For the past year and a half, Tandra Cooper Harris and her husband Marcus have both done just that diabeteshave had difficulty filling their prescriptions for the medications they need to control their blood sugar levels.
Without Ozempic or a similar drug, Cooper Harris suffers blackouts, becomes too tired to babysit her grandchildren and struggles to make extra money braiding hair. Marcus Harris, who works as a Waffle House chef, needs Trulicity to keep his legs and feet from swelling and bruising.
The couple’s doctor tried to prescribe it similar medications, which mimic a hormone that suppresses appetite and controls blood sugar levels by stimulating insulin production. But these are also often the case Out of Stock. Other times, their insurance through the Affordable Care Act marketplace burdens the couple with a lengthy approval process or out-of-pocket costs 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.
Supply shortages and insurance barriers for this powerful class of drugs, called GLP-1 agonists, have left many people suffering from diabetes and obesity without the medications they need to stay healthy.
One of the causes of the problem is the very high prices set by drug manufacturers. About 54% of adults who had taken a GLP-1 drug, including those with insurance, said the cost was “difficult” to afford, according to KFF survey results released this month. But it is the patients with the lowest disposable incomes who are hit hardest. These are people with few resources who struggle to visit doctors 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. Prices for a month’s supply of various GLP-1 medications range from $936 to $1,349 before insurance coverage, according to the Peterson-KFF Health System Tracker. According to KFF research, Medicare spending for three popular diabetes and weight loss drugs – Ozempic, Rybelsus and Mounjaro – reached $5.7 billion in 2022, up from $57 million in 2018.
The “scandalously high” price has “the potential to bankrupt Medicare, Medicaid and our entire health care system,” wrote Sen. Bernie Sanders, an independent from Vermont and chairman of the U.S. Senate Committee on Health, Education, Labor and Pensions. in a letter to Novo Nordisk in April.
The high prices also mean that not everyone who needs the medicines can get them. “They’re already disadvantaged in multiple ways and this is just one way,” says Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper Harris, are underserved, on high-deductible health care plans, or on public assistance programs such as Medicaid or Medicare.
Many drug manufacturers have programs that allow patients to get started and continue taking medications at little or no cost. But those programs have not proven reliable for drugs like Ozempic and Trulicity due to supply shortages. And many insurers’ requirements that patients obtain prior approval or try cheaper medications first are causing delays in care.
By the time many of Rahman’s patients see her, their diabetes has been unmanaged for years and they are suffering from serious complications such as foot wounds or blindness. “And that’s the end of the road,” Rahman said. “I have to choose something else that is more affordable and not as good for them.”
GLP-1 agonists – the class of drugs that includes Ozempic, Trulicity and Mounjaro – were first approved for the treatment of diabetes. In the past three years, the Food and Drug Administration has approved the new brand versions of Mounjaro and Ozempic for weight loss, causing demand to skyrocket. And demand is only growing as more of the drugs’ benefits become apparent.
In March, the FDA approved the weight loss drug Wegovy, a version of Ozempic, after treat heart problems, which is likely to increase demand and spending. Up to 30 million Americans, or 9% of the U.S. population, are expected to use a GLP-1 agonist by 2030, financial services firm JP Morgan estimates.
As more patients try to get prescriptions for GLP-1 agonists, drug manufacturers are struggling to make enough doses.
Eli Lilly is urging people to avoid using the drug Mounjaro for cosmetic weight loss to ensure adequate supplies for people with medical conditions. But the popularity of the medicines nevertheless continues to grow side effects such as nausea and constipation, driven by their effectiveness and celebrity endorsement. In March, Oprah Winfrey has released an hour-long special on the drugs’ ability to aid weight loss.
It may seem like everyone in the world is taking this class of drugs, says Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But it’s not as many people as you think,” she said. “It’s just not there.”
Even when the drugs are in stock, insurers continue to crack down, leaving patients and providers to navigate a maze of ever-changing coverage rules. State Medicaid plans vary in their coverage of the weight loss medications. Medicare does not cover the drugs if they are prescribed for obesity. And commercial insurers limit access because of the cost of the drugs.
Healthcare providers create care plans based on what is available and what patients can afford. For example, Cooper Harris’ insurer covers Trulicity, but not Ozempic, which she says she prefers because it has fewer side effects. When her pharmacy ran out of Trulicity, she relied more on insulin instead of switching to Ozempic, Rahman said.
One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to change prescriptions for all 18 patients she was seeing because of drug availability and cost issues, she said. One patient, insured through a high-deductible teacher retirement plan, couldn’t afford to take a GLP-1 agonist, Addison said.
“Until she reaches that deductible, that’s just not a drug she can take,” Addison said. Instead, she gave her patient insulin, which is priced at a fraction of the cost of Ozempic but does not provide the same benefits.
“The patients on fixed incomes are going to be our more vulnerable patients,” Addison said.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of its core operating programs KFF – the independent source for research, polls and journalism in the field of health policy.
