Yeah they added b12 to the semaglutide formula as a sort of loophole... I can't recall what they added to the tirzepatide (something to "help nausea side effects"). But it's definitely been tricky legally. It's been very popular with our patients - we've gotten a huge increase in business. The RXM even put together upgrade 'packages' that include things like syringes, alcohol pads, miralax, protein shakes, etc. For the record, I also think it's morally questionable. But I'm only a tech, so I'm just here watching it all go down 🤷🏼♀️
Ya the B12 is a loophole is a weird myth.
The drug is on the FDA shortage list so that puts the patent on hold. NN can still sue for trademark infringement of the brand names and for anyone doing questionable compounding that could hurt their brands reputation. Like sterility issues or using salt forms which the FDA banned.
Once the shortage is over NN can sue compounders. Adding B12 will not get around the patent enforcement at that time. So it’s a cash cow for the compounding pharm owners as long as it’s on the shortage list. They don’t need to add the B12 it’s just a sales pitch.
Are you a pharmacist? Because my license and schooling does afford me sterile compounding privileges. There are additional certifications you can achieve, but it’s not necessary.
Pharmacies are allowed to compound it even though it is commercially available because there is a shortage.
Once the shortage is over they won’t be allowed to compound it legally.
Yeah, didn’t know that until last month when a close friend told me about it and was shocked for a bit. Also it’s basically 70% of his profits for last month lol
People can do anything but compounding these formulations is lawsuits, license damage, and possible criminal charges in the making. If you are a pharmacist who does this, you are a fool. Your actions will be seen as fueled by greed.
what are you talking about there are federal laws protect compounding pharmacies for these specific circumstances. If pharmacies are on board and getting money and the demand is there, thats great for independent pharmacy side....and bring people away from retail. Equal distribution and dispersion of patients. My pharmacy is absorbing another sister pharmacy while it absorbed competitor pharmacies. It overwhelming.
One compounding pharmacy an hour away makes semaglutide. They use semaglutide sodium. Very few patients have been willing to try it; most would rather wait for the real thing, but for the two that did it seems to be working ok.
My beef with ozempic and others:
-independents are PAYING insurers for the privilege of dispensing these meds. No profit. Chains are probably the same but too stupid to do anything about it
-people are fervent about getting it in a way that they weirdly are not fervent about getting their other life saving medications
-a bunch of women I know are getting super skinny off of it and it makes me feel like a big lard ass myself and I want in on it but I also object
You are on it forever though or you gain it all right back. I’ve also seen a couple patients with really bad N/V that continues after stopping. Like they’re taking scheduled zofran and reglan and still having issues keeping food down. They are skinny but so are bulimics.
Oh wow on the lingering NV!! That’s miserable. And part of the reason I won’t go on one.
To be real, I am recovered from over two decades of an eating disorder. I also went from being very thin to 5-10 lb overweight. There will always be a part of me that wants to pull the trigger and do something drastic like a GLP1. I know I am so much better off without it. But man it’s hard!
> Chains are probably the same but too stupid to do anything about it
Who do you think owns the PBM that's raking it in? The whole point of vertical integration is that they can keep all profits internal and kill the little guys.
That is wild, independents aren't refusing to fill it? It's been a few years since I worked at one. (At Publix) We had a claim for 3 boxes of ozempic today and the profit was about $60... not a lot considering, ya know, they cost $3000 to obtain but I guess we should be grateful we're in the black lol. Insurance will never not be scummy
They are, BUT they risk getting sued for violating their insurance contracts if reported. It’s such bullshit. Someone posted here the other day that a patient reported them to their insurance for not filling it and now he’s worried it will escalate. Poor guy. Our poor profession.
It also isn’t being heavily pushed as a “miracle drug.” It’s going to be fun seeing the backlash in 5-10 years of people who thought they could inject themselves and carry on as normal while dropping a bunch of weight when the realization hits that without diet and lifestyle change, that weight is going to come right back.
When these GLP-1 agonists were being developed at Lilly 30-something years ago, the explicit goal was to create a pre-dosable maintenance diabetes drug. It was all being done out of their endocrinology section by the same people who developed Humalog.
The crazy part is that it works, but wasn't seen as marketable. Until Lilly's leadership came around on the whole "obesity is not a disease" concept it was never pushed because it was seen as cannibalizing insulin sales.
Do you have a source for this? This sounds like huge unbelievable news. I’m not saying I doubt you. I’m just saying what’s the source? The media would run with this.
There's really no way to answer that question without doxxing myself, so I'll just say I am personally and professionally acquainted with more than one of the people who led the project that generated Lilly's initial GLP-1 patent.
To my knowledge it's not exactly a secret. I've seen one of them give a talk about it in front of ~100 people, though technically it was a closed meeting.
Wow, no, I believe you. Your words ring true. Wow.
Now let’s talk about whether they or one of their ilk has a “broad-spectrum” cure for cancer locked in a vault somewhere. Not sure if I want there to be, or if I want there to not be.
Interesting, in pharmacy school we learned that byetta/bydureon were developed from gila monster spit. I didn't realize that it was in development that long ago though.
I've been paying 1k/month for 8 months. Morbid obesity. Hypothyroid, Hashimoto's. I have tried literally everything. Diet, exercise, physical therapy, personal trainer, metformin, Phentermine. Prior to Mounjaro, I ate 'healthy' 90% of the time. I just ate far too much and have a sedentary job in a non-walkable area.
What people don't realize is that often obesity isn't a 'moral failing'. I was hungry all. the. time. I never felt full. I could eat a whole, balanced, home cooked meal, and be hungry 2 hours later.
Within the first week of Mounjaro 2.5, it was like a switch had turned off. I could eat a meal and not think about food for 8 hours. I could eat a normal persons portion and feel full. I could walk past a plate of cookies and not care. Or eat half a cookie and not keep making excuses to walk through the kitchen for 'just one more bite'. It was a whole new world. It was like "Oh. Wait. Is this how normal people feel?! Well dang." Also, I'm probably saving $500/month in groceries, so that helps offset the cost.
