The Black Friday-style run on the weight-loss drugs Ozempic and Mounjaro prescriptions started in 2021. Many early adopters were wealthy urbanites seeing general practitioners willing to help them skip the line, which got longer as breathless news reports hit the wire. When Mounjaro received FDA approval as a treatment for type 2 diabetes in 2022, it quickly became a hit among non-diabetics looking for an appetite suppressant. Only a fourth of prescriptions are currently written for patients with diabetes. What percentage of those people were in need of a genuine medical intervention is unclear – not the sort of statistic that gets captured – but the Ozempic joke at the Oscars was indicative of appetite suppressing drugs’ sudden off-label ubiquity.
Wall Street is betting on that ubiquity. Johnson and Johnson stock has come back to Earth (more or less) post pandemic; not so for Eli Lilly and Novo Nordisk, which manufacture Ozempic and Mounjaro. This reflects a belief that the FDA will approve the drug to treat obesity and an understanding that, because these are new drugs, generics won’t eat market share. It also reflects a view of unmet demand. Prescriptions for semaglutides have increased 2,082% in the last three years with more than 5 million prescriptions written in 2022, a 259% increase from 2021 alone. Now, 8,000 people per month are searching for “how to get Ozempic for weight loss,” up 2,531% from 2022. It’s Tickle-Me-Elmo to the power of American body dysmorphia.
And the price tag is significant. A 30-day supply of the once-a-week injectable drugs currently runs between $1,000 and $1,200 for those without morally flexible primary care physicians or a clear and undeniable (from an insurer’s perspective) medical need. While the drugs were in short supply earlier this year due to the rush, Novo Nordisk and Eli Lily are scaling production. It’s not clear that increased supply will affect pricing even if it does affect availability.
As it happens, Ozempic and Mounjaro arrived at an interesting moment in the history of American prescriptions. Brands like Hims, Hers, and Ro, a DTC erectile disfunction play that showed turgid pandemic growth, are leveraging telehealth tech and pandemic-related legal loopholes to squeeze doctors out of the prescription process. Questionnaires full of obviously leading queries lead into quick conversations with “providers” lead to generic prescriptions for ED and anxiety disorders. Now, Ro is offering Wegovy prescriptions and Plenity as an alternative medication for those who don’t qualify. Plenity is a daily pill taken before a meal to curb appetite that was FDA-approved for weight loss in 2019. It’s not as effective, though, with results tapping out at 10% body weight loss, or around 22 pounds, on average.
Ro requires that potential patients fill out a notably longer questionnaire and take an at-home metabolic test. Ro has also instituted a waiting period of 3-6 weeks minimum after a patient chats with a provider. Still, it’s clear where this is going.
Prescriptions for Ozempic and Mounjaro are harder to come by. They are ostensibly available online through telehealth providers like PlushCare and Push Health, which charge between $30-$129 for a first-time chat with a doctor, depending on insurance coverage as well as Sequence, a weight loss-specific platform recently acquired by WW, formerly known as Weight Watchers. But these telehealth fees don’t include the cost of the actual medicine and it’s not clear that all patients get what they came for (which might not be a bad thing).
Dr. Sue Decotiis, who treats obese patients in Manhattan, has seen an influx of patients who’ve tried and failed at acquiring Ozempic online. One patient paid $1500 upfront to a doctor who claimed they could provide the goods then offered a lesser weight loss medication she could’ve sourced from any doctor with her insurance. Her accounts emphasize the importance of working with accredited telehealth agencies like the ones above, and even then proceeding with cautious optimism.
“These companies can’t get their hands on this medication. You can’t stockpile this medication. No one can,” explains Dr. Decotiis. “Even if they want to serve the patients, they won’t be able to get it. So they’re going to take the patients’ money and put them on a lesser medication…. I can’t call Duane Reade and CVS and call in prescriptions for unnamed patients.”
Presumably, this is why Novo Nordisk is actively distancing itself from the companies most capable of distributing its products at scale.
“Some weight loss clinics, online pharmacies, “telehealth” and other companies claim to have availability of compounded “semaglutide” products, including products that purport to offer “semaglutide” in combination with other ingredients,” Novo Nordisk explained in a statement to SPY. “These compounded products do not have the same safety, quality, and effectiveness assurances as FDA-approved drugs, and may expose patients to potentially serious health risks.”
This underscores the current state of play: Weight loss drugs are being treated like a consumer good, but they aren’t being priced like one. This is no surprise given that they are, in fact, cutting-edge pharmaceuticals, but it creates an unusual market dynamic. The price of the drug is almost uncorrelated from the price of the drug. What you pay has everything to do with how the drug is obtained. The price is stable.
But then there’s Canada. In Canada, the drugs now cost $250 for a month’s worth of this medication. Some Americans have made the run north, but dosing and administration are problematic. It is possible to get the drug by filling prescriptions at Canadian pharmacies, but difficult to figure out how much to take. Dr. Salas-Whalen, an endocrinologist and obesity specialist in New York, now has patients who arrive at her clinic on the Upper East Side with the drug, but without a notion of how to take it.
“But I’m supervising the drug, I’m supervising the dosing,” says. Dr. Salas-Whalen. “I’m supervising the side effects. As long as it’s under supervision, it’s okay.”
To date, no one has died from taking either of these drugs. But the reported side effects can be bad. Dr. Andrew Kraftson, an endocrinologist and Director of the Weight Navigation Program at the University of Michigan described a patient who had explosive diarrhea for three days and ended up being hospitalized with an acute kidney injury.
“Potassium was completely out of whack,” Dr. Kraftson says. “Other medications had to be adjusted. Was she totally appropriate to go on the medication? Yes. Was she understanding that there were risks? Yes, but still bad things can happen.”
Nausea, vomiting, and dehydration are more common side effects and many patients “suffer” from what has been dubbed “Ozempic Face,” apparent aging that’s driven by the rapid loss of body fat.
Dr. Decotiis and Dr. Salas-Whalen both use a body composition scale to track patients’ weight loss, making it easier to tell that Ozempic is burning away what it’s supposed to. These scales can be purchased on Amazon and used at home, if folks are truly looking to DIY the whole process.
Without this, both doctors described, patients can gain the weight right back or develop what’s called “sarcopenic obesity” also dubbed “skinny fat” obesity where a body has a high fat percentage and a low percentage of muscle mass.
Dr. Decotiis compares Ozempic and Mounjaro favorably to appetite suppressants. They do the same thing in the same way that Aaron Judge and the best kid on a Little League team both hit.
“I tell my patients when they start this drug, especially the tirzepitide because I prefer it over the semaglutide, I say ‘you’re gonna feel like you’ve had Thanksgiving dinner every single day,” said Dr. Decotiis. “You feel so sated, and it’s a good feeling because you don’t want for anything.”
The irony is, of course, that everyone wants for something. Hunger is just one urge.