SAN FRANCISCO — When she prescribes the popular weight-loss drug Wegovy, Dr. Angela Fitch sends patients on a quest she likens to “The Hunger Games."
They will have to call drugstores over several days to find one with the properly sized first dose. Then they'll do that again for their second dose, and probably the third. And that’s only if the patient has insurance or the means to afford a drug that can cost more than $1,300 a month.
“This is not for the weak-willed,” said Fitch, who is president of the Obesity Medicine Association and also consults for drugmakers.
Supply problems and insurance complications have made it difficult for people to start — and stay on — Wegovy and similar medications that are transforming obesity treatment, according to doctors and patients around the country. They say getting the high-demand, injectable drugs requires persistence and a fair amount of luck.
People starting on Wegovy have to take injections of gradually increasing strength before they reach the so-called maintenance dose that they stay on.
The drug's maker, Novo Nordisk, says that demand has forced it to restrict the supply of those smaller, initial doses in the U.S. The company also is warning those taking another weight-loss drug, Saxenda, to expect difficulty filling prescriptions “for the remainder of 2023 and beyond.”
Another drugmaker, Eli Lilly, has said it expects tight supplies until year's end for its diabetes treatment Mounjaro, which also is prescribed for weight loss.
Finding Wegovy can become a part-time job for patients, said Dr. Diana Thiara, medical director of the weight management clinic at the University of California, San Francisco.
Thiara said some wind up driving 45 minutes or more to get prescriptions filled, a barrier for hourly workers who can’t leave their job and for people without cars.
“It’s usually patients who are a little bit more privileged, able to take off from work to go make those drives,” Thiara said.
One of Fitch's patients, Mike Bouboulis, has taken Saxenda, Mounjaro or Ozempic, a Novo diabetes drug with the same active ingredient as Wegovy, since around 2019. It became much harder for him to find the drugs in the past year, after their popularity exploded.
Refilling a prescription involved calling five to seven pharmacies.
“They all know what you’re calling for, and they all have the same answer: ‘I don’t know. We’ll see tomorrow,’" said the 35-year-old small business owner who lives outside Boston.
Pharmacy technician Lizzy Nielsen used insider knowledge to start Wegovy earlier this year.
She regularly checked drug wholesalers' supply lists, refreshing her screen each morning, and then ordering Wegovy for her pharmacy as soon as she saw it in stock.
“I was really lucky ... because that’s when it was like starting to be constantly back-ordered,” the 42-year-old West Springfield, Massachusetts, resident said.
While patients have had to deal with shortages of many medications in the past year, those taking weight-loss drugs can face coverage complications too.
The federal Medicare program for people age 65 and older doesn’t cover obesity medicines, but some privately run Medicare Advantage or Medigap plans do, according to Novo. Coverage from Medicaid programs for people with low incomes varies.
Doctors and patients say many insurers have stopped covering Ozempic and Mounjaro outside their approved use for diabetes. Some insurers and employers don't pay for Wegovy.
Novo Nordisk even offers a form letter on its Wegovy website to help doctors request coverage.
Bouboulis, the Boston-area resident, said his insurer stopped covering Mounjaro earlier this year. He then tried switching back to Ozempic but found that also was no longer covered.
He’s taking low doses of leftover Ozempic until he can find coverage.
“I know the insurance companies don’t want to pay, but between (them) and the pharmaceutical industry, they need to find some kind of nice middle ground because these medications, they can save people’s lives,” said Bouboulis, who has lost around 80 pounds since he started taking them.
Employers and insurers that do pay for the weight-loss treatments often require patients to get pre-approval or to first try other strategies like diet and exercise.
Some require patients to show they’ve lost 5% of their body weight after six months on the drugs in order to continue coverage. Supply problems make that hard, Thiara noted.
“A lot of patients are not staying on it consistently because they can’t get it,” she said.
Dr. Laura Davisson estimates that less than 30% of her patients with insurance through an employer or an individual plan have obesity medicine coverage.
Davisson directs a weight-loss program in West Virginia, a state that consistently ranks as having one of the highest obesity rates in the country. The state's Medicaid program doesn't cover Wegovy, but neighboring Pennsylvania's does.
“For me, it’s either they have coverage through insurance, or they’re not taking it,” she said. “No one can afford it.”
Coverage may improve over time, as it has with other obesity treatments like bariatric surgery.
About 46% of large U.S. employers cover obesity medicines like Wegovy, according to the benefits consultant Mercer. Another 18% are considering it. Mercer’s experts say employers are still trying to learn about how the added cost will affect them and what other support patients may need.
Dr. Deborah Horn says she thinks supply problems and coverage will eventually smooth out, but it may take a couple years. She noted that the FDA may soon approve Mounjaro to treat obesity, which could improve coverage.
Drugmakers also are developing other weight-loss medications, including easier-to-take pills.
In the meantime, more patients are realizing that they can get medical help for their disease and don't have to manage it on their own, said Horn, an obesity medicine expert at UTHealth Houston.
“I feel like this is the beginning of the change in obesity care, where we will see every year better and better medications coming to market and people getting their disease under control,” she said. “We're just in the hard part ... right now.”