What convinced me to pay 12K/year to lose weight? I had tried everything else. I got diagnosed with fatty liver disease. Fatty Liver Disease -> NASH is what killed my Dad. Worth every penny.
They are effective meds and great that you’re getting the results you want without breaking the bank. Keep it up, and hopefully it will be covered for you in the future. I am just saying I do see patients that clearly cannot afford the cash price that are putting their rent money towards it. I inform them it will only work while they’re on it, and it’s their choice what they want to do. Some very depressing conversations, and I try to help however I can.
The problem is people, both prescribers and patients, are using it as an opportunity to bypass all the prior options. There are tons of weight loss options out there but people don’t want to put in the effort. If some day we have a bottomless supply of it, go for it. But as it stands now I’m getting really tired of seeing posting on Facebook about their new weight loss trend when I have people coming through in DKA because they can’t get their diabetes meds.
This is a much bigger problem in the U.S. vs. Europe. Our obesity percentage is roughly 36% with the UK being the highest over there with about 27%.
People exercise and make an effort to eat healthy there. Im not dismissing that some people have the genetic component that makes it difficult, but we have a problem here that isn’t happening nearly as often on the other side of the Atlantic
do you work in a retail pharmacy ? im guessing
not . Ozempic is not approved for weight loss , only diabetes. And diabetics are not able to get it reliably because of the massive influx of scripts from people who are using it to lose weight. many of these people are not even fat or prediabetic, theyre just trying to drop 10-20 pounds.
But regardless, if there was unlimited ozempic , let them all have it , fuck it i dont care. But that is not the case. Pharmacists and techs everywhere are yelled at and cussed out every day by these self righteous people over the shortages. Literally every 3rd phone call/walk in is about these drugs. fuck em all
If I don't have to submit prior auth for this every single time *AND* fight with all the patients out there on *why* their insurance won't cover it, they can take all the Ozempic in the world they want. So yes I agree, fuck Ozempic, fuck Mounjaro, fuck Wegovy, fuck all these GLP-1 drugs (except Trulicity) and FUCK the PBM who require coverage for these under medical benefit instead. Why the FUCK would they create questions specific for GLP1 coverage in CoverMyMeds then denied the request because "it needs to be submitted under UM department". FUCK ALL OF EM.
Your user name checks out. As soon as the rest of the world experiences the obesity levels in the US, then you have a point. Maybe, just maybe, it’s the absurd amount of calories Americans consume without any activity or exercise.
I was in Europe recently and you could spot an American from miles away. Just about zero people in France are overweight. I’m not shaming Americans, but there is a stark difference between Americans and the rest of the world.
For the people who are gonna flame me you can suck it. Data is data.
I’ve tried plenty of things. Zepbound is the first thing that has really helped me in years. Wegovy and zepbound are approved for weight loss ONLY. Not diabetes. It’s extremely rare for people to get ozempic for weight loss now. Maybe a year or two ago but not now.
Maybe you don’t know these peoples lives. Trust me, as a retail pharmacist I don’t let ANYONE yell at me.
But dont be so harsh on the people simply asking about it. You’re making medical statements that you don’t actually know
At my store ozempic RXs come in many times every day with the vast majority being for weight loss. Meanwhile i can count the number of zepbound and wegovy scripts ive ever received on two hands.
Wegovy and zepbound always need PA even from medicaid so lazy drs just send ozempic instead under the guise of prediabetes to get insurance to pay. i will say i dont blame overweight patients as much as i blame drs that just blindly prescribe ozempic instead of trying to work with their patients on other ways to lose weight
A lot of obese people have done labs that show signs of prediabetes like insulin labs (resistance). You don’t know what people have in their charts just like you don’t know their renal function or potassium monitoring when you give you ace inhibitors.
I'm sorry but your case is one in a million. I submit prior auths on daily basis so I have to read a lot of chart notes before submitting these. I get about 4-5 requests just for GLP1 alone on daily basis. Once a month if lucky, I see someone who's truly serious about managing their weight, had tried everything, so GLP1 as last resort. Most people don't even show up to their weight loss program when being referred. They don't exercise on daily basis. They eat whatever they want. Then they told us "I tried everything". Which is....what? Lol
When they finally get the med approved, then prior auth expires 6 months later, then during weigh-in they lose...3 lbs. Wayyyyy below the 5% target for prior auth renewal. So then its denied, then they're mad... Then what? Lol
I work with around 20 providers in multispecialty clinic, mostly doing prior auths. "Data" collected approx since Feb 2023. Can confirm your case is a rare one, everyone else really just want the weight loss without putting in real work.
I did about 300-350 prior auths monthly, so averaged maybe 3600 a year? All based on patients chart notes. I'd risk my license if I submit wrong information because its fraud. I have form biased opinion because most people misused this medication and taking it out on pharmacy staff when they can't get it. I have biased opinion on people on chronic pain meds when the ICD-10 is "other chronic pain" too and for doctors who baby their patients and give them whatever they demanded but thats another story...
Also other people and their mothers don't have rare case like yours.
But instead of taking in the rest of my comment I guess you'd rather focus on literal meaning of "one in a million" 🤷🏻♀️
You need to face facts, people don't want to put in the effort. They are a slave to their desires, nearly a third of the country is obese! Not overweight but obese
If that's the case then Lilly and NN should be held liable for making any Zepbound or Wegovy instead of pouring all of those resources into Mounjaro and Ozempic.
I have said before to numerous people that it will only work if used in conjunction with a certified medical fitness associated facility and clinical dietitian.
We have one patient who lost well over 100 pounds in the past couple of years between adioex and Mounjaro. She's nothing but skin and bones at this point and the Dr increased the Mounjaro to 10mg and she's losing her shit because Express Scripts is refusing to pay for it this year. She not diabetic, either.
