CMHC Pulse Blog

As ‘magic’ weight loss drugs capture public attention, you’ve likely seen an uptick in patients asking about GLP-1 RAs for weight loss. As your go-to partner for cardiometabolic risk reduction research, industry news, and practical strategies, we’ve created this highly practical guide to help you educate patients on safe access to GLP-1 RAs for weight loss.

#1 Discuss the Risks of Fraudulent Weight Loss Medications

Due to the insatiable demand for weight loss and the proven fat-shredding powers of GLP-1 RAs, scams and counterfeit drugs flood the marketing. The FDA warns that drugs purchased from fraudulent pharmacies threaten the health and safety of your patients. Fraudulent drugs may contain harmful ingredients or no active ingredients at all. 

In October 2023, the FDA issued two warning letters to fraudulent sites selling unapproved GLP-1 RAs: Gorillahealing and Semaspace. Later in December 2023, the FDA warned of thousands of counterfeit Ozempic prescriptions in active circulation and advised patients and pharmacists to verify lot numbers and dates.

This just scratches the surface of the serious public health issue. With a global obesity epidemic and rising rates of diabetes leading to drug shortages, patients hearing about these life-changing drugs on TV and social media may attempt to get these drugs through alternative routes. There have been reports of salons and other unconventional sources of places claiming to give cheap weekly injections of weight loss drugs.

How can patients know whether they are getting real or fake GLP-1 RAs on health websites, social media, and Med Spas?

3 Steps to Protect Patients from Fake Weight Loss Medications

  1. Advise patients to only buy medication with a prescription and from a licensed pharmacist.
  2. Guide patients to check for the original, unsealed package. Look for misspellings, poor-printing, and other signs of fraud.
  3. Share the FDA BeSafeRX site with patients who are buying drugs online.

 

Important note for providers: Healthcare professionals considering working with compounders should know that compounded semaglutide may not contain the same active ingredient as FDA-approved semaglutide products and may be the salt formulations.

#2 Explain the Long-term Commitment of Weight Loss Medications

Patients may need to be on weight loss drugs indefinitely. One study has shown that one year after stopping weekly doses of semaglutide, ⅔ of participants regained the lost weight and saw a similar rebound of cardiometabolic variables. You need to educate patients that weight loss medications may require indefinite use to maintain weight loss.

Anecdotally, Dr. Nadolsky, Medical Director at WeightWatchers has observed tens of thousands of patients using GLP-1 RAs for weight loss and has seen success with weaning patients off GLP-1 RAs through long-term lifestyle changes. However, some patients regain the weight lost when treatment stops.

Patients should be aware that long-term use can be cost-prohibitive. Weekly injections list for $1,200 per month or more for higher dosing, and insurance coverage can be limited.

Additionally, drug shortages, fueled by social media, celebrities, and widespread news coverage, can block patients from accessing medication and lead to substandard outcomes.

There are tolerability concerns that can prevent patients from staying on medications. The most common side effects are nausea, vomiting, and diarrhea. GLP-1 RAs have been associated with muscle mass loss and subsequent muscle weakness. Researchers believe that GI-related events and muscle mass loss can be prevented or addressed with appropriate lifestyle modifications (dietary and physical). It is in the hands of prescribing clinicians and patients to develop a comprehensive, whole-patient plan.

#3 Increase Awareness and Reporting of Mental Health Symptoms

A recent report, using qualitative and quantitative/mixed methods, social media listening, and AI and Natural Language Processing techniques, assesses GLP-1 RAs and perceived mental health issues by a large number of open web and social media platform customers. Some posts support the belief that GLP-1 RAs are an antidepressant, and significant/rapid weight loss can have positive impacts on the individual. GLP1-RAs are reported to affect both inflammation and hormones associated with mood and appetite.

However, many posts suggest GLP-1 RA-related depression may have occurred. This could be due to pre-existing mental health issues. It could also be due to a GLP-1 RA hypoglycemic state negatively impacting mood.

While potential cause and effect remain unclear, we must recognize the limits of social media listening (ethical boundaries and the lack of regulation) and the need for further research to uncover the complex interplay between metabolic diseases, depression, and medications.

