There’s been a lot of buzz going around GLP-1 medications, but what exactly are they? GLP-1 stands for glucagon-like peptide-1, which is a hormone found naturally in the body that manages blood sugar, digestion, and appetite. GLP-1 medications mimic the GLP-1 hormone, helping to manage conditions such as diabetes and weight loss.
When it comes to getting GLP-1 medications prescribed, there are a lot of things to consider. First is where you are going to obtain your prescription, specifically whether you will choose a 503A or 503B pharmacy. Then, of course, comes cost. The price of GLP-1 therapy will depend on several factors, and things like medical insurance and the purpose for which you are using GLP-1s will determine your copays. Let’s dive into these considerations a bit deeper.
Wegovy and Ozempic (Semaglutide)
Wegovy and Ozempic both contain the active ingredient semaglutide, which is a GLP-1 receptor agonist. As aforementioned, this class of medications mimics GLP-1 in the body, helping to activate insulin secretion, delay gastric emptying, and lower glucagon release. These mechanisms together help to control blood sugar levels while also promoting weight loss through increasing satiety. The brand Ozempic is indicated for type 2 diabetes, while the brand Wegovy is indicated for weight loss.
Ozempic dosing usually begins at 0.25 mg weekly and is increased to a maintenance dose of 1 mg weekly (1). Ozempic also costs between $900 to $1,000 out of pocket for a one-month supply depending on where you purchase it (2). Wegovy dosing also starts at 0.25 mg weekly, but it can be increased to 2.5 mg weekly (3). It usually runs for around $1,200 to $1,300 per week (4).
Mounjaro and Zepbound (Tirzepatide)
Mounjaro and Zepbound, also known as tirzepatide, is similar to semaglutide because it’s also a GLP-1 receptor agonist. However, it differs in that it has an additional mechanism as a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. Through this dual mechanism, tirzepatide can increase insulin secretion, lower glucagon levels, and decrease gastric emptying, all to promote weight loss and lower blood sugar levels.
Tirzepatide is similar in cost to other GLP-1s on the market, costing around $1,000 to $1,200 monthly (5). However, this cost will vary depending on one’s insurance plan. Recently, the manufacturer of Zepbound Eli Lilly developed a self-pay option for patients. Because of the high demand for Zepbound, the 2.5 and 5 mg single-dose vials are now available at a 50% or greater discount for those with an on-label prescription for the first few months of therapy. This self-pay process allows patients to get discounts on the medication directly instead of having to go through insurance (6).
Trulicity and Others
Although semaglutide and tirzepatide are some of the newer weight loss and diabetes medications to hit the market, there are a few other GLP-1s available. These include Trulicity (dulaglutide), Victoza (liraglutide), and Saxenda (liraglutide). These medications work in a similar fashion, helping to increase insulin release and lower appetite.
Before getting your GLP-1 medication, it is important to understand the differences between 503A and 503B pharmacies. Both 503A and 503B pharmacies are compounding pharmacies. The two types of pharmacies are described under the Drug Quality and Security Act (DQSA) of 2013, which was created in response to a compounding-related health crisis.
503A pharmacies are those that compound prescriptions for specific patients. Alternatively, 503B pharmacies, referred to as outsourcing facilities, manufacturer larger batches of product without the need for a prescription. Though both types of pharmacies are regulated, there are some key differences in what is required for each:
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503A Pharmacies |
503B Pharmacies |
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So, how do these different types of pharmacies impact your GLP-1 therapy? Based on the above table, you can glean that 503B pharmacies must adhere to more regulations than 503A pharmacies. 503B facilities are susceptible to more frequent FDA inspections and are required to adhere to cGMP unlike 503A. These inspections help ensure that the compounded products are meeting federal safety standards. That being said, 503A pharmacies must still follow several state-level regulations and USP standards.
The relationship between 503A/503B pharmacies and the giants of the pharmaceutical industry is marked by a silent yet intense battle for market share, creating a landscape rife with contention and strategic maneuvering. These specialized pharmacies, which tailor medications to meet specific patient needs, often find themselves at odds with large pharmaceutical companies whose interests lie in mass-producing drugs for widespread distribution. This rivalry intensifies as both sectors vie for the attention and loyalty of the same customer base, leading to a proliferation of media narratives that sometimes border on clickbait. These narratives are crafted to sway public opinion, painting one side as a safer or more effective option over the other, without always providing the nuanced details necessary for consumers to make informed decisions. Such a dynamic not only confuses the healthcare landscape but also sparks debates over the true cost, safety, and accessibility of medications, with each side pushing its agenda in a high-stakes game of influence and control.
