For Diabetes Drugs, How Expensive is Too Expensive?

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A group of diabetes drugs that do double duty to help people lose weight is outrageously expensive. If you need one, it may be out of reach.

It’s been about three years since I was officially diagnosed with Type 2 Diabetes. Fortunately, at its worst, my case was not severe enough to require insulin injections or even daily blood-sugar testing. But I have tried a few different diabetes drugs and the price tag for them has been nothing short of outrageous.

The first such drug my doctor tried with me was Ozempic. It comes in an injectable pen, similar to epipens used for allergic reactions. You take one injection per week and the needle is so small you barely notice it.

My doctor gave me a few samples. But when I took the prescription he wrote to the pharmacy, they wanted to charge me $828 for a month’s supply. I told the pharmacist that there must be some mistake.

Insurance often doesn’t cover such drugs. ABC News reported that analysis and reports show that drugs used for weight loss aren’t often covered by Medicare, most Medicaid programs, and some commercial insurances, limiting access.

I asked about my insurance. Yes, my health insurance did help a little. The regular price would have been about $1,000. But $828 was as low as they could go.

I went back to my doctor and told him the price tag. He found samples of a similar product called Trulicity, which seems to be similar in concept. When the samples of that ran out, the pharmacist wanted to charge $800+ for a month’s supply of that.

So now, we’re trying the third medication, Mounjaro, and this one, so far, has come with a monthly price of just $25 at the pharmacy thanks to some paperwork my doctor and I had to fill out.

I asked my doctor what was so different that two of them would cost so much but yet the third was so much cheaper. He told me that Mounjaro was about the fourth such drug to hit the market, and when you’re late to the party, you can’t charge as high a price.

Well thank goodness for being late!

The diabetes drugs also help with weight loss…and therein lies the problem

After a month on Mounjaro, my A1C, a measure of your average blood sugar level over the past three months, was down to 5.7. The normal range is 5.6 and below. Anything from 5.7 to 6.4 is considered prediabetes. Anything above 6.4 is officially classified as diabetes.

At my worst, my A1C was 8.8. So a 5.7 is a marvelous number. In fact, most of these drugs advertise that they they can keep patients’ A1C below 7.0! I’m happy I’m so far below that figure that I’m almost back into the normal range. (Keep in mind, that’s not a cure per se. Once you have diabetes, you have it — unless you’re permanently able to keep your A1C below 5.7. In this day and age, that’s a pretty tall order.

But there’s another challenge at play here: these drugs have been shown to help people lose weight. That means there are patients running to their doctors’ offices asking for these medications — whether they’re diabetic or not. That, of course, causes a higher demand for the drugs, which, in turn causes two problems: higher prices and shortages.

Because of the buzz about these drugs’ ability to help people lose weight, people have rushed to their doctors’ offices to get them. In the case of Ozempic, that led to a six-month shortage for the medication.

Between the cost and the shortages, Bloomberg reported some patients had to skip treatment

“Extended periods of uncontrolled blood sugar can raise the risk for complications including heart attacks, infections, kidney and eye disease and death; even short-term bouts of high blood sugar can cause complications,” it reported. 

A serious question

It might be easy for diabetics to get a little frustrated by the weight loss craze aspect of the situation.

They might ask if those with diabetes shouldn’t be prioritized over those who just want to shed a few pounds.

To a point, I think they should. These drugs, as expensive as they are and as effective as they can be if you don’t mind some side effects that includes indigestion that makes you not want to even think about food, much less each too much, can help you lose weight. For many people, they do work quite well.

Diabetes is linked to multiple, serious conditions.

But obesity is as well. Even worse, researchers link obesity to a higher chance of diabetes onset, which takes us right back to the list of dangerous conditions linked back to diabetes.

Both conditions are serious in their own right.

But I’ve also read about people who want to lose less than, say, 30 pounds, who want to go on one of these medications just to give their weight loss efforts a boost. That, at least for me, is where I’d want to draw the proverbial line. If you’re not technically obese and aren’t at least in the prediabetes range, drugs like this ought to go to those who are.

We know what happens with supply and demand

What happens as Mounjaro increases in popularity? It’s on the fast track for approval as a weight loss drug, and manufacturer Eli Lilly expects to receive that approval this year.

When that approval comes and doctors who haven’t prescribed it solely for weight loss now can freely do so, how will that affect that price?

Will that $25-per-month I’m paying now jump up to the $800+ that those other drugs are demanding? I suspect there’s a good chance that it will. If that happens, I’ll have to stop taking Mounjaro. I’ll hope there’ll be yet another alternative with similar results.

When prices for medication reach that kind of price, something’s wrong with our health system. I don’t know how many of the folks who read this have an extra $800 per month sitting in the bank to pay for any kind of medication. (Not that it matters what kind it is, as long as it has the potential to make you healthier.)

I don’t know how insurance companies can get away with not covering a drug that can prevent people from having a lifetime of worse health, especially when the insurance companies would have to pay more for those consequences.

But until we allow this kind of foolishness to continue, you can bet it will do just that.

the authorPatrick
Patrick is a Christian with more than 30 years experience in professional writing, producing and marketing. His professional background also includes social media, reporting for broadcast television and the web, directing, videography and photography. He enjoys getting to know people over coffee and spending time with his dog.