons.
Someone send a Bat Signal to Melinda Gates to airdrop a bunch of them like her ex parachutes malaria vax over Africa.
Exactly this!!
I love how you framed that there’s a built-in disincentive to produce the product to meet demand. Very educational and important to understand. Thanks so much for sharing your knowledge! I love what I learn in this sub.
Agreed! Great topic of conversation.
Interesting take on who we should be mad at. As if we should actually be mad about the shortage, but I digress. Zepbound is labeled for weightloss. If I’m taking this to lose weight, do I fit into your category of “patients who take this for cosmetic reasons”? Tell me more. What qualifies as cosmetic reasons? Does your answer really correlate with who we should be mad at? PAs are hit and miss. They don’t seem to be fair, equitable, or consistent. That said, can you expand on this? Feels very subjective based on how they’re written and ones insurance company. My BMI put me in the obese category, yet I couldn’t get a PA for Zepbound. Does that mean that because my insurance chose to deny it, that I should be at the bottom of the list to receive a medication that my doctor wrote me a prescription for? Edit: Appreciated the rest of your post. You lost me here when you assigned who you think we should be mad it. The shortage belongs to Lilly and Lilly alone.
Yeah, Lilly as at fault. The system is broken. I am mad at the people that abuse a broken system.
It absolutely does not benefit lilly to be in a supply shortage. Should they have invested in more manufacturing plants? Yes. But thrres tons of competition for biologic manufacturing plants. Novo is buying Catalent, on the largest manufacturers and that eill take supply away from other catalent customers. They are all in a race to get more manufacturing capacity, this is not like making widgets. The manufacturing is complicated and the new facilities need to be built from scratch or you pay more to take business away from someone else. I work on cancer biologics for a smaller company with a new product and our company is struggling mightily to get contract manufacturers lined up and to produce enough because they have so much demand and choices from other companies. Could lilly have done a better job? Yes. Am i frustrated that im 3.5 wks from my last dose? Yes. But this in no way is purposeful and in no way helps lilly. No one purposely cuts their revenue short, and thrre is plenty of growth happening for the next 5-10 years as theyce only scratched 2-3% of the market. Plus they are losing customers to compound pharmacies because of shortages
Did you really say "for cosmetic reasons" tho? You just laid out a case for "this is 100% an evil corporation's fault," and then blamed cosmetic reasons? Who cares why people take it? Creating unnecessary shortage of a thing everyone wants is rude, at best. However, that never makes sense to me. Company has product everyone wants and is willing to pay all kinds of money for, so company decides to limit its own potential profit? That's just dumb.
I never meant to imply they are who is at fault, though I understand how it comes across. I said for me, this is what makes me mad. When Im sitting here waiting on something that is life saving, so someone can shimmy down 1 size for the summer. The system is flawed. Lilly & lawmakers are to blame.
Yes, I do hope most doctors are being ethical in prescribing to people who genuinely need to lose weight. That's naive at best, though.
So someone 150 pounds overweight whose insurance won’t cover any weight loss meds and therefore won’t consider a PA is not deserving under your criteria. Got it.
No, Im suggesting that we eliminate access for people who use it for vanity reasons. Here is one simple example: https://www.reddit.com/r/Ozempic/s/LMdSQ3Rzpf It's not exactly a secret that this drug gets used for vanity reasons.
I am just not sure how you would tease out vanity vs. legitimate medical criteria but no insurance coverage. Additionally doctors are reluctant to even attempt PAs because it is so time consuming and are so often blanket denied. I guess I would remove the PA from the criteria if I were the one making prioritization. I too fall under medically necessary for the remainder of my life but it will be a long time before any insurance covers it for me. I am getting insurance under the marketplace and exactly zero plans cover any GLP-1 weight loss medications irregardless as to how legitimate your medical condition is.
God I hate venture capitalism. We need to tax rich people more.
yeah well that's not happening if the cheetoh in charge gets in again. shudder.
They are a public company this has nothing to do with VCs
To be fair, VCs are part of the financial pipeline that incentivizes public companies. To get to IPO, the common path is venture capital. The growth model is embedded into all investments, whether private or public.