Knowing the implications of compounded medications, you may seek your GLP-1 therapy from a compounding pharmacy to get it at a cheaper price. The price will depend on the dosage strength and the individual clinic fee, but the typical cost for popular GLP-1s at compounding pharmacies are as follows:
Insurance coverage
Insurance coverage for GLP-1 medications varies widely depending on the indication and insurance provider. In general, GLP-1s can get covered by insurance if used for type 2 diabetes. If used exclusively for weight loss, insurance companies won’t typically cover the cost of therapy. Additionally, weight loss drugs are often restricted to "on-label" use, meaning the drug is being used for the purpose it was approved by the FDA for. When a drug is prescribed for a different purpose, it's considered off-label prescribing. In general, insurance is less likely to cover off-label prescribing.
Insurance denials or partial coverage for GLP-1 meds are common, specifically when they are being used for weight loss. Healthcare providers may be able to submit an appeal to the insurance company to combat this. Additionally, understanding your insurance plan’s requirements, such as meeting a certain body mass index (BMI) (e.g., 30 or higher) can help you to anticipate potential roadblocks.
It’s crucial to also know that using insurance for Ozempic or Mounjaro for weight loss purposes could be considered insurance fraud. This is because these medications are indicated for diabetes and not weight management.
Copays
Your copay will vary widely depending on your insurance plan and coverage. While a copay may be as low as $25 for some, it could be as much as $200 for others. To minimize copays, you can discuss with your provider generic alternatives or other medications that may be covered at a lower tier.
Additionally, many pharmaceutical companies will offer copay assistance programs and discount coupons to help minimize the out-of-pocket cost for GLP-1s. You can talk to your healthcare provider or visit the manufacturer’s website to see what types of discount cards may be available.
Savings programs
There are a few other ways to help mitigate the cost of your GLP-1 therapy. One such way involves the direct pay offer for Zepbound, which is a program by its manufacturer Eli Lilly. This program allows patients to pay directly for the first two months of treatment at a lower cost. This can be particularly helpful for those that don’t have insurance coverage or those who have particularly high copayments. With this offer, the price can be:
However, note that this program only covers the first two months of therapy. After reaching a dose higher than 5 mg weekly, patients will require a 7.5 mg dose, which can be as much as $1,432 per month.
Other pharmaceutical companies, such as Novo Nordisk, offer other programs to help reduce costs. Novo Nordisk provides savings cards for both Ozempic and Wegovy, which can reduce the monthly price for certain patients (8).
Another option is to purchase your medications from Canadian pharmacies or other reputable online sources. Canadian pharmacies tend to price GLP-1s significantly cheaper than pharmacies in the states. However, individuals should be cautious as some international pharmacies are not legitimate or licensed. Additionally, some patients might choose to bulk purchase medication, which can help to lower the per-unit cost of medications over time. In a few years, generics will start hitting the market as well at a significantly lower cost.
Consulting healthcare providers
Choosing the right GLP-1 medication is important, and the decision should be made together with your healthcare provider. These medications vary in their indications, side effects, and cost, and your provider can help determine which option best aligns with your health needs and financial situation. Some questions you should ask your provider include:
You should consider not only the cost of the medication itself but also any associated fees due to medical care. Hidden costs, such as clinic fees, regular doctor visits, lab tests, and potential insurance deductibles, can add up over time. As GLP-1 medications are often prescribed for long-term or chronic use, budgeting for long-term medication costs can be challenging. Consider setting up a health savings account (HSA) or flexible spending account (FSA) to help manage these ongoing expenses.
Making informed decisions about your GLP-1 medication treatment is essential to your health and financial well-being. Your healthcare provider and pharmacist are valuable resources who can offer personalized advice tailored to your medical needs.
We invite you to share your experiences or concerns about GLP-1 medications in the comments section. If you're looking for more information or personalized consultations, feel free to contact a healthcare provider for further guidance.
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