The semaglutide shortage probably won't last forever. But for now, physicians strive to provide the best care for their patients as they navigate the shortage as part of a crucial aspect of their practice.
But even when drug manufacturers like Novo Nordisk straighten out supply chain issues and the obesity drug Wegovy, for instance, becomes plentiful, millions of patients won't see the likes of these drugs: Most on label for the treatment of type 2 diabetes have been found to reduce body weight, but insurers may not cover the drugs or deny coverage for weight loss medications like Ozempic, Mounjaro, Saxenda, Victoza, Zepbound, and Trulicity.
"Insurance coverage is difficult for a majority of patients. Certainly, they're more likely to get coverage for Ozempic (indicated for type 2 diabetes) if they have type 2 diabetes as opposed to just obesity, but still, the likelihood of insurance coverage for any of these medications, no matter the indication, is statistically unlikely," said Jonathan Kaplan, MD, MPH, a board-certified plastic surgeon at Pacific Heights Plastic Surgery in California.
"Just like the patient doesn't want to pay out-of-pocket due to the cost of the name-brand medication, even with a discount, the insurance company doesn't want to pay a relatively high amount for the cost of these medications," Kaplan told Medscape Medical News.
Managing Patient Relationships Amid Medication Shortages
Despite all the hype, glucagon-like peptide 1 (GLP-1) receptor agonists don't work for every patient and come with common unpleasant side effects. Still, patients are clamoring for the drugs, and doctors play a crucial role in addressing their concerns, providing reassurance, and collaborating with their patients to find suitable alternatives.
Many physicians feel that they're robbing Peter to pay Paul, creating secondary shortages of Ozempic and other GLP-1 receptor agonists for patients with type 2 diabetes who might have a challenging time finding their medication. Should physicians prescribe Ozempic for a patient with normal blood sugar but who needs to lose 60 lb before knee replacement surgery? How about a patients with severe obesity with 100 lb to lose who has prediabetes and high blood pressure? What about a patient who needs to lose 40 lb and has no metabolic disease but is so frustrated and depressed about their weight that their quality of life has plummeted?
"Physicians, grappling with the scarcity of Wegovy and Ozempic, must now prioritize patients at the greatest risk who stand to benefit considerably: a complex decision-making process it is. Consequently — owing partly to insurance hurdles and an emphasis on treating diabetes over weight loss alone — many individuals face significant barriers when accessing these drugs," said Kevin Huffman, DO, a board-certified bariatric physician and CEO of AmBari Nutrition in Elyria, Ohio.
The broader issue, Huffman added, is disparities in healthcare access and an urgent need for solutions tailored to address patients' diverse requirements for effective weight management.
Physicians treating weight loss, therefore, face a bias from private insurers and Medicare, who won't cover weight loss medications except when they do with a loophole that covers Ozempic for people without type 2 diabetes and would prefer patients try and fail at every diet plan and weight loss medication, many with serious cardiovascular side effects before being approved for newer drugs. Manufacturers like Novo Nordisk have issued statements that Ozempic and Wegovy aren't interchangeable.
Kaplan noted that the shortage of the name-brand medication isn't as significant of a problem for his patients because he can access semaglutide and tirzepatide (active ingredients in Mounjaro and Zepbound) from compounding pharmacies. "We use pharmacies that use FDA-approved manufacturers," he noted.
However, the US Food and Drug Administration reported that some compounded versions of Ozempic and Wegovy may use salt-based forms of semaglutide instead of the pure ingredient, causing adverse effects for people taking the compounded versions.
Empathy and Clear Communication May Help Maintain Trust and Patient Satisfaction
For now, undertaking several measures to address the shortage more effectively is crucial. "Foremost, we must increase production and distribution of these drugs; moreover, we should explore alternatives with comparable mechanisms of action — efforts that may lead us toward what is known as expedited approval for new medications in the same class," said Huffman. There are several medications for obesity in clinical trials currently with promising results.
Reassessing the classification of weight and obesity in healthcare is also essential. "It is something that extends beyond mere metabolic consequences — understanding this leads to a pivotal moment: ensuring unrestricted access to effective weight management medications," Huffman noted.
"This, in turn, prompts a larger conversation about holistic healthcare approaches encompassing both metabolic and weight-related issues — to ensure patients receive treatments tailored for their unique needs."
From a policy and industry perspective, physicians must advocate for solutions that ensure a stable supply chain for essential medications, allowing doctors to focus on delivering optimal care without the added burden of navigating unpredictable drug shortages.
Jennifer Nelson is Features Editor, Reports at Medscape. Her work has also appeared at WebMD, Medical Economics, MedPage Today, as well as The Washington Post, AARP, US News & World Report, The Oprah Magazine, Women's Health, and others.
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