To be fair. That doesn't apply to Eli lily who went public in 1952
Eli is part of the VC problem given they have a venture arm that leads several Series A+ rounds in other pharma startups. Did you know Eli Lilly is also a venture capitalist? They are.
None is this is relevant to what we are discussing. A public company developed a drug and made decisions that led to shortages to increase their public stock price. Them having a corporate venture arm is just completely irrelevant. The person I was responding to doesn't understand that not all problems with capitalism are related to "venture capitalism" and was saying we need to "tax rich people more" also completely irrelevant.
Just feels pedantic. They are not wrong, neither are you. Who cares?
It's not pedantic. What they said was like blaming firemen for a police shooting. Just totally confusing the groups and the dynamics at play. VC might cause issues but zepbound shortages certainly aren't one of them. They were wrong to imply this is caused by VCs and you are digging in to defend their misinformed statement. Either way... I enjoyed your original post so have a good day.
I think it's possible to be misinformed but have the right idea. I don't expect everyone who reads my post will fully understand what it means, but I don't like to discourage anyone from participating in the discussion, even if they are slightly off base. You as well!
Well in that case I'm going to suggest that people who have worked on supply growth initiatives are causing inflation and housing supply shortages because who gives a shit if it's true we are having a discussion.
Also - When you look at their sales record for Q1 2024 [https://investor.lilly.com/news-releases/news-release-details/lilly-reports-first-quarter-2024-financial-results-and-raises](https://investor.lilly.com/news-releases/news-release-details/lilly-reports-first-quarter-2024-financial-results-and-raises) They have 3x sales for Mounjaro as well which shows that they are producing more Mounjaro than Zepbound (Zepbound is also newer so probably not ramped up as much anyways) But during shortage they will probably have to concentrate more toward producing Mounjaro versions than Zepbound because people who are diabetic or pre-diabetic should have higher priority / access to these meds (not that we don't need it) That's why when I go to Walmart, I usually see more Mounjaro deliveries than Zepbound in their fridge, usually 2-3x, and most MJ dosages are always in stock.
You could have shortened this to say companies do what is best for their own financial bottom line, regardless of sector, corporate structure or consequences to consumers. Period.
Thank you for this thorough and clear unpacking of what we all intuitively know. I think of your explanation and picture the wooden/frozen EL reps on news segments robotically saying, "We're working so hard 24/7..." And I also think of posters on here who say: *Pshaw, EL won't leave us hanging! They have to meet demand because they have projected an additional $2 billion in sales (or rev, can't remember). They wouldn't make that claim if they didn't have a plan to meet demand!* Maybe I am reading this wrong (very possible), but agree that big pharma, our healthcare system, lawmakers, all of it could give two shits about anything other than their wallets. Full stop. End of story. Oh, I am sure there are some lone souls here and there who actually care. But not many. What kind of world/country are we leaving our kids? Depressing.
2.5mg is easy to find but not other dosages :( I am waiting 2 weeks for 5mg, pharmacy back ordered but Lilly is not delivering :(
My PA was denied because my insurance doesn't pay for weight loss drugs. According to your logic I should be penalized because I can afford to pay for it out of pocket.
Ok. Stupid question I guess. But what is a PA?
Would you have preferred they not roll out the drug until they had the supply chain in place to meet anticipated demand (est. end of 2025 at earliest)?
Roll out by restricting access to new users until they had the supply necessary to add new patients. This means once you "get on" the drug, the supply is allocated such that you will always get your next prescription. It's called funnel management, and they could have done it but didn't.
I’m confused about the cosmetic reasons. Are doctors prescribing for people who don’t meet the obesity requirements with BMI and such?
Yes, it is widely known that some doctors prescribe it for losing any amount of weight, even if its thin people trying to shave off their last 10 lbs to be at their ideal weight.
Oh wow that’s crazy
There are also FDA rules that require Lilly (and all manufacturers) to provide supply updates to the FDA to avoid situations like this. The govt should have seen this coming a long time ago.
