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Weaning off Ozempic?

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A Woman Injects Insulin with Insulin Injection Device into the Subcutaneous Tissue of AbdomenA number of our customers have asked us for advice about their options regarding their desire to stop using the drug Ozempic. Primarily, people want to know how to minimize any possible consequences of weaning off Ozempic. These new drugs brought improved care to people living with type 2 diabetes, most notably those drugs based on GLP-1 agonists like Ozempic and Mounjaro. As we’ve all learned, these drugs also have the remarkable feature of promoting fast weight loss. 

What follows are two separate case studies from two different customers who each approached us with questions about weaning from Ozempic. (The names and some details have been changed to protect privacy).

Case 1: Ozempic has done its job, and Charlie has reached his target weight.

The guidelines that doctors use when deciding to prescribe Ozempic or Mounjaro off-label for weight loss are either that the patient must have a body mass index (BMI)  of 30 or higher (obese) or BMI between 27 and 30, with at least one comorbidity such as hypertension, cardiovascular disease, osteoarthritis, dyslipidemia or sleep apnoea.

Charlie was diagnosed as overweight and had two of the comorbidities that can qualify a patient for treatment with GLP-1. His doctor advised him that using Ozempic together with reasonable dietary control and moderate exercise would be the best way to achieve substantial weight loss, which was crucial in his case to minimize the dangers of hypertension and cardiovascular disease, which Charlie had been suffering from for many years.

Happily for him, it turned out that his weight had fallen by more than twenty percent in just two years, to the point where his BMI no longer rated him as overweight. As well, many of the test results for hypertension have shown that his blood pressure is normal. He can now perform much more vigorous exercise, and his eating habits are well-controlled.

Charlie feels that there’s no longer the need for Ozempic in his medicine basket and has asked for our advice about how best to wean himself off in a way that won’t take back all the great benefits he has earned.

The general opinion among specialists on how to stop using GLP-1 is that there are two main issues:

  • To reduce the dosages slowly to give the body time to adjust. This mimics how Ozempic is introduced into therapy, where successively larger doses are given over the first few months, only reaching the total dose after four months. 
  • To remain on fairly strict dietary control and maintain exercise routines; otherwise, there may be a “rebound” effect in which much of the lost weight is regained.

Our advice to Charlie was, before weaning from Ozempic, to consult with his healthcare professional, who is the best person to guide and manage the transition and monitor his health during this period.

Case 2: Ozempic is working well, but I can’t get reliable supplies at affordable prices. 

Laura was a long-term diabetic who had been treated with the standard pre-Ozempic therapies like Metformin for many years and was put onto Ozempic in the very early days of the product’s launch. For the first three years before Ozempic became such a star performer after it morphed into the “drug of choice” for weight loss, there was no problem getting supplies from US retail pharmacy outlets, and her health insurance paid a substantial part of the costs. 

Then, in 2020, the COVID-19 pandemic swept in, and massive supply chain disruptions spoiled the picture for millions of people who relied on Ozempic as their preferred drug for treating diabetes. Before things could settle down after the havoc of the pandemic, the popularity of Ozempic as a weight loss medication set in, and the factories were quickly overwhelmed with orders they couldn’t match. Suddenly, the shelves of pharmacies all over the world ran dry. Laura was dependent on some form of diabetic medication for her condition and had to go back to the older forms like Metformin when she could no longer get access to Ozempic. 

For Laura, there’s now an additional problem. Her insurance company has changed its rules on co-payments for Ozempic. Because Laura’s history shows that Metformin still works for her, her insurance company has declined to issue prior authorization, so if she wants to stay on Ozempic, she will have to pay the full retail price of approximately $1000 per month.

We were happy to be able to provide Laura with access to Ozempic through our online prescription delivery service here at IsraelPharm.

Additionally, our price is roughly 50% less than the current retail price of Ozempic from US pharmacies. So, IsraelPharm has been an excellent fit for Laura and others like her who now no longer have to worry about weaning from Ozempic.

FAQ

Are insurance companies tightening the rules on co-payment for GLP-1 therapies?

There has been a strong trend among benefits executives of US insurance companies rewriting the rules for the level of cover they will provide for drugs like Ozempic and Mounjaro. This is claimed to be necessary because prescriptions were being written for patients whose conditions were treatable by older therapies like metformin or whose primary purpose was weight loss. Some insurance companies require prescribers to document in a patient’s medical record that the medication is being used for its approved indication, such as diabetes, only when alternatives are ineffective, rather than off-label for weight loss.

It was reported by Reuters in December 2023 that “a recent JP Morgan survey of U.S. benefits executives found that 74% of large employer-based health plans required diabetes patients to get prior authorization for a GLP-1, and a third of the rest planned to add the requirement as they grapple with higher spending on the medications as weight-loss tools. Doctors often have to provide evidence of diagnosis and document that other medicines, such as generic metformin, were not adequate to control blood sugar or caused intolerable side effects.”

How did Ozempic become such a star performer?

The first thing to explain is what made Ozempic, Mounjaro, and other drugs designed to treat type 2 diabetes so popular. It started when the Norwegian drug manufacturer Novo Nordisk released its novel diabetes medicine Ozempic in 2017. Ozempic does not supply the missing quantity of insulin that diabetics lack but uses a form of glucagon-like peptide-1 receptor agonist (GLP-1RA). It is a specific hormone produced in the gut that is crucial in regulating blood sugar levels and appetite. Its role in a diabetic patient is to get the body to boost its own production of insulin. For people with type 2 diabetes who were not responding well to the older forms of treatment, it was a significant improvement to their health to now be able to manage their condition with self-administered weekly doses of Ozempic rather than the daily doses of insulin or metformin. 

In the clinical trials of Ozempic, conducted on thousands of patients over three years in different counties, there were reports of one very specific and almost universal side effect: the participants lost weight, even when that was not their intention. Across the board, losing 10-15 percent of total body mass was quite common. This quickly turned the world’s attention onto Ozempic and the other big drug also based on GLP-1 called Mounjaro.

Can IsraelPharm continue to supply Ozempic at competitive prices?

Like pharmacies around the globe, we are not immune to supply chain disruptions like those the world saw during and after the pandemic. Luckily, we have maintained a steady supply of Ozempic and other weight loss drugs and can deliver brand-name drugs to our US customers at lower prices than US retail prices for the foreseeable future. Learn more about IsraelPharm’s telehealth solutions for weight loss drugs.

Are shortages of Ozempic and Mounjaro going to persist?

As recently as December 2023, as reported by the website Diabetes Canada, both Novo Nordisk and Eli Lilly, manufacturers of Ozempic and Mounjaro, respectively, are warning that following intermittent shortages in the drugs throughout 2023, they have had to extend their warning of shortages into 2024.

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