Touted by celebrities, raved about by TikTok users, and advertised by med spas, a new class of drugs for treating diabetes and obesity has exploded in popularity for its weight-loss effects, leading to rippling shortages across several of the medications.
Amid the surge in demand, Eli Lilly and pharmacies have started to tighten access to the latest of this type of drug, tirzepatide, focusing on giving it to people with type 2 diabetes, the only population it’s authorized for so far. But that’s left another set of patients scrambling — people with clinical obesity who turned to the medication as one of their few options for treatment.
The class of drugs are GLP-1 receptor agonists, which mimic the effects of a hormone that can help people feel full. Within this group, Novo Nordisk’s obesity drug Wegovy and diabetes drug Ozempic have been in short supply for months due to manufacturing issues and increased demand. Lilly’s diabetes medication Trulicity has also been in tight supply, according to the drugmaker.
That leaves tirzepatide, sold under the name Mounjaro. Lilly said in a statement that the drug is currently not in shortage, but that the company is continuing to monitor availability of competitor therapies and “supply with a focus on access for people with type 2 diabetes.”
In October, Lilly made changes to a discount program for the drug, now requiring people to attest they have type 2 diabetes. The coupons allowed patients to get the drug for $25 a month when it would otherwise cost about $1,000. Some pharmacies are also now checking if people have a diabetes diagnosis before filling prescriptions.
Those moves have barred many people with obesity from using the medication. Their doctors had been prescribing it off-label, as data showed it to be effective in helping people with obesity shed weight, but patients are now having to stop the drug and see their weight and related health problems come back.
Though it’s understandable for Lilly to be focusing on the people its medication is indicated for, the situation is “unfair to everybody,” said W. Scott Butsch, director of obesity medicine in the Bariatric and Metabolic Institute at Cleveland Clinic. “It’s unfair to people who have obesity because there’s a drug that actually can very well help them and there’s a provider who wants to treat obesity, yet does not have access to a very reasonable treatment.”
Butsch noted that while patients with diabetes have some alternative medications available, people with obesity have fewer options. Regulators will be expediting their review of tirzepatide for obesity, but Lilly is expecting a decision late next year at the earliest. Additionally, many insurers don’t cover obesity drugs, considering them to be lifestyle treatments rather than medically necessary.
“It’s an unfair system,” Butsch said.
Megan Hoffman, a 47-year-old in Portland, Ore., has had obesity for over 20 years. She developed gestational diabetes when she was pregnant six years ago and now has pre-diabetes. Every attempt to shed weight wasn’t working, and “I just wanted to try to have a last-ditch effort,” she said.
Aided by Lilly’s coupon, she began taking Mounjaro in September, and “it’s a complete game changer,” she said. She experienced feelings of satiety that she didn’t have before, and she started to lose weight and see lower glucose levels.
But when she tried to get a refill this month, she said, her Walmart pharmacy refused to process her coupon without a type 2 diabetes diagnosis. She called the Walgreens and Safeway pharmacies in her area and they also refused.
Hoffman, who works at a nonprofit, is now considering taking on another job to afford to pay for the drug out-of-pocket. “I just want to live longer,” she said.
Shannon George, a 54-year-old in St. Louis, Mo., recounted offering to pay full price to get her refill at Walgreens last month, but the pharmacist still denied it without a type 2 diabetes diagnosis. George has had obesity for much of her adult life and was recently diagnosed with pre-diabetes and insulin resistance.
After she started taking Mounjaro in October, she not only began to lose weight, but her joint aches also started subsiding, she said. Now without the drug, her weight has fluctuated and her joint pain has come back. “It’s frustrating that I got teased with something that helped other things plus the weight loss, and now I can’t get it,” she said.
Lilly said its coupon program was designed to help commercially insured people with diabetes get Mounjaro as the drugmaker seeks coverage for the medication. “As we continue to broaden access for patients, we also want to continue to emphasize appropriate on-label utilization of the savings program,” the company said.
“Lilly only promotes Mounjaro consistent with its approved FDA indication and label and cannot comment on scripts for the treatment of indications outside of type 2 diabetes,” the drugmaker said.
Walgreens said it has not imposed a policy for pharmacists to check diagnoses before filling Mounjaro. Walmart said, “We rely on the professional judgment of our pharmacists when it comes to caring for our patients.” Safeway’s parent company Albertsons did not respond to requests for comment.
Many people with obesity, like Hoffman and George, have a high risk of developing diabetes. There’s much overlap between the two conditions, said Beverly Tchang, an endocrinologist and assistant professor of clinical medicine at Weill Cornell Medicine. “Obesity can lead to diabetes, diabetes can lead to obesity,” she said. “They’re very much intertwined, and to treat one but not the other seems inequitable.”
Tchang treats both types of patients and feels the drug shouldn’t be conserved for one group at the expense of the other.
It appears people “want to ‘save the medication’ for the people who ‘need it,’ and I understand that sentiment,” she said. But, she said, “we need to look at obesity as its own disease that is equally deserving of treatment.”
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