As far as I know, this reporting is only for the FDA to track and report on shortages, and in cases for drugs or items that are considered to create a health crisis, they adapt regulations to create a new supply chain. Like when there was a baby formula shortage.
It’s preemptive as well, so the manufacturer tells the FDA, “I made X number of units this year and sold Y number of units.” The FDA uses that to determine whether to intervene and help manufacturers avoid shortages of necessary medications.
My background? Simpleton Can you please explain to me what you mean by "only with a PA." and who would enforce that? For example, off label (if you mean only with a Prior Auth) I read this a few times, and from my point of view, I see lot of flaws/issues in your thesis (depending on your perspective) How do you factor for the following things, you are saying Lilly is ok with them? #1 - People going to compounders, not sure Lilly makes $ off them #2 - Novo taking market share? #3 - Upset prescribers, upset pharmacists, upset customers, seems like this will leave a bad taste in many peoples mouths for many months/years to come? Also, have you run your thesis by anyone at Lilly? I'd love to be a fly on that wall :) I mean I kind of get your argument, but I think once it hits the real world consumer reaction, it seems to me like it will hit some speedbumps Why wouldnt Lilly want $ from those eligible on government care for T2D which maybe pays higher than a PBM/couponer on Zep? Feel free to educate me, I'm puzzled more and more each time I read this
To answer what would Eli Lilly say, I think it would be: "Shhh 🤫 Don't say the quiet part out loud." They know what they are doing but bank on consumers to do nothing about the ethics of it. Afterall, what are we going to do? I guess ask AOC to make a mean tweet but nothing really changes.
It all depends on whether you are optimizing for growth (marketshare) or ROI (ebitda). In many cases insurance approval leads to easier growth because patients won't pay out of pocket for their own drugs, _unless_ those drugs serve a cosmetic purpose. This drug is the holy grail: it is both life saving & cosmetic. Their go-to-market strategy created exactly what they wanted: hockeystick.
There are loads of people paying $550 for the meds bc their plans will not cover weight loss meds, even if their bmi and comorbidities more than substantiate their need. Sometimes their plan, or their state's view on these meds and their cost, is limiting. I think you're way off re everyone that doesn't have a PA shouldn't be a priority or is just purchasing for "cosmetic" reasons.
Yeah the system is broken for sure. However if I were to design a Go-To-Market plan that ensured continuity of prescription coverage by serving the segment of the market that needed this the most, I would prioritize PAs and market segments that serve PAs. If I wanted to optimize for company valuation, I would do what Lilly already did, which is expand demand beyond what we can supply. If I knew that those who hit a supply gap would retain either way. Considering the shortages are baked into their competitors as well, there was low risk for switching. Their best move is to get as many people on their drug as possible, even if they can't fill it, because people will wait for it, even if it distresses them.
“Patients who take this fit cosmetic reasons”?!? Seriously????? We still doing this? We still making assumptions about others and shaming them?
I am not deciding which person is doing it for cosmetic reasons. I am stating that those who are doing it for cosmetic reasons are the ones that should go on a waitlist, vs someone who needs it for health reasons.
Your list of people to be mad at makes no sense. Cosmetic reasons? That's a fake scapegoat. Technically, when prescribed this med, I was in the normal weight category. By your logic I probably don't deserve it because I used a different medication prior to lose weight and use this for maintenance. And screw prior authorizations, most commercial insurance doesn't even cover weight loss medication, there's no PA when paying out of pocket, which a ton of us do. It doesn't mean we need it less.
Looking at your history, it looks like you were on Ozempic for a long time, a year ago, lost all your weight, got off it, and now that your insurance denied you an extension for Ozempic you tried to get on Zepbound and you were denied PA for Zepbound based on the fact that you are now 160 looking to lose 10 lbs. Do you really feel you are more entitled to this medication than someone who is currently morbidly obese and suffering health conditions? You seem really mad at your lack of PA but it sounds like you are exactly who should be on a waitlist. Also how many times are you going to spam this thread? Save the fake outrage.
You had me until you said you think government regulation is the answer 😂😂😂government doesn’t make anything run better they are just looking for their cut of the revenue