CNN
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For Christy Nguyen, menopause hit simply because the Covid-19 pandemic did. With each, she mentioned, got here undesirable weight achieve.
“I had gained 30 kilos in about two years, and so I used to be type of determined to seek out one thing” to assist with weight reduction, the 56-year-old mom of two mentioned. She’d tried WeightWatchers and the keto eating regimen, hoping to drop a few pounds and be capable to cease taking her not too long ago prescribed medicines for hypertension and ldl cholesterol. However nothing appeared to work.
That’s how Nguyen discovered herself on a 15-month journey via a brand new class of medicines like Ozempic and Wegovy. Referred to as GLP-1 receptor agonists, they’re exploding in reputation however can typically be inconceivable to get due to insurance coverage hurdles and shortages. Like an rising variety of sufferers, Nguyen started taking a decades-old prescription drug for weight reduction as a substitute.
“Folks come within the door in search of therapy with a GLP-1, after which for no matter cause, they will’t get it or change their thoughts,” mentioned Nguyen’s doctor, Dr. Jody Dushay of Beth Israel Deaconess Medical Middle.
Older weight-loss medicines have a number of advantages, Dushay mentioned. They are often extra reasonably priced, even out-of-pocket; are much less more likely to be in scarcity; include completely different unwanted effects than Wegovy and comparable medicine; and are tablets as a substitute of injections.
As total prescriptions of weight-loss medicine have soared, these for older medicines within the class have as effectively – though on a extra modest scale than medicine like Wegovy, in accordance with knowledge from Epic Analysis offered completely to CNN.
Battling insurance coverage and shortages
It began for Nguyen in spring 2022, when a earlier physician prescribed Wegovy. However although she certified primarily based on her physique mass index – about 35, she mentioned – the medication prices greater than $1,000 a month, and Nguyen’s insurance coverage wouldn’t cowl it. So her physician prescribed its sister drug, Ozempic, which is authorized for kind 2 diabetes and makes use of the identical key ingredient, semaglutide, at typically decrease doses. It’s typically used off-label for weight reduction.
Nguyen, who lives outdoors Boston, mentioned she was capable of finding a three-month provide of Ozempic for $900 via a web site that allowed her to order the drug from Canada. Over these three months, she mentioned, she misplaced 10 kilos.
“It wasn’t loopy quick,” Nguyen mentioned. “It was sufficient to type of really feel like ‘oh, nice. I discovered one thing that works.’”
However after three months, Nguyen mentioned, it wasn’t sustainable for her to maintain paying a lot out of pocket for the medication. By that time, a brand new choice had come available on the market: Mounjaro, a drug much like Ozempic that’s authorized for kind 2 diabetes. The producer, Eli Lilly, supplied a coupon to decrease some sufferers’ copays, and that helped Nguyen get that medication for a few yr.
She misplaced a further 10 kilos and thinks she might have misplaced much more, besides the drug was beginning to be briefly provide in increased doses, so she was caught on a decrease dose for longer than she in any other case may need been.
Even so, Nguyen mentioned, she’d lastly discovered one thing that was working for her, one thing that quieted the “meals noise” that had made it onerous to drop a few pounds prior to now.
“I simply sort of felt impartial about it for the primary time,” Nguyen mentioned. And greater than that, she mentioned, having new medicines like these was gratifying in how she felt the sphere of drugs was approaching weight reduction.
“All of the sudden, you type of really feel seen and heard for the primary time,” Nguyen mentioned, “when weight problems is sort of talked about as a illness fairly than as a type of lazy life-style.”
Then the Mounjaro coupon program ended, and Nguyen was left with out entry to the medicines but once more.
Nguyen’s physician then tried prescribing an older medication from the identical GLP-1 class, referred to as Saxenda. Nguyen’s insurance coverage denied it, she recalled, “as a result of my BMI was not within the morbidly overweight class.”
