With the rising costs of weight loss medications like Wegovy and Zepbound, many Americans are grappling with the stark reality of either unaffordable copays or uncertainty about whether their insurance will cover these drugs. It’s no surprise then, as prescriptions for compounded copies of these medications soar, the U.S. Food and Drug Administration (FDA) is reevaluatEffect ing the position of these lifesaving drugs on its list of shortages.
Over 200,000 prescriptions for compounded versions of Novo Nordisk's Wegovy are being filled each month. According to the Alliance for Pharmacy Compounding, these alternatives have become increasingly popular among those who find the official versions either too pricey or hard to find. Wegovy, which can help patients shed up to 15% of their body weight, is now put at risk of being taken off the shortage list entirely, which might force many to revert back to its significantly more expensive corporate counterpart.
For patients like Debbie Halstead, who lost 60 pounds and significantly improved her quality of life through Wegovy, any disruption could mean facing insurmountable costs. Currently, her monthly cost is around $25, but starting January, her out-of-pocket expenses could balloon to $713—a price tag she can’t handle. Halstead said, "Even if I didn't lose another pound, I'd take this drug as long as I could. But at $700 a month, that's not going to happen." The steep increase in price has left her scrambling to find coupons and alternate options.
Halstead isn’t alone—many Americans are confronting this harsh reality as they turn to compounding pharmacies, which offer compounded versions at lower prices. Insurers seem to be strategically upping copays or dropping coverage for weight-loss drugs altogether, leaving many patients with dwindling options. Just about one-third of those prescribed these medications remain on them for more than one year, often due to issues around affordability and insurance coverage.
A growing number of states have stopped covering weight-loss drugs for those relying on public health plans due to high costs, making matters worse for individuals who depend on such assistance. Specific Blue Cross Blue Shield plans have removed these drugs from their coverage lists, hence drastically limiting access for many consumers. A recent analysis revealed only 1% of marketplace plans under the Affordable Care Act provided coverage for anti-obesity drugs like Wegovy, severely curtailing accessibility for working-age Americans who need these treatments.
Dr. Angela Fitch, former president of the Obesity Medicine Association, pointed out, "Insurance coverage for weight loss is the biggest barrier we have... Denying weight loss coverage should be illegal, should be immoral, and should be malpractice."
The high list prices and shifting insurance frameworks have mounted frustrations for consumers trying to access these potentially life-saving drugs.
On another front, employers are feeling the weight of these rising costs as well. A survey from Mercer indicated employers attribute skyrocketing spending to the increased use of GLP-1 drugs, with prescription drug expenses continuing to climb year after year. Most health plans cover these drugs for diabetes, but for obesity treatments, stricter guidelines exist. While nearly half of large employers cover GLP-1 drugs for obesity, only 5% of plans allow access without restrictions, compelling employees to jump through hoops to qualify.
"One way employers responded from last year to this year was to put some guardrails up," remarked Beth Umland, Mercer's research director. These restrictions often mean requiring prior authorization or consultations with dieticians, presenting obstacles for those trying to access the drugs they need.
On the ground, patients are searching for alternatives as the weight-loss drug market continues to tighten. Amanda Bonello, worried about her rising blood sugar, couldn't find coverage through her insurance for Eli Lilly's drugs—Mounjaro and Zepbound. Faced with high out-of-pocket costs and no insurance assistance, she turned to telehealth providers and purchased compounded versions for $211, dramatically less than the expected $1,000 copay for brand-name medications. After just one month on these compounded drugs, Bonello has already lost 18 pounds and feels healthier.
Yet, even as consumers like Bonello celebrate their successes, they remain anxious about the future. The FDA recently declared the shortages for Zepbound and Mounjaro were resolved, leading to stricter regulations at compounding pharmacies, potentially limiting access to these lower-cost alternatives.
With the stakes now higher than ever, both patients and industry professionals are eagerly awaiting the FDA's decisions. The rising costs, combined with spotty insurance coverage, are prompting individuals not only to advocate for their own health but to question the system at large. Are we, as a society, inadvertently prioritizing corporate profit over health?
Unless meaningful changes come through, the story of weight-loss drugs and their accessibility will remain one of frustration and growing costs for patients across the United States.