For the past year and a half, Tandra Cooper Harris and her husband, Marcus, both of whom have diabetes, have struggled to fill their prescriptions for medications necessary to control their blood glucose.
Without Ozempic or a similar drug, Cooper Harris experiences blackouts, becomes too fatigued to watch her grandchildren, and struggles to earn extra money braiding hair. Marcus Harris, who works as a Waffle House cook, requires Trulicity to prevent swelling and bruising in his legs and feet.
Their physician has tried prescribing alternative medications, which mimic a hormone that suppresses appetite and controls blood glucose by increasing insulin production. However, these drugs are frequently out of stock. Additionally, their insurance through the Affordable Care Act marketplace often imposes a lengthy approval process or an unaffordable out-of-pocket cost.
“It’s like, I’m having to jump through hoops to live,” said Cooper Harris, 46, a resident of Covington, Georgia, east of Atlanta.
Supply shortages and insurance barriers for GLP-1 agonists have left many individuals with diabetes and obesity without the necessary medications to maintain their health.
One root of the problem is the exorbitant prices set by drug manufacturers. Approximately 54% of adults who had taken a GLP-1 drug, including those with insurance, reported that the cost was “difficult” to afford, according to KFF poll results released this month. Those with the lowest disposable incomes are hit the hardest, as they struggle to see doctors and buy nutritious foods.
In the United States, Novo Nordisk charges about $1,000 for a month’s supply of Ozempic, and Eli Lilly charges a similar amount for Mounjaro. Prices for a month’s supply of different GLP-1 drugs range from $936 to $1,349 before insurance coverage, according to the Peterson-KFF Health System Tracker. Medicare spending for three popular diabetes and weight loss drugs—Ozempic, Rybelsus, and Mounjaro—reached $5.7 billion in 2022, up from $57 million in 2018, according to KFF research.
The “outrageously high” price has “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the U.S. Senate Committee on Health, Education, Labor, and Pensions, wrote in a letter to Novo Nordisk in April.
The high prices also mean that not everyone who needs these drugs can obtain them. “They’re kind of disadvantaged in multiple ways already and this is just one more way,” said Wedad Rahman, an endocrinologist with Piedmont Healthcare in Conyers, Georgia. Many of Rahman’s patients, including Cooper Harris, are underserved, have high-deductible health plans, or are on public assistance programs like Medicaid or Medicare.
Many drugmakers have programs that help patients get started and stay on medications for little or no cost. However, these programs have not been reliable for medications like Ozempic and Trulicity due to supply shortages. Additionally, many insurers require patients to obtain prior authorization or try less expensive drugs first, which adds to delays in care.
By the time many of Rahman’s patients see her, their diabetes has been unmanaged for years, and they are suffering from severe complications like foot wounds or blindness. “And that’s the end of the road,” Rahman said. “I have to pick something else that’s more affordable and isn’t as good for them.”
GLP-1 agonists, which include Ozempic, Trulicity, and Mounjaro, were initially approved to treat diabetes. In the last three years, the Food and Drug Administration (FDA) has approved rebranded versions of Mounjaro and Ozempic for weight loss, leading to a surge in demand. This demand is expected to grow as more of the drugs’ benefits become evident.
In March, the FDA approved the weight loss drug Wegovy, a version of Ozempic, to treat heart problems, which will likely increase demand and spending. Up to 30 million Americans, or 9% of the U.S. population, are expected to be on a GLP-1 agonist by 2030, according to estimates from J.P. Morgan.
As more patients seek prescriptions for GLP-1 agonists, drugmakers struggle to produce sufficient doses.
Eli Lilly is urging people to avoid using its drug Mounjaro for cosmetic weight loss to ensure adequate supplies for those with medical conditions. However, the drugs’ popularity continues to grow, driven by their effectiveness and celebrity endorsements, despite side effects such as nausea and constipation. In March, Oprah Winfrey released an hourlong special on the medications’ ability to aid in weight loss.
“It can seem like everyone in the world is taking this class of medication,” said Jody Dushay, an assistant professor of medicine at Harvard Medical School and an endocrinologist at Beth Israel Deaconess Medical Center. “But it’s kind of not as many people as you think,” she said. “There just isn’t any.”
Even when the drugs are in stock, insurers are imposing restrictions, leaving patients and health care providers to navigate a complex landscape of ever-changing coverage rules. State Medicaid plans vary in their coverage of these drugs for weight loss. Medicare will not cover the drugs if they are prescribed for obesity. And commercial insurers are tightening access due to the drugs’ cost.
Health care providers are cobbling together care plans based on what is available and what patients can afford. For example, Cooper Harris’s insurer covers Trulicity but not Ozempic, which she prefers because it has fewer side effects. When her pharmacy was out of Trulicity, she had to rely more on insulin instead of switching to Ozempic, Rahman said.
One day in March, Brandi Addison, an endocrinologist in Corpus Christi, Texas, had to adjust the prescriptions for all 18 of the patients she saw due to issues with drug availability and cost. One patient, insured through a teacher retirement health plan with a high deductible, could not afford to be on a GLP-1 agonist, Addison said.
“Until she reaches that deductible, that’s just not a medication she can use,” Addison said. Instead, she put her patient on insulin, whose price is capped at a fraction of the cost of Ozempic, but which does not offer the same benefits.
“Those patients who have a fixed income are going to be our more vulnerable patients,” Addison said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF, an independent source of health policy research, polling, and journalism. Learn more about KFF.