The US Facilities for Illness Management and Prevention defines weight problems as a BMI of 30 or extra, and Saxenda – in addition to different GLP-1 medicine – is authorized for folks with a BMI of a minimum of 30, or with a BMI of 27 and a minimum of one weight-related situation, like hypertension.
The CDC classifies BMI of 35 to 40 as “class 2 weight problems” and 40 and better as “class 3,” or what some consult with as extreme or, beforehand, “morbid” weight problems.
“So I’m like, ‘Effectively, , if you need me to turn out to be morbidly overweight, I assume I’ll come again and discuss to you in a few yr, as a result of we’ll most likely be there by then,’” Nguyen mentioned. “I’m not fats sufficient, or one thing.”
Within the three months after Nguyen stopped Mounjaro, from August to November, she mentioned, she gained again about 80% of the 20 kilos she’d misplaced over the earlier 15 months.
“It was alarming, the speed I gained it again,” Nguyen mentioned. “It was a minimum of a pound per week.”
That’s when she was referred to Dushay, an endocrinologist centered on weight problems and kind 2 diabetes at Beth Israel and an assistant professor of drugs at Harvard Medical Faculty. The 2 began brainstorming about choices.
It’s a dialog Dushay says she has with lots of her sufferers as the recognition of latest medicine like Ozempic leads folks to hunt weight reduction therapy the place they may not have earlier than, however then they encounter limitations to truly getting the medicines.
“I believe there may be this underlying sense of ‘I ought to be capable to do that by myself,’ which doesn’t apply to quite a lot of different persistent illnesses and which, I believe, is a misperception for a lot of causes,” Dushay mentioned.
The increase in reputation of latest medicine, she mentioned, “I believe perhaps has allowed folks to hunt medical look after the therapy of a illness the identical manner you’d for those who had diabetes or for those who had hypertension.”
Due to persistent shortages of Mounjaro, Ozempic and Wegovy, insurance coverage denials and myriad different causes, Dushay and different docs have been reaching for instruments they used earlier than these medicine grew to become accessible: older prescription medicines used each on- and off-label for weight reduction, like phentermine, metformin and bupropion.
For Nguyen, Dushay prescribed bupropion, first approved by the US Meals and Drug Administration in 1985 and greatest generally known as the brand-name antidepressant Wellbutrin. It’s additionally authorized for smoking cessation and, in 2014, was approved by the FDA for weight reduction together with one other drug, naltrexone, as Contrave.
“You’ll be able to attempt it for folks in whom afternoon or night snacking is an enormous downside or who’ve numerous yearning for sweets,” Dushay mentioned. “Just like the way in which that it helps to work for smoking cessation, via cravings – I believe that’s the first mechanism via which it may well assist.”
Nguyen mentioned in November that after per week on bupropion, she felt it could lastly have stopped the continual weight achieve she’d been experiencing since she misplaced entry to Mounjaro.
Charges of weight-loss prescriptions amongst adults characterised as chubby have greater than doubled since 2017, in accordance with knowledge from Epic Research primarily based on evaluation of hundreds of thousands of digital well being information. Simply from 2022 to 2023, the information exhibits, charges jumped 25%.
The largest will increase are for semaglutide and tirzepatide, the generic names for Ozempic and Wegovy (semaglutide) and Mounjaro and Zepbound (tirzepatide). However there have additionally been vital will increase in prescription charges of older medicines.
The prescription price for bupropion rose 29% between 2017 and 2023, in accordance with Epic’s knowledge, whereas the speed for phentermine, authorized by the FDA in 1959, is up 34%. The evaluation checked out adults characterised as chubby who had prescriptions for any medicines in a given yr and the charges who had been prescribed a weight-loss drug.
The numbers are larger for the newer medicines: Semaglutide’s prescription price practically doubled prior to now yr alone, whereas tirzepatide’s rose 141%. Semaglutide was authorized as Ozempic for kind 2 diabetes in 2017 and cleared for persistent weight administration as Wegovy in 2021. Tirzepatide, as Mounjaro for kind 2 diabetes, was cleared in Might 2022 and final month for weight reduction as Zepbound.
