Tucson resident Shari Healy started taking Ozempic in October and by March had lost 40 pounds.
It wasn't without struggle. She had bouts of nausea and episodes of severe vomiting.
A back surgery on Jan. 20 left Healy so weak ― she could barely eat and had extremely low energy ― that her son begged her to stop the weekly Ozempic injections she was giving herself.
In April, she finally did.
By the third week of May, with her strength returning, Healy was back on Ozempic. She has battled excess weight for most of her life, trying multiple diets, pills and programs. Finally, she has found something that works and she's not about to give it up, Healy said.
"(Ozempic) is probably the only successful intervention that I've tried. And especially that I tried that wasn't me thinking about food every second of the day," said Healy, 61, who works as a utilization management consultant. "Getting rid of that chatter in my head was just amazing. I am not obsessing about food all the time."
Healy is more fortunate than many patients who want to get one of the newer and much-hyped injectable drugs like Ozempic that are showing promise in helping with weight loss. Ozempic is indicated for Type 2 diabetes, which Healy doesn't have, though she does have other health problems, including hyperthyroidism. Her insurance initially declined to cover the Ozempic but on a second try said yes. So far, she's had no out-of-pocket costs, she said.
Social media posts and news stories about people losing weight with the drugs Ozempic, Wegovy and Mounjaro have been ubiquitous for much of 2023. The drugs, often collectively referred to as Ozempic in popular culture, appear to have promising results in helping some people shed pounds. Yet the medications are divisive because of who can and can't get them.
The problem isn't so much a matter of demand that's higher than the supply, though that can be an issue, too. The bigger challenge with Ozempic and the other new drugs is about insurance companies and affordability, doctors and patients say. Many insurers won't pay for medications that are prescribed for weight loss. The insurance denials and high list price of the drugs are creating a have and have-not divide when it comes to who can get them.
Linzy Taylor, a mother, actor, writer and TikTok content creator, says her insurance company refused to cover the prescription for Mounjaro that her primary care doctor wrote, and when she looked into paying the full price, she realized that there was "no way" she could afford the Mounjaro list price of about $1,000 per month for an indefinite period of time.
Taylor, a 38-year-old Surprise resident, chose a solution that many other patients