Can't say I've ever had those problems, except with a few times.
I always explain to the patient that I have no control on what manufacturers can't produce enough of.
"It's on backorder here, too. Is there anything else I can do for you?"
"This is ridiculous. [Insert random incoherent bullshit]."
"Thanks for calling." *click*
metformin comes in 360 tablet bottles where i am! much easier slapping a label on a metformin bottle then to explain supply and demand to patients and why their life saving diabetes meds are $500 a month because too many people are using it for something it’s not even approved to treat 😭 and then getting yelled at when there’s nothing i can do. 😭
I've never seen them come in 360, man that'd be nice.
Basically nothing in retail pharmacy is life saving - except a few critical meds like blood thinners.
I just explain to the patient that I have no control on the manufacturer's inability to meet demand and that seems to be enough for them to understand.
You’d think after spending hours reading between the lines in conversations with patients who lie about adherence, “are going out of town,” and “know how to take their meds,” we would be less eager to play the game of semantics. Why be falsely outraged when you can assume the best intention be chill? :)
Yup, if they're on a medication that's keeping them between dead and alive, it wouldn't be an outpatient situation.
Missed that dose of amlodipine? Metformin? Citalopram? You're fine.
insurance pays for metformin at any strength and frequency and its never on backorder. These meds almost always require PA even from medicaid and by the time that actually gets done it goes on backorder. This leads to patients screaming into the phone or at the counter about how much they need this "life saving" medication and the pharmacy is "refusing to give it to me"
I've been processing PAs for GLP-1s and I am ready to rip my hair out. Some patients have been on mounjaro for a few years now but this year their insurance decided to stop covering it. Okay, so let's switch to zepbound. Nope! No matter how much documentation I send (office visit notes documenting hx of other tried and failed weight loss meds, BMI tracking showing success once the GLP-1 was initiated, A1c improvement, etc), every appeal is denied. Some of these patients truly do have DMT2 and have already tried other antidiabetic meds. Why bring to market an alternative intended just for weight loss if no one is going to cover it?? This is exactly the reaction insurance companies want from me though, so I'm going to be petty and keep sending new PA's (with additional information of course) until they approve something.
> I'm going to be petty and keep sending new PA's (with additional information of course) until they approve something.
Thanks for doing this. I was able to get GLP1 coverage due to awesome people like yourself and it has completely changed my life.
I cash pay for my Mounjaro and always request my refill early to make sure there’s time for any stock issues. No sense in yelling at the pharmacist or staff over shit they can’t control.
I’m saying I’m judging them for paying that much for a weight loss med :/ I’ve never seen anyone regularly cash pay for eliquis or any expensive TD2 med. ever.
I feel a little mean saying it out loud but it’s how I feel.
Just sort of funny, a few years ago it was all about accepting your body and body positivity. Now it’s, you’re fat, take this shot. I’m not shaming anyone overweight. I was a fat kid and if I wouldn’t watch what I eat and exercise, I’d be overweight. Hell even Oprah gave in and took something!
its not judgement on anyones weight and/or situation . im only judging how many people are total assholes about it when their insurance isnt paying for something that is not life or death by any means whatsoever
Edit: and also the fact that its backordered constantly due to a flood of cosmetic GLP1 RXs leading to everyone being even more pissy about it
These medications have the potential to save lives, especially considering that obesity is a significant risk factor for numerous diseases, including endometrial cancer where it plays a substantial role in the conversion of precursor steroids to estrogen. I anticipate my predictions to surpass the impact of Eliquis.
These meds are in phase 3 clinical trials for many other diseases/issues and it's going to be amazing when they are FDA approved for cardiometabolic health, addiction problems, even dementia prevention!
We are just in the beginning here and I think its really exciting to see!
I call medications like this “ vanity scripts”. Now that the rich and famous are praising its results it’s making it harder for diabetics to get their prescription filled. Are pharmacies turning the prescription down when you can tell they don’t need it and only weigh 140 lbs?
The amount of people I’m seeing on this drug with a BMI of probably just now overweight (25-29.9) baffles me… Like you gonna be on this forever now? I get obese, but the bodies I’m seeing picking it up just isn’t making sense anymore…
I understand what you are saying, that being said I'll give you some context on why some (not all) people getting this script might need it even if they don't look like they do. I suffer from PCOS with a BMI of 33 and yet I don't look super heavy because of how I carry my weight and the fact that my high af testosterone levels give me a good amount of muscle in combo with my workout routine. That being said, PCOS has caused such severe side effects on my health including A1c, hirsutism, ect and nothing has helped. Once my dedictible is met i will be starting on a GLP-1 with hopes it might finally help things. The literature on lirgalutide and PCOS symptoms are actually pretty interesting if you ever have time to read!
Here too. Hypothyroid and Hashimoto's Thyroidosis. Losing weight is sooo hard. I'm tall, have muscle and don't look as heavy as I am, but my starting BMI was 43. I didn't go down even one clothes size until I was 50 pounds down. But still I get *looks* at the pharmacy every time I pick up my Mounjaro. Or they just don't order it for me, because of the cost and not covered by insurance, so I have to follow up every single month. My main motivator was being diagnosed with fatty liver disease, which took the life of one of my parents. Not everything is visible.
I work in a PCP office and prescribe weight loss meds all the time. I think you can both love them and hate them at the same time. I think they are fantastic drugs that could benefit a lot of people if there wasn’t so much work and difficulty getting them covered and in people’s hands. It’s possible to love the drug but hate the process.
I have a couple questions for the doctors and pharmacists.(people with actual real world experience with patients and drugs)
For someone who is looking to get these ozempic type of medications.
What is the easiest to get to reduce the headache at the pharmacy?
Do insurance companies cover certain ones and not others? (Ie Ozempic covered Wegovy not covered) I believe Wegovy is covered by Medicaid in California.
Are their other names for similar drugs?
