For the past year and a half, Tandra Cooper Harris, who has diabetes, and her husband, Marcus, have struggled to fill prescriptions for the medication they need to control their blood sugar levels.
Without Ozempic or similar drugs, Cooper Harris faints and feels exhausted from caring for his grandchildren and braiding hair for extra income, while Marcus Harris, a Waffle House cook, relies on Trulicity to keep his feet from swelling and bruising.
Their doctors have tried to prescribe similar drugs that mimic hormones that suppress appetite and stimulate insulin production to control blood sugar, but those drugs are often out of stock, and insurance through the Obamacare marketplaces can burden the couple with lengthy approval processes and out-of-pocket costs they cannot afford.
“It’s like you have to jump through all the hoops to survive,” said Cooper Harris, 46, of Covington, Georgia, east of Atlanta.
Shortages of these powerful drugs, called GLP-1 agonists, and insurance barriers mean many people suffering from diabetes and obesity cannot get the medications they need to stay healthy.
One root of the problem is the sky-high prices set by drug companies: About 54% of adults who take GLP-1 drugs, including those with insurance, said the cost is “difficult to afford,” according to a KFF poll released this month. But it’s the patients with the least disposable income who are hit hardest: those with fewer resources who struggle to see a doctor or buy healthy foods.
In the U.S., Novo Nordisk sells a month’s supply of Ozempic for about $1,000, and Eli Lilly charges a similar price for Maunjaro. Prices for a month’s supply of various GLP-1 drugs range from $936 to $1,349 before insurance coverage, according to the Peterson-KFF Health Systems Tracker. Medicare spending for three popular diabetes and weight-loss drugs — Ozempic, Ryversus and Maunjaro — is expected to reach $5.7 billion in 2022, up from $57 million in 2018, according to the KFF study.
The “exorbitantly high” prices “have the potential to bankrupt Medicare, Medicaid and our entire health care system,” Sen. Bernie Sanders, I-Vt., who chairs the Senate Health, Education, Labor and Pensions Committee, said in a letter to Novo Nordisk in April.
High prices also mean that not everyone who needs the medicines can get them.
“They’re already at a disadvantage in so many ways, and this is just one more thing that puts them at a disadvantage,” said Wedad Rahman, an endocrinologist at Piedmont Healthcare in Conyers, Georgia.
Many of Lerman’s patients, including Cooper-Harris, are medically underserved and have high-deductible health plans or are on public assistance programs like Medicaid or Medicare.
Many drug companies have programs to help patients start and stay on their medications at little or no cost, but for drugs like Ozempic and Trulicity, these programs are unreliable because of supply shortages, and many insurers require patients to get pre-approved or try cheaper drugs first, leading to treatment delays.
Many of Rahman’s patients have been suffering from untreated diabetes for years by the time they see her, leading to serious complications such as leg scars and blindness.
“And that’s the end of the road,” Lerman says. “They have to choose something else that’s more affordable and not as good for them.”
GLP-1 agonists (a category of drugs that includes Ozempic, Trulicity, and Maunjaro) were initially approved to treat diabetes. In the past three years, the Food and Drug Administration has approved rebranded versions of Maunjaro and Ozempic as weight-loss drugs, and demand has skyrocketed. And as the benefits of the drugs become more clear, the demand is only getting higher.
In March, the FDA approved a derivative of Ozempic, the weight-loss drug Wegovy, for use in treating heart disease, which is likely to boost demand and spending: Financial services firm JPMorgan estimates that as many as 30 million Americans, or 9% of the population, will be taking GLP-1 agonists by 2030.
As more patients seek prescriptions for GLP-1 agonists, pharmaceutical companies are struggling to produce enough of the drugs.
Eli Lilly and Company has urged people not to use its drug, Munjaro, for cosmetic weight loss, to ensure supplies for people with pre-existing conditions. But the drug’s effectiveness and celebrity endorsements have kept it growing in popularity, despite side effects that include nausea and constipation. In March, Oprah Winfrey aired an hour-long special about the drug’s ability to help with weight loss.
“It seems like everyone in the world is taking these types of drugs,” said Jody Dachey, an assistant professor at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center.
“But there aren’t as many people here as you might think,” she said. “In fact, there’s no one here.”
Even when the drugs are in stock, insurers are cracking down, and patients and providers must navigate a complex web of ever-changing coverage rules: State Medicaid plans vary in their coverage of weight-loss drugs; Medicare doesn’t cover drugs prescribed for obesity; and private insurers are tightening access to them because of their cost.
Healthcare providers put together care plans based on what’s available and what patients can pay. For example, Cooper-Harris’ insurance company covers Trulicity but not Ozempic, which she prefers because it has fewer side effects, Lerman said. When pharmacies ran out of Trulicity, she had to rely on insulin instead to switch to Ozempic, Lerman said.
On a recent day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, said she had to adjust prescriptions for all 18 of her patients because of drug availability and cost issues. One patient, who was on a Teachers Retirement Health plan with high deductibles, couldn’t afford to take a GLP-1 agonist, Addison said.
“Until you meet your deductible, you can’t use this medication,” Addison said. Instead, she prescribed her patients insulin, which costs a fraction of Ozempic but doesn’t have the same effect.
“Patients on fixed incomes are going to be our more vulnerable patients,” Addison said.
KFF Health News is a national newsroom producing in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of health policy research, polling and journalism.
