Shortage of Ozempic and other drugs harms patients with type 2 diabetes: Injections

A model walks the runway during the Namilia show during Berlin Fashion on July 3, 2024 in Berlin, Germany. The message on the shirt caused outrage on the brand's Instagram, with readers noting that Ozempic has a deficiency in type 2 diabetes.

A T-shirt from fashion brand Namilia shown at Berlin Fashion on July 3, 2024, sparked outrage on the brand’s Instagram, with readers noting that Ozempic is in short supply for people in medical need.

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Jim Cox had heard of people with type 2 diabetes who couldn’t get Ozempic because the drug was being used off-label for weight loss. He just didn’t think the shortage would affect him.

He also has the disease, but he takes a different drug, Trulicity, which belongs to the same class of GLP-1 drugs as Ozempic.

But “then I went to my local pharmacy to get my Trulicity and they said, ‘Sorry, we’re out of stock,’” Cox says. “I couldn’t renew my prescription.”

Cox says the pharmacist suggested calling a few times a week to see if the medication was back in stock. Eventually, he had to ration his Trulicity to make it last longer.

“There are people who are worse off than me who need this stuff, and it’s their lifeline,” he says.

He’s right. Missing doses can lead to uncontrolled blood sugar levels in people with type 2 diabetes, which can lead to kidney and eye complications, for example. Trulicity and similar diabetes drugs such as Ozempic and Mounjaro have all been in short supply over the past 18 months.

Patients cannot have prescriptions filled

Telehealth company Ro has built a free online tool to help patients report shortages of these medications. Every few seconds, the map lights up with a little lightning bolt, indicating that someone at that location went to the pharmacy to pick up their weight-loss or diabetes medication and couldn’t fill the prescription.

The tracker received 35,000 reports of shortages by mid-June, within the first two weeks of its launch, says Ro.co CEO Zach Reitano. “It’s sad that we received that many.” The tool, which is available even to people who aren’t Ro.co customers, also tells people when a supply of their GLP-1 drug is found within 100 miles of where they live.

These drugs are so successful that pharmaceutical companies can’t keep up with demand, says Rena Conti, a health economist at Boston University.

“They should have been prepared to meet the demand, given their very aggressive advertising campaigns,” Conti says.

“This is an unprecedented situation because these are medications that are used very widely to treat a very serious condition, diabetes,” she says, adding that obesity is also a serious metabolic condition. “The question that comes from weight loss and from off-label use is also real.”

However, the immense popularity of Ozempic, fueled by Hollywood, social media influencers and ubiquitous social media advertising, means that there are also people who use these drugs to lose a few pounds for cosmetic reasons.

“If someone is morbidly obese, they have every right to use that medication to lose weight,” says Cox, the Type 2 diabetic who defaulted on his Trulicity prescription. “I have no problem with that. It’s the people who are doing it strictly for about 8, 10, 12, 20 pounds.”

And in the pharmaceutical companies’ own TV ads for GLP-1 drugs approved for treating type 2 diabetes, they also talk about how many pounds patients have lost, even though that’s not officially what the drugs are intended for.

Cox gets angry with this kind of advertising.

“They just went overboard,” he says. “And they saw dollar signs and they went for it and they didn’t take into account that they were hurting their core clientele, their patients.”

Eli Lilly, which makes Trulicity and Mounjaro, has made public statements against the use of GLP-1 drugs for “cosmetic weight loss” and other inappropriate uses. And Novo Nordisk, which makes Ozempic, says its advertising is intended to educate patients, not promote off-label uses.

“While Wegovy and Ozempic both contain semaglutide, they are different products with different indications, dosages, prescribing information, titration schedules, and administration forms,” ​​Eric Althoff, representing Novo Nordisk, wrote in an email to NPR. “The products are not interchangeable and should not be used outside of their FDA-approved indications.”

Which patients should be given priority?

However, preserving medicines for the people for whom they are approved remains a challenge.

At CVS Caremark, a pharmacy benefits manager, the solution involves looking at a patient’s history with the company to see if there’s any prior evidence that they have diabetes. About a third of the time, there isn’t, says Dr. Daniel Knecht, chief innovation officer at CVS Caremark, and then the company will require a prior authorization, asking the doctor to justify the prescription.

“Of the prescribers who go ahead and complete that prior authorization, we reject about 84%, which means most of those patients are not actually diabetic and it’s an off-label use,” he said.

However, some doctors believe that CVS Caremark’s approach could lead to more problems.

Dr. Scott Isaacs, president-elect of the American Association of Clinical Endocrinology, says there’s a lot of overlap between patients with type 2 diabetes and patients who need GLP-1s to lose weight. Still, he says he can prescribe a diabetes drug to a patient who wants to lose weight, and vice versa — he’ll prescribe whichever drug is available and covered by the patient’s insurance.

He is angry about a worrying trend at the pharmacy.

“I feel like it’s discrimination based on obesity,” he says. “They would tell patients things like, you know, you don’t deserve to be on this or, you know, this is for patients with diabetes, you’re abusing this drug even if the doctor prescribes it.”

While someone with diabetes may respond more immediately to skipping a dose of one of these medications, Isaacs says both groups of patients really need their medications.

It is unclear how quickly the shortage will be resolved, but pharmaceutical companies have invested in new factories and say they are ramping up production.

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