For the past year and a half, Tandra Cooper Harris and her husband, Marcus, who have both diabeteshave struggled to fill their prescriptions for the drugs they need to control their blood sugar.
without ozempic or a similar drug, Cooper Harris suffers blackouts, gets too tired to see his grandchildren, and struggles to make extra money braiding hair. Marcus Harris, who works as a cook at Waffle House, needs Trulicity to keep his legs and feet from swelling and bruising.
The couple's doctor has tried prescribing similar drugs, which mimic a hormone that suppresses appetite and controls blood sugar by increasing insulin production. But these are often too exhausted. Other times, their insurance through the Affordable Care Act marketplace burdens the couple with a lengthy approval process or an out-of-pocket cost they can't afford.
“It's like I have to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.
Short supply and insurance hurdles for this powerful class of drugs, called GLP-1 agonists, have left many people with diabetes and obesity without the drugs they need to stay healthy.
One of the causes of the problem is the very high prices charged by drug manufacturers. About 54 percent of adults who had taken a GLP-1 drug, including those with insurance, said the cost was “difficult” to bear, according to KFF survey results released this month. But it is patients with the lowest disposable income who are most affected. They are people with little resources who struggle to see the doctor and buy healthy food.
In the United States, Novo Nordisk charges about $1,000 for a month's supply of Ozempic, and Eli Lilly charges a similar amount for Mounjaro. According to the Peterson-KFF Health System Tracker, prices for a month's supply of different GLP-1 drugs range from $936 to $1,349 before insurance coverage. Medicare spending for three popular diabetes and weight loss drugs (Ozempic, Rybelsus and Mounjaro) to reach $5.7 billion in 2022, up from $57 billion in 2018, according to KFF research .
The “outrageously high” price tag has “the potential to bankrupt Medicare, Medicaid and our entire health care system,” wrote Vermont Independent Sen. Bernie Sanders, who chairs the Senate Health, Education, Labor and Pensions Committee. United States. in a letter to Novo Nordisk in April.
High prices also mean that not everyone who needs the drugs can get them. “They're already at a bit of a disadvantage in a number of ways and this is just one more way,” said Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia. Many of Rahman's patients, including Cooper Harris, are underserved, have health plans with high deductibles, or are on public assistance programs like Medicaid or Medicare.
Many pharmaceutical manufacturers have programs that help patients get started and stay on medications for little or no cost. But those programs have been unreliable for drugs like Ozempic and Trulicity because of supply shortages. And many insurers' requirements that patients receive prior authorization or try less expensive drugs first add to delays in care.
When many of Rahman's patients see her, their diabetes has gone untreated for years and they suffer from serious complications such as foot injuries or blindness. “And that's the end of the road,” Rahman said. “I have to choose something else that's more affordable and not as good for them.”
GLP-1 agonists, the class of drugs that includes Ozempic, Trulicity and Mounjaro, were first approved to treat diabetes. In the past three years, the Food and Drug Administration has approved rebranded versions of Mounjaro and Ozempic for weight loss, causing demand to skyrocket. And demand is only growing as more benefits of the drugs become apparent.
In March, the FDA approved weight loss drug Wegovy, a version of Ozempic, a treat heart problems, which will likely increase demand and spending. As many as 30 million Americans, or 9% of the US population, are expected to be on a GLP-1 agonist by 2030, estimated financial services firm JP Morgan.
As more patients try to get prescriptions for GLP-1 agonists, drugmakers struggle to make enough doses.
Eli Lilly urges people to avoid using its drug Mounjaro for cosmetic weight loss to ensure sufficient supply for people with medical conditions. However, the popularity of the drug continues to grow secondary effects such as nausea and constipation, boosted by its effectiveness and celebrity endorsements. In March, Oprah Winfrey aired a one-hour special on the ability of drugs to help with weight loss.
It may seem like everyone in the world is taking this class of drugs, said Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But there aren't as many people as you think,” he said. “There just aren't any.”
Even when drugs are in stock, insurers are cracking down, leaving patients and health care providers to navigate a thicket of ever-changing coverage rules. State Medicaid plans vary in their coverage of weight loss medications. Medicare will not cover the drugs if they are prescribed for obesity. And commercial insurers are restricting access because of the cost of the drugs.
Health care providers are developing care plans based on what is available and what patients can afford. For example, Cooper Harris' insurer covers Trulicity but not Ozempic, which he said he prefers because it has fewer side effects. When his pharmacy was out of Trulicity, he had to rely more on insulin instead of switching to Ozempic, Rahman said.
On one day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust the prescriptions of the 18 patients she saw because of problems with the availability and cost of the drugs, she said. One patient, insured through a teachers' retirement health plan with a high deductible, could not afford to be on a GLP-1 agonist, Addison said.
“Until I get to that deductible, it's not a drug I can use,” Addison said. Instead, he put his patient on insulin, the price of which is limited to a fraction of the cost of Ozempic, but which does not have the same benefits.
“Those patients who are on fixed incomes are going to be our most vulnerable patients,” Addison said.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF — the independent source of health policy research, polling and journalism.