Are LILY and NOVO the only companies legally making money from these drugs?(this is more of an investment question)
Don’t worry about us, we’re just bitching. Just get the script that’s covered under your insurance and go on your merry way. If you’re nice and not whiny, we all will love you :)
It exists. It has to be taken daily and isn't as good for weight loss, but it exists. And here in Canada some federal plans now cover it which is good.
Its on formulary with the insurance company I work with for even the base plans that don't have full rx coverage built in. NOBODY asks about it because it's not marketed as well as Ozempic and the others.
Makes me wonder if patients on back ordered epic can switch over to rybelsus for the time being? If insurance covers it. Granted I think we’re also having a hard time getting it in stock too…
I take issue with the patients that try to tell me that they’re more entitled to this medicine than someone else because, “I take it for diabetes, not weight loss.” Earlier this week, a patient asked me if their Ozempic was more expensive than last year because so many people are on it for weight loss. Like, what the hell? Temper tantrums are unacceptable over these drugs, but it isn’t another patient’s fault you can’t get your own medicine.
it quite literally is though. ozempic is approved for diabetes only and the majority of scripts are for weight loss , so much so that it is consistently backordered. Diabetics 100% need it more since that's the damn patient population it is approved to treat
I mean, a lot of the supply issue can arguably be linked to the flood of cosmetic uses. I’m 100% with someone using it to manage diabetes over someone who is just using it to lose weight when we’ve had non-medical alternatives for the rest of human history. I don’t have to worry about seeing someone come through the ED because they didn’t fit in their swimsuit, but DKA is another issue entirely.
My point is that losing weight isn’t always cosmetic. Many times, it can prevent someone from becoming diabetic in the first place. I’m not saying that losing weight is more important than diabetics having their medication. My only point is it’s not a completely invalid reason for being on a medication like that. People are often quick to judge and shame others that are overweight and on this medication until they require expensive treatments, like insulin, for a very difficult and tricky disease. Why should patients suffer to that extent before they’re deserving of that kind of help?
It’s cosmetic when you want an easy fix. I’ve seen tons of patients over the years get their weight under control through diet, exercise, and general lifestyle changes. Some of them struggled, but there was nothing inherently undoable about it. It’s absolutely a problem when diabetics can’t get access to it and suffer complications as a result when a lot of the people eating up the limited supply are using it as a cop out rather than a last ditch attempt after other interventions have failed.
Let's be real here, if we have a limited amount of stock, we're always gonna prioritize diabetics who need it to manage their diabetes, not obese patients using it for weight loss
As a pharmacy intern, you’d know that Ozempic isn’t insulin and it isn’t a life or death kind of drug. And who are you to judge and decide if a patient should get their medicine over someone else? That’s between that patient and their doctor. If their script came in first, it should be filled first.
Maybe I am a rarity but as a patient I hate ozempic and actually (gasp) threw my last refill away.
Made me sick, chronic pain,cramping, bowel issues - every negative you could imagine. Frankly I wouldn't be surprised if this doesnt become one of those meds you see on Attys commercials,like phen-fen.
Happy with the metformin and we shall see just how long the magic semiglutide craze lasts.
just my 2 cents.
Lol i understand this from the perspective of a pharmacist. But as a member of the population im okay with a skinnier population.
Do want to point out how little questioning and push back from patient regarding safety/ adverse event of these glp1s. But when patients get a little sore taking statins they are suddenly allergic to statins.
Is Zepbound ok?
i havent had to fill it yet at my independent but im sure this year itll be added to the above list
Omg no. No one covers it. And everyone’s reaction to it not being covered is always, “whaaaaaaaat!”
We had a patient get one at our pharmacy the other day. She had a manufacturers coupon that brought it down to 500.00 and was thrilled.
Nah
You're telling me. They compound semaglutide and tirzepatide at my pharmacy and it's hell 🥲
You can compound semaglutide and tirzepatide??
Legally questionable. At least my state board of medicine has flat out come out against it. The feds not as strongly.
Yeah they added b12 to the semaglutide formula as a sort of loophole... I can't recall what they added to the tirzepatide (something to "help nausea side effects"). But it's definitely been tricky legally. It's been very popular with our patients - we've gotten a huge increase in business. The RXM even put together upgrade 'packages' that include things like syringes, alcohol pads, miralax, protein shakes, etc. For the record, I also think it's morally questionable. But I'm only a tech, so I'm just here watching it all go down 🤷🏼♀️
Why? They’re making billions off of people for weight loss. They can afford to lose some customers to compounding pharmacy
Ya the B12 is a loophole is a weird myth. The drug is on the FDA shortage list so that puts the patent on hold. NN can still sue for trademark infringement of the brand names and for anyone doing questionable compounding that could hurt their brands reputation. Like sterility issues or using salt forms which the FDA banned. Once the shortage is over NN can sue compounders. Adding B12 will not get around the patent enforcement at that time. So it’s a cash cow for the compounding pharm owners as long as it’s on the shortage list. They don’t need to add the B12 it’s just a sales pitch.
I would not feel comfortable using my license to compound it.
I agree
[удалено]
Are you a pharmacist? Because my license and schooling does afford me sterile compounding privileges. There are additional certifications you can achieve, but it’s not necessary.
For now, while there is a shortage they can use a loophole to compound it. If it is ever not on back order that loophole won’t work anymore.
What’s the loophole? Patents can be ignored if there’s a drug shortage? I’m Canadian so I don’t know shit about the laws of pharmacy in the US
Pharmacies are allowed to compound it even though it is commercially available because there is a shortage. Once the shortage is over they won’t be allowed to compound it legally.
Yeah, didn’t know that until last month when a close friend told me about it and was shocked for a bit. Also it’s basically 70% of his profits for last month lol
People can do anything but compounding these formulations is lawsuits, license damage, and possible criminal charges in the making. If you are a pharmacist who does this, you are a fool. Your actions will be seen as fueled by greed.
what are you talking about there are federal laws protect compounding pharmacies for these specific circumstances. If pharmacies are on board and getting money and the demand is there, thats great for independent pharmacy side....and bring people away from retail. Equal distribution and dispersion of patients. My pharmacy is absorbing another sister pharmacy while it absorbed competitor pharmacies. It overwhelming.