While the FDA has been evaluating reports of suicidal thoughts or actions in patients taking GLP-1 RAs, preliminary evaluation did not find any evidence that these drugs cause suicidal thoughts or actions. Consistent with the prescribing information, prescribers should advise and monitor patients taking these medications to report new or worsening depression, suicidal ideation, and/or any changes in mood or behavior.

#4 Navigating the High Costs of Weight Loss Drugs

In 2003, the Medicare Part D law specifically excluded coverage of drugs for weight loss or weight gain, as well as cosmetic drugs. At the time, there was skepticism about weight loss drugs on the market and widespread belief that obesity is a behavioral problem, not a medical condition. However, Medicare Part D will cover Ozempic for the treatment of diabetes.

With private/commercial insurance, the price patients pay will vary depending on what condition you are treating, plan coverage, and the pharmacy. It is important to note that even if insurance covers the drug, coverage may lapse after a set period.

For your patients with a valid prescription and commercial insurance, there are savings options available to overcome the affordability barriers of GLP-1 RAs for weight loss with

Savings Cards:

  1. Wegovy (semaglutide)(obesity) savings card
  2. Zepbound (trizepatide) (obesity) savings card
  3. Saxenda (liraglutide) (obesity) savings card
  4. Ozempic (semaglutide)(diabetes) savings card
  5. Trulicity (dulaglutide) (diabetes) savings card
  6. Rybelsus (semaglutide) (diabetes) savings card
  7. Bydureon Bcise (Exenatide)(diabetes) savings card

 

Patient Assistance Programs: At the time of this writing, Patient Assistance Programs include GLP-1 RAs approved for diabetes (not obesity). Programs may provide a patient cost estimator and help with prior authorizations.

  1. NovoCare Patient Assistance Program provides medication at no cost to those who qualify.
  2. Lilly Cares Foundation Patient Assistance Program provides medication at no cost to those who qualify.
  3. AZ&Me Prescription Savings Program provides medication at no cost to those who qualify.

 

Off-Label Use: You may be able to use prior authorizations and medically accepted indications to get insurance coverage for off-label use of GLP-1 RAs for greater coverage and potential savings. The FDA recommends clinicians be well-informed when prescribing medications off-label. Sometimes healthcare professionals prescribe GLP-1 RAs off-label and patients then use them with savings cards. It is legal and common for clinicians to prescribe drugs off-label: however, this puts pharmacists in a difficult position if they have to say a patient has diabetes when they do not for the savings card.

Looking forward: There is increasing pressure on drug companies to lower costs and insurance companies to cover GLP-1 RAs for obesity or overweight with a weight-related condition. Also, with any new weight loss drugs coming down the pipeline soon, competition may lower medication costs.

#5 Accessing Legitimate and Safe GLP-1 RAs

Patients may decide to get weight loss telehealth and access GLP-1 RAs online. There is a lot of money to be made in weight loss, and there are many unapproved websites selling weight loss products. Patients need to understand that weight loss medication is not a quick fix and requires lifestyle modification. Online options should be honest about results and include a comprehensive plan to support the whole patient including dietary and physical lifestyle changes.

You can educate patients on the growing number of telehealth weight management options. Explore recent launches:

This January 2024, Eli Lilly launched the direct-to-consumer service LillyDirect for obesity, insulin, and migraine medication. Currently, Lilly offers Zepbound for weight loss. Consumers get a telehealth visit and delivery of medication to their homes. Telehealth visits are through independent, third-party providers.

Weight Watchers Clinic powered by Sequence, also launched a new GLP-1 program. This clinic gives members access to a multidisciplinary care team and access to and management of these medications. The team includes a care coordinator (to help with the insurance process) registered dietitian, a fitness specialist, and a board-certified clinician.

There is a fast-growing rooster of telehealth and virtual care companies that offer telehealth weight management and access to GLP-1 medications including Teladoc, Ro, Everly Health, and Form Health. Him & Hers has a weight loss program but is still working out supply chain issues for GLP-1 RAs.

Celebrities, influencers, and large numbers of people online and on social media singing the praises of GLP-1 RAs coupled with easy online access to drugs have created the perfect storm. As a clinician, it is your job to educate your patients and ensure healthy, safe, and affordable use of these ‘magic’ weight loss drugs.

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