“Not all people has insurance coverage protection for the brand new medicines,” mentioned Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medication who makes use of older medicines, in addition to newer ones, extensively in his observe. “In order that they’re doing what they will to drop a few pounds.”
The older medicines will be very efficient, he mentioned, however as with every class of remedy, it’s a matter of discovering the correct one for every individual. Phentermine, for instance, can enhance coronary heart price and blood strain, so he mentioned he wouldn’t attain for that drug for somebody with heart problems.
Phentermine was a part of the infamous fen-phen mixture that led to severe coronary heart valve issues in some sufferers; the opposite medication within the mixture, fenfluramine, was pulled from the market in 1997. The FDA didn’t request elimination of phentermine.
The medication was additionally authorized as a part of a mix with one other drug, topiramate, because the weight-loss drug Qsymia in 2012.
Medical trials of Qsymia and Contrave didn’t yield as a lot weight reduction because the GLP-1 class, and the medicines by no means grew to become industrial successes.
For some folks, the newer medicines are much less interesting exactly as a result of they’re new. Sixty-two-year-old Henry Benson mentioned he’d misplaced about 70 kilos over 4 years via a lifestyle program with Dushay and hoped to lose 20 extra. He and Dushay mentioned Wegovy and different comparable medicines, and he determined they weren’t for him.
The potential unwanted effects related to GLP-1s sounded “significantly disagreeable,” he mentioned; they will embrace nausea, vomiting and constipation, significantly as sufferers first begin the medicines.
Moreover, he mentioned, “the drug is comparatively new, so we don’t actually know what the long-term unwanted effects are. … I simply I checked out all of that and I mentioned, ‘You understand what, I simply don’t assume that that is proper for me.’”
He and Dushay settled on metformin, a generic drug authorized in 1994 for kind 2 diabetes. He’s misplaced about 5 extra kilos, and his objective is to cease taking the medication after shedding about 15 extra kilos after which to keep up his weight reduction with out remedy. He famous that he’s already been capable of cease different medicines, like statins, as a result of his levels of cholesterol fell with modifications he made within the sorts of meals he was consuming.
And though physicians are glad to have new instruments like GLP-1s, their elevated use can include downsides, mentioned Dr. Zhaoping Li, a professor of drugs and chief of the Division of Medical Vitamin on the College of California, Los Angeles.
“Persons are shedding weight, all proper, however they’re additionally shedding quite a lot of muscle,” which will be significantly worrisome for geriatric sufferers, Li mentioned. “One other main situation is, persons are consuming so little, they begin to have malnutrition and vitamin deficiencies. So it’s not a free journey for everybody to a greater place.”
These dangers, docs mentioned, should be balanced with dramatic advantages from the brand new medicines; Dushay and Aronne each cite trial results from this yr exhibiting that Wegovy can cut back the danger of coronary heart assaults, strokes or heart-related loss of life in folks with heart problems by 20%, along with weight reduction.
And with Zepbound newly accessible from Eli Lilly, sufferers like Nguyen are hoping for higher luck gaining access to it. Dushay mentioned that about 75% of her requests for insurance coverage protection of the drug, which was priced at a reduction to Wegovy however nonetheless at greater than $1,000 monthly, have been getting denied. Wegovy, Dushay mentioned, has improved protection after being available on the market for longer, but it surely’s in shortage, significantly in decrease doses.
Prefer it did for Mounjaro, Lilly is providing a coupon to decrease some sufferers’ out-of-pocket prices. Nguyen mentioned her insurance coverage denied protection, however the financial savings card permits her to pay $550 a month. She plans to make use of that as she begins on decrease doses of Zepbound and, when she’s reached a better dose, probably swap to Wegovy, which is roofed.
She took her first injection of Zepbound final week.