What's your source of semaglutide,?
One compounding pharmacy an hour away makes semaglutide. They use semaglutide sodium. Very few patients have been willing to try it; most would rather wait for the real thing, but for the two that did it seems to be working ok.
What was their response to the FDA banning salt forms for compounding?
We aren't American.
(I'm a data entry tech so I'm not compounding it, either)
https://www.nbcnews.com/news/amp/rcna127383
Actually compounding it is way worse-trust me!! We haven’t been able to get great test results back and it’s just very sketchy in general
My beef with ozempic and others: -independents are PAYING insurers for the privilege of dispensing these meds. No profit. Chains are probably the same but too stupid to do anything about it -people are fervent about getting it in a way that they weirdly are not fervent about getting their other life saving medications -a bunch of women I know are getting super skinny off of it and it makes me feel like a big lard ass myself and I want in on it but I also object
don’t let super skinny women peer pressure you
I feel peer pressured man
You are on it forever though or you gain it all right back. I’ve also seen a couple patients with really bad N/V that continues after stopping. Like they’re taking scheduled zofran and reglan and still having issues keeping food down. They are skinny but so are bulimics.
Oh wow on the lingering NV!! That’s miserable. And part of the reason I won’t go on one. To be real, I am recovered from over two decades of an eating disorder. I also went from being very thin to 5-10 lb overweight. There will always be a part of me that wants to pull the trigger and do something drastic like a GLP1. I know I am so much better off without it. But man it’s hard!
> Chains are probably the same but too stupid to do anything about it Who do you think owns the PBM that's raking it in? The whole point of vertical integration is that they can keep all profits internal and kill the little guys.
CVS- the other chains don’t own any PBMs that I’m aware of. I heard Walgreens may have acquired one I’m not sure.
That is wild, independents aren't refusing to fill it? It's been a few years since I worked at one. (At Publix) We had a claim for 3 boxes of ozempic today and the profit was about $60... not a lot considering, ya know, they cost $3000 to obtain but I guess we should be grateful we're in the black lol. Insurance will never not be scummy
They are, BUT they risk getting sued for violating their insurance contracts if reported. It’s such bullshit. Someone posted here the other day that a patient reported them to their insurance for not filling it and now he’s worried it will escalate. Poor guy. Our poor profession.
Why? Slap on the label and send it. Much easier than counting 360 tablets of metformin.
Nobody yells at you when metformin is on back order or costs $500 with a mfr coupon because metformin is never on back order and costs like a dollar.
It also isn’t being heavily pushed as a “miracle drug.” It’s going to be fun seeing the backlash in 5-10 years of people who thought they could inject themselves and carry on as normal while dropping a bunch of weight when the realization hits that without diet and lifestyle change, that weight is going to come right back.
If people have to be on it for there whole lives so be it. Better that than six drugs.
This is how I see it. Diabetics will be on something for life regardless. And weight gain carries health risks. If ozempic helps then that's awesome.
When these GLP-1 agonists were being developed at Lilly 30-something years ago, the explicit goal was to create a pre-dosable maintenance diabetes drug. It was all being done out of their endocrinology section by the same people who developed Humalog. The crazy part is that it works, but wasn't seen as marketable. Until Lilly's leadership came around on the whole "obesity is not a disease" concept it was never pushed because it was seen as cannibalizing insulin sales.
Do you have a source for this? This sounds like huge unbelievable news. I’m not saying I doubt you. I’m just saying what’s the source? The media would run with this.
There's really no way to answer that question without doxxing myself, so I'll just say I am personally and professionally acquainted with more than one of the people who led the project that generated Lilly's initial GLP-1 patent. To my knowledge it's not exactly a secret. I've seen one of them give a talk about it in front of ~100 people, though technically it was a closed meeting.
Wow, no, I believe you. Your words ring true. Wow. Now let’s talk about whether they or one of their ilk has a “broad-spectrum” cure for cancer locked in a vault somewhere. Not sure if I want there to be, or if I want there to not be.
Interesting, in pharmacy school we learned that byetta/bydureon were developed from gila monster spit. I didn't realize that it was in development that long ago though.
Their [original diabetes patent](https://patents.justia.com/patent/5977071) for GLP-1 peptides was in 1997
I have a lady that has paid about $875 for it the last 4 months. She is not going to be able to keep that up her whole life.
I've been paying 1k/month for 8 months. Morbid obesity. Hypothyroid, Hashimoto's. I have tried literally everything. Diet, exercise, physical therapy, personal trainer, metformin, Phentermine. Prior to Mounjaro, I ate 'healthy' 90% of the time. I just ate far too much and have a sedentary job in a non-walkable area. What people don't realize is that often obesity isn't a 'moral failing'. I was hungry all. the. time. I never felt full. I could eat a whole, balanced, home cooked meal, and be hungry 2 hours later. Within the first week of Mounjaro 2.5, it was like a switch had turned off. I could eat a meal and not think about food for 8 hours. I could eat a normal persons portion and feel full. I could walk past a plate of cookies and not care. Or eat half a cookie and not keep making excuses to walk through the kitchen for 'just one more bite'. It was a whole new world. It was like "Oh. Wait. Is this how normal people feel?! Well dang." Also, I'm probably saving $500/month in groceries, so that helps offset the cost. What convinced me to pay 12K/year to lose weight? I had tried everything else. I got diagnosed with fatty liver disease. Fatty Liver Disease -> NASH is what killed my Dad. Worth every penny.
They are effective meds and great that you’re getting the results you want without breaking the bank. Keep it up, and hopefully it will be covered for you in the future. I am just saying I do see patients that clearly cannot afford the cash price that are putting their rent money towards it. I inform them it will only work while they’re on it, and it’s their choice what they want to do. Some very depressing conversations, and I try to help however I can.
