Hyped weight loss drugs raise supply, equity concerns

illustration "prescription" there is a positive line coming out "x".

Illustration: Shoshana Gordon/Axios

The buzz among celebrities and social media influencers surrounding off-label use of diabetes drugs for weight loss is fueling a surge in prescriptions and concerns about costs and possible shortages.

big picture: Weight-management prescriptions for Novo Nordisk's Ozempic or Eli Lilly's Mounjaro will top 5 million by 2022, up from about 230,000 in 2019, according to Komodo Health.

detail: With an estimated 37.3 million people in the U.S. (11.3% of the U.S. population) living with diabetes and an estimated 42% prevalence of obesity in the U.S., these drugs are seen as potential game-changers.

  • But there are concerns about who should take the drugs, which don't work for everyone and can cost as much as $1,400 a month in out-of-pocket costs if insurance doesn't cover them. They can also produce a range of side effects, including facial drooping known as “ozone face”.
  • Consumer demand has created supply issues, and the FDA has placed Ozempic on a shortage list. And there are questions of fairness about whether people who can afford out-of-pocket payments are getting drugs that might otherwise be available to those in greater need.
  • Insurance companies are reviewing the long-term effects of these drugs.
  • AHIP, the insurer's lobby group, said in a statement: “Diabetes treatments … have not been shown to be effective for long-term weight management and may have complications and adverse effects on patients.”

How it works: These drugs mimic a hormone in the body that regulates appetite and blood sugar levels.

  • Ozempic and Mounjaro have been approved by the FDA to treat type 2 diabetes, while drugs such as Novo Nordisk's Wegovy and Saxenda have been approved to treat obesity.
  • Prescriptions for the drugs have soared more than 2,000% in four years because they help patients lose an average of 15% of their body weight and have relatively few safety concerns, according to Komodo.
  • This was driven in large part by off-label prescribing by physicians in response to demand sparked by social media buzz.

Search TikTok or other popular sites You'll find plenty of before and after weight loss testimonials from patients in bikinis and crop tops.

  • “Whether you hear it from your friends, you hear it from the news, you hear it from a celebrity, it lets the patient know it's real and maybe I should ask for it. That gives the health The system is under pressure,” said Tabby Khan, chief clinical product specialist at Komodo Health.

What are they saying: CEO and founder Isabelle Kenyon said: “I've been convincing people in my first year in business that this is even a category, and in my last year in business I've been convincing consumers that you have to be The right person, and the right commitment to take the drug.” Virtual weight loss provider Calibrate.

  • Her company screens patients to make sure they are only prescribed the drugs when appropriate, she said. In her experience, she's seen the pandemic trigger patients' fears about their weight.
  • “I've been talking to members all day long and they say … it's never about getting a bikini body or losing weight,” Kenyon said. “It's always been about getting back in control of my health, and at some point during COVID, I saw a number — whether it was cholesterol, blood sugar or triglycerides — and it scared me.”

Yes, but: These drugs also open a Pandora's box about how we perceive obesity as a health problem.

  • Celebrities like “The Real Housewives of Beverly Hills” stars Kyle Richards and Khloe Kardashian have publicly stayed away from drugs, saying they “work really hard” on their physiques, according to The Cut.
  • Meanwhile, patients who are sensitive to the belief that obesity is a lifestyle choice say they “feel more stigmatized for seeking help with weight loss services than for erectile dysfunction or herpes,” says Ro CEO Zach Reitano Say, Ro is a digital direct-to-consumer provider of weight loss services to patients along with Wegovy.

  • “For a long time, people have viewed obesity as a moral lapse, a matter of self-discipline…but [these drugs] In my opinion, emphasizing obesity is a disease that needs to be treated,” Retano said.

Between the lines: The data showed that family physicians and nurse practitioners were most often prescribing these treatments, not endocrinologists.

  • “Anyone who thinks, ‘Yeah, it would be beneficial if my patient lost 20 or 25 pounds,' is saying, ‘I'm going to prescribe this. What's the big deal?'” Kenyon said. “No one is thinking about the cost, and no one is thinking about what happens when the patient stops the drug.”

enlarge: The question itself is part of a larger industry debate: Should patients have a long-term opinion on drugs?

  • “If someone is on insulin and they finally get their blood sugar levels under control, our first reaction is not, ‘Well, why can't they stop using it?'” Reitano said. “They have a disease and this miracle drug is helping them.”
  • But Kenyon said she “didn't agree with that at all.”
  • She said her company was built around combining behavior-change modification with medications, with the goal of freeing patients from their medications. She said the data they've gathered since their launch suggests patients can be weaned.
  • Patients don't want to be on injectable drugs forever, she said. Moreover, she added: “It is not possible for a commercial plan to pay for these drugs for half of U.S. adults indefinitely,” she said. “We're going to bankrupt the health system.”

what to see: Experts said they expected the shortage of drug supplies could be resolved in the short term.

  • A generic version of diabetes drug Victoza will hit the market in the summer, and other companies are developing other drugs for that market.
  • Eli Lilly's Mounjaro is still only approved for diabetes and is expected to be approved for weight management this year.
  • “If the next generation of drugs appears to be more effective, has fewer side effects, and is cheaper to manufacture, that's an amazing set of advances we're going through,” Kenyon said.

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