People searching for lower-priced GLP-1 weight loss drugs are facing a series of obstacles lately.
On Monday, a pharmaceutical company ended a direct sale deal offering Wegovy at a discount through the Hims & Hers telehealth company.
The collapse of the Novo Nordisk deal comes as less-expensive compounded versions of semaglutide — the active ingredient in Ozempic and Wegovy — come off the market, leaving consumers in a frantic search for replacements.
A Northeastern pharmacy professor says people seeking weight loss drugs may be able to get help from patient financial assistance programs and alternative medications. But it appears the days when lower-priced GLP-1 compounds were manufactured on an industrial scale may be over.
Manufactured by Novo Nordisk, Ozempic and Wegovy are once-a-week injectable medications.
Their active ingredient, semaglutide, belongs to a class of GLP-1 receptor agonists that work to reduce weight by mimicking a naturally occurring hormone that signals your body to feel full and slows digestion by increasing the time it takes for food to leave the body.
Compounding pharmacies were allowed to mix their formulations of semaglutide when demand for the ingredient outstripped supply in 2022.
The result was an explosion of sale offerings from online telehealth outlets and medical spas that marketed versions of Ozempic and Wegovy for hundreds of dollars less a month than the full retail price of $1,000 or more.
The companies were basically “mass producing” copycat medications, says Mansoor Amiji, distinguished professor of pharmaceutical sciences and chemical engineering at Northeastern.
“It created a lot of concerns as to the quality of the compounded product and whether these products were safe and effective,” he says.
The reign of compounded GLP-1s appeared to end in February, when the U.S. Food and Drug Administration declared the semaglutide shortage over. The agency said compounding pharmacies had to phase out manufacturing the copycat versions over the spring.
Months prior, the FDA had also taken tirzepatide, a GLP-1 and GIP dual receptor and the active ingredient in weight-loss drug Zepbound and type 2 diabetes drug Mounjaro, off a similar shortage list.
Don’t expect prices for brand-name GLP-1 drugs to drop dramatically any time soon, Amiji says.
“They are very expensive right now,” he says. “Over time, we may see the cost going down, but right now these products are making a lot of money for these companies.”
Novo Nordisk entered a partnership with Hims & Hers in April to make Wegovy more accessible to consumers, but ended the deal on Monday over claims the telehealth firm sold knockoff versions that put patient health at risk.
Consumers searching for a monthly loss prescription that doesn’t equal two car payments have some options, Amiji says.
The first is to explore insurance coverage. While many plans cover GLP-1 drugs for type 2 diabetes, coverage for weight loss varies a great deal.
More than a dozen states have filed legislation that would require insurers to cover weight loss plans.
For now, people who lack coverage have the option of contacting Novo Nordisk or Eli Lilly about their patient assistance and savings programs to see if they qualify for free or reduced-cost weight loss medications.
The Hims & Hers telehealth company has found a couple loopholes that appear to allow it to continue selling some compounded GLP-1 products, Amiji says.
Liraglutide, the active ingredient in Victoza, another blockbuster weight loss medication, “is still listed under the FDA registry as being in short supply and that’s why they can still compound and sell it,” he says.
The downside of Victoza is that it needs to be injected once a day instead of weekly, Amiji says.
Another workaround appeared when the CEO of Hims & Hers went public with the pronouncement that the company would sell more “personalized” compounded products, such as compounded GLP-1s with vitamin B6 or B12, Amiji says.
“There’s this gray area which they’re playing with,” he says.
Savanna DiCristina, a Northeastern assistant clinical professor of pharmacy and health systems sciences, says she has seen a growing demand for older weight loss drugs such as Qsymia and Contrave.
Qsymia, approved in 2012, combines an old stimulant, phentermine, with topiramate, an anticonvulsant medication.
Contrave, which has been around for 10 years, is a combination of the antidepressant bupropion and naltrexone, an opioid antagonist designed to combat cravings.
Neither medication is as effective in promoting weight loss as GLP-1 drugs, and Qsymia is known to cause birth defects, while Contrave comes with a “black box” warning label for the risk of suicidal thoughts and behaviors.
Metformin, an old drug for the treatment of diabetes, has been used off-label for weight control, but Amiji says it’s not clear whether the modest weight loss associated with the medication is due to the drug or lifestyle changes.
While weight loss medication can be a powerful tool for people fighting diabetes or obesity-related health problems, Amiji says his recommendation for people looking to lose a modest amount of weight is to improve nutrition and exercise.
“Eat healthy, eat things that you cook yourself as opposed to a lot of eating out,” he says. “Exercise. Try to do 10,000 steps a day. Even simple things like taking the stairs instead of the escalator or elevator can make a difference.”