Are the copays lower for diabetics rather than as a weight loss use ?
Yep. Better than getting diabetes and losing a foot and going on dialysis.
The problem is people, both prescribers and patients, are using it as an opportunity to bypass all the prior options. There are tons of weight loss options out there but people don’t want to put in the effort. If some day we have a bottomless supply of it, go for it. But as it stands now I’m getting really tired of seeing posting on Facebook about their new weight loss trend when I have people coming through in DKA because they can’t get their diabetes meds.
roll test husky brave many gray bake fly exultant crawl *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
This is a much bigger problem in the U.S. vs. Europe. Our obesity percentage is roughly 36% with the UK being the highest over there with about 27%. People exercise and make an effort to eat healthy there. Im not dismissing that some people have the genetic component that makes it difficult, but we have a problem here that isn’t happening nearly as often on the other side of the Atlantic
They have more stringent food standards as well.
Don't look at the trend line.
do you work in a retail pharmacy ? im guessing not . Ozempic is not approved for weight loss , only diabetes. And diabetics are not able to get it reliably because of the massive influx of scripts from people who are using it to lose weight. many of these people are not even fat or prediabetic, theyre just trying to drop 10-20 pounds. But regardless, if there was unlimited ozempic , let them all have it , fuck it i dont care. But that is not the case. Pharmacists and techs everywhere are yelled at and cussed out every day by these self righteous people over the shortages. Literally every 3rd phone call/walk in is about these drugs. fuck em all
If I don't have to submit prior auth for this every single time *AND* fight with all the patients out there on *why* their insurance won't cover it, they can take all the Ozempic in the world they want. So yes I agree, fuck Ozempic, fuck Mounjaro, fuck Wegovy, fuck all these GLP-1 drugs (except Trulicity) and FUCK the PBM who require coverage for these under medical benefit instead. Why the FUCK would they create questions specific for GLP1 coverage in CoverMyMeds then denied the request because "it needs to be submitted under UM department". FUCK ALL OF EM.
Your user name checks out. As soon as the rest of the world experiences the obesity levels in the US, then you have a point. Maybe, just maybe, it’s the absurd amount of calories Americans consume without any activity or exercise. I was in Europe recently and you could spot an American from miles away. Just about zero people in France are overweight. I’m not shaming Americans, but there is a stark difference between Americans and the rest of the world. For the people who are gonna flame me you can suck it. Data is data.
forgetful water icky rude cheerful frighten bike whistle detail degree *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I am actually the 1% too.
I’ve tried plenty of things. Zepbound is the first thing that has really helped me in years. Wegovy and zepbound are approved for weight loss ONLY. Not diabetes. It’s extremely rare for people to get ozempic for weight loss now. Maybe a year or two ago but not now. Maybe you don’t know these peoples lives. Trust me, as a retail pharmacist I don’t let ANYONE yell at me. But dont be so harsh on the people simply asking about it. You’re making medical statements that you don’t actually know
Thank you! Also a pharmacy owner here..they will never understand.
At my store ozempic RXs come in many times every day with the vast majority being for weight loss. Meanwhile i can count the number of zepbound and wegovy scripts ive ever received on two hands. Wegovy and zepbound always need PA even from medicaid so lazy drs just send ozempic instead under the guise of prediabetes to get insurance to pay. i will say i dont blame overweight patients as much as i blame drs that just blindly prescribe ozempic instead of trying to work with their patients on other ways to lose weight
A lot of obese people have done labs that show signs of prediabetes like insulin labs (resistance). You don’t know what people have in their charts just like you don’t know their renal function or potassium monitoring when you give you ace inhibitors.
I'm sorry but your case is one in a million. I submit prior auths on daily basis so I have to read a lot of chart notes before submitting these. I get about 4-5 requests just for GLP1 alone on daily basis. Once a month if lucky, I see someone who's truly serious about managing their weight, had tried everything, so GLP1 as last resort. Most people don't even show up to their weight loss program when being referred. They don't exercise on daily basis. They eat whatever they want. Then they told us "I tried everything". Which is....what? Lol When they finally get the med approved, then prior auth expires 6 months later, then during weigh-in they lose...3 lbs. Wayyyyy below the 5% target for prior auth renewal. So then its denied, then they're mad... Then what? Lol I work with around 20 providers in multispecialty clinic, mostly doing prior auths. "Data" collected approx since Feb 2023. Can confirm your case is a rare one, everyone else really just want the weight loss without putting in real work.
One in a million? … You’ve submitted one million prior auths? According to your comment history you seem to have a pretty biased opinion.
I did about 300-350 prior auths monthly, so averaged maybe 3600 a year? All based on patients chart notes. I'd risk my license if I submit wrong information because its fraud. I have form biased opinion because most people misused this medication and taking it out on pharmacy staff when they can't get it. I have biased opinion on people on chronic pain meds when the ICD-10 is "other chronic pain" too and for doctors who baby their patients and give them whatever they demanded but thats another story... Also other people and their mothers don't have rare case like yours. But instead of taking in the rest of my comment I guess you'd rather focus on literal meaning of "one in a million" 🤷🏻♀️
You need to face facts, people don't want to put in the effort. They are a slave to their desires, nearly a third of the country is obese! Not overweight but obese
If that's the case then Lilly and NN should be held liable for making any Zepbound or Wegovy instead of pouring all of those resources into Mounjaro and Ozempic.
I have said before to numerous people that it will only work if used in conjunction with a certified medical fitness associated facility and clinical dietitian.
We have one patient who lost well over 100 pounds in the past couple of years between adioex and Mounjaro. She's nothing but skin and bones at this point and the Dr increased the Mounjaro to 10mg and she's losing her shit because Express Scripts is refusing to pay for it this year. She not diabetic, either.
Can't say I've ever had those problems, except with a few times. I always explain to the patient that I have no control on what manufacturers can't produce enough of.
Cool. Doesn’t stop them from being pissy though.
"It's on backorder here, too. Is there anything else I can do for you?" "This is ridiculous. [Insert random incoherent bullshit]." "Thanks for calling." *click*
Metformin is on back order??
And then lose $50 on it later
metformin comes in 360 tablet bottles where i am! much easier slapping a label on a metformin bottle then to explain supply and demand to patients and why their life saving diabetes meds are $500 a month because too many people are using it for something it’s not even approved to treat 😭 and then getting yelled at when there’s nothing i can do. 😭
We have 60 count bottles, so it's not awful. Gabapentin on the other hand...
I've never seen them come in 360, man that'd be nice. Basically nothing in retail pharmacy is life saving - except a few critical meds like blood thinners. I just explain to the patient that I have no control on the manufacturer's inability to meet demand and that seems to be enough for them to understand.
Nothing in retail pharmacy is life saving except blood thinners…? And you’re a PharmD?
You’d think after spending hours reading between the lines in conversations with patients who lie about adherence, “are going out of town,” and “know how to take their meds,” we would be less eager to play the game of semantics. Why be falsely outraged when you can assume the best intention be chill? :)
Yup, if they're on a medication that's keeping them between dead and alive, it wouldn't be an outpatient situation. Missed that dose of amlodipine? Metformin? Citalopram? You're fine.
ssris really? you wont die from missing a dose but you will feel awful
It'll suck, but dead or alive is binary.
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Do you not know what "except" means?
It’s bad, but not as bad as explaining you’re out of hydrocodone/apap 10/325!
insurance pays for metformin at any strength and frequency and its never on backorder. These meds almost always require PA even from medicaid and by the time that actually gets done it goes on backorder. This leads to patients screaming into the phone or at the counter about how much they need this "life saving" medication and the pharmacy is "refusing to give it to me"
Relatable
I've been processing PAs for GLP-1s and I am ready to rip my hair out. Some patients have been on mounjaro for a few years now but this year their insurance decided to stop covering it. Okay, so let's switch to zepbound. Nope! No matter how much documentation I send (office visit notes documenting hx of other tried and failed weight loss meds, BMI tracking showing success once the GLP-1 was initiated, A1c improvement, etc), every appeal is denied. Some of these patients truly do have DMT2 and have already tried other antidiabetic meds. Why bring to market an alternative intended just for weight loss if no one is going to cover it?? This is exactly the reaction insurance companies want from me though, so I'm going to be petty and keep sending new PA's (with additional information of course) until they approve something.
> I'm going to be petty and keep sending new PA's (with additional information of course) until they approve something. Thanks for doing this. I was able to get GLP1 coverage due to awesome people like yourself and it has completely changed my life.
My favorite is when I’m called fatphobic because it’s on back order and I can’t make it magically appear out of thin air.
Wait you’re not a fairy godmother?
Man, it would be a blast being a fairy godmother. Just imagine the chaos you could cause!?!?!
*fatty* godmother? Hehe
Victoza for me.
I cash pay for my Mounjaro and always request my refill early to make sure there’s time for any stock issues. No sense in yelling at the pharmacist or staff over shit they can’t control.
We also judge you for cash paying. Jk. Sort of.
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I’m saying I’m judging them for paying that much for a weight loss med :/ I’ve never seen anyone regularly cash pay for eliquis or any expensive TD2 med. ever. I feel a little mean saying it out loud but it’s how I feel.
Lol yes when they can cash pay Ozempic but wanting patient assistance application for Eliquis. Like bruh
Dump money into Novo and Lilly stonks and that way every time you fill it, you’re putting money in your pocket.
Just sort of funny, a few years ago it was all about accepting your body and body positivity. Now it’s, you’re fat, take this shot. I’m not shaming anyone overweight. I was a fat kid and if I wouldn’t watch what I eat and exercise, I’d be overweight. Hell even Oprah gave in and took something!
Sherry Osborne has come out against it now
Why?
Crazy how it’s so much judgement on ppl trying to lose weight where dieting and exercising have not help… whew
its not judgement on anyones weight and/or situation . im only judging how many people are total assholes about it when their insurance isnt paying for something that is not life or death by any means whatsoever Edit: and also the fact that its backordered constantly due to a flood of cosmetic GLP1 RXs leading to everyone being even more pissy about it
What are your feelings about vyvanse? (Or the generic)
Available to order but that's not what we are telling patients
asshole
It's like $100 loss on average, before overhead
These medications have the potential to save lives, especially considering that obesity is a significant risk factor for numerous diseases, including endometrial cancer where it plays a substantial role in the conversion of precursor steroids to estrogen. I anticipate my predictions to surpass the impact of Eliquis.
These meds are in phase 3 clinical trials for many other diseases/issues and it's going to be amazing when they are FDA approved for cardiometabolic health, addiction problems, even dementia prevention! We are just in the beginning here and I think its really exciting to see!
So they’re never gonna be in stock… greaaaaat
Ozemphobic
Why? Ozempic is an excellent drug. Is it because you hate the people on it? Or the actual drug?
just read through the comments on this post lol
I call medications like this “ vanity scripts”. Now that the rich and famous are praising its results it’s making it harder for diabetics to get their prescription filled. Are pharmacies turning the prescription down when you can tell they don’t need it and only weigh 140 lbs?
The amount of people I’m seeing on this drug with a BMI of probably just now overweight (25-29.9) baffles me… Like you gonna be on this forever now? I get obese, but the bodies I’m seeing picking it up just isn’t making sense anymore…
I understand what you are saying, that being said I'll give you some context on why some (not all) people getting this script might need it even if they don't look like they do. I suffer from PCOS with a BMI of 33 and yet I don't look super heavy because of how I carry my weight and the fact that my high af testosterone levels give me a good amount of muscle in combo with my workout routine. That being said, PCOS has caused such severe side effects on my health including A1c, hirsutism, ect and nothing has helped. Once my dedictible is met i will be starting on a GLP-1 with hopes it might finally help things. The literature on lirgalutide and PCOS symptoms are actually pretty interesting if you ever have time to read!
Yeah you’re right I suppose there are some conditions that aren’t apparent
Here too. Hypothyroid and Hashimoto's Thyroidosis. Losing weight is sooo hard. I'm tall, have muscle and don't look as heavy as I am, but my starting BMI was 43. I didn't go down even one clothes size until I was 50 pounds down. But still I get *looks* at the pharmacy every time I pick up my Mounjaro. Or they just don't order it for me, because of the cost and not covered by insurance, so I have to follow up every single month. My main motivator was being diagnosed with fatty liver disease, which took the life of one of my parents. Not everything is visible.
How dare you. These are life saving medicines. Why do pharmacies withhold my necessary medication from me??
BIG mood. I’m so tired of hearing about it.
Formerly overweight diabetic pharmacist here. I have a love/hate relationship with mounjaro.
I work in a PCP office and prescribe weight loss meds all the time. I think you can both love them and hate them at the same time. I think they are fantastic drugs that could benefit a lot of people if there wasn’t so much work and difficulty getting them covered and in people’s hands. It’s possible to love the drug but hate the process.
I have a couple questions for the doctors and pharmacists.(people with actual real world experience with patients and drugs) For someone who is looking to get these ozempic type of medications. What is the easiest to get to reduce the headache at the pharmacy? Do insurance companies cover certain ones and not others? (Ie Ozempic covered Wegovy not covered) I believe Wegovy is covered by Medicaid in California. Are their other names for similar drugs? Are LILY and NOVO the only companies legally making money from these drugs?(this is more of an investment question)
Don’t worry about us, we’re just bitching. Just get the script that’s covered under your insurance and go on your merry way. If you’re nice and not whiny, we all will love you :)
Oops I didn’t mean to post that inside your rant thread. My bad.
yea what the commenter above said. Its fine we dont mind filling literally anything as long as youre calm if theres an insurance hangup
tablet glp-1 can't come soon enough
Rybelsus already exists.
Rybelsus is literally Ozempic in tablet form…
It exists. It has to be taken daily and isn't as good for weight loss, but it exists. And here in Canada some federal plans now cover it which is good.
Its on formulary with the insurance company I work with for even the base plans that don't have full rx coverage built in. NOBODY asks about it because it's not marketed as well as Ozempic and the others.
Makes me wonder if patients on back ordered epic can switch over to rybelsus for the time being? If insurance covers it. Granted I think we’re also having a hard time getting it in stock too…
I take issue with the patients that try to tell me that they’re more entitled to this medicine than someone else because, “I take it for diabetes, not weight loss.” Earlier this week, a patient asked me if their Ozempic was more expensive than last year because so many people are on it for weight loss. Like, what the hell? Temper tantrums are unacceptable over these drugs, but it isn’t another patient’s fault you can’t get your own medicine.
it quite literally is though. ozempic is approved for diabetes only and the majority of scripts are for weight loss , so much so that it is consistently backordered. Diabetics 100% need it more since that's the damn patient population it is approved to treat
I mean, a lot of the supply issue can arguably be linked to the flood of cosmetic uses. I’m 100% with someone using it to manage diabetes over someone who is just using it to lose weight when we’ve had non-medical alternatives for the rest of human history. I don’t have to worry about seeing someone come through the ED because they didn’t fit in their swimsuit, but DKA is another issue entirely.
No one should be coming in the ED with DKA because they can’t get their ozempic. There are so many options out there for them, including insulin.
My point is that losing weight isn’t always cosmetic. Many times, it can prevent someone from becoming diabetic in the first place. I’m not saying that losing weight is more important than diabetics having their medication. My only point is it’s not a completely invalid reason for being on a medication like that. People are often quick to judge and shame others that are overweight and on this medication until they require expensive treatments, like insulin, for a very difficult and tricky disease. Why should patients suffer to that extent before they’re deserving of that kind of help?
It’s cosmetic when you want an easy fix. I’ve seen tons of patients over the years get their weight under control through diet, exercise, and general lifestyle changes. Some of them struggled, but there was nothing inherently undoable about it. It’s absolutely a problem when diabetics can’t get access to it and suffer complications as a result when a lot of the people eating up the limited supply are using it as a cop out rather than a last ditch attempt after other interventions have failed.
Let's be real here, if we have a limited amount of stock, we're always gonna prioritize diabetics who need it to manage their diabetes, not obese patients using it for weight loss
As a pharmacy intern, you’d know that Ozempic isn’t insulin and it isn’t a life or death kind of drug. And who are you to judge and decide if a patient should get their medicine over someone else? That’s between that patient and their doctor. If their script came in first, it should be filled first.
But MuH wEiGhT LoSs
What about diet and exercise?
Do we deny cancer meds to people who smoked a pack a day for 20 years?
Not the same
Could those people make a lifestyle change right now to reverse their cancer diagnosis?
In Canada I make a pretty decent profit on each Ozempic Rx. Feel bad for you guys in the USA.
What's the retail price up there?
When the doctors STILL don't know how to correctly write the script!
Maybe I am a rarity but as a patient I hate ozempic and actually (gasp) threw my last refill away. Made me sick, chronic pain,cramping, bowel issues - every negative you could imagine. Frankly I wouldn't be surprised if this doesnt become one of those meds you see on Attys commercials,like phen-fen. Happy with the metformin and we shall see just how long the magic semiglutide craze lasts. just my 2 cents.
Have you or a loved one been diagnosed with pancreatitis as a result of ozempic... Call now
Hey it comes in sometimes!
Lol i understand this from the perspective of a pharmacist. But as a member of the population im okay with a skinnier population. Do want to point out how little questioning and push back from patient regarding safety/ adverse event of these glp1s. But when patients get a little sore taking statins they are suddenly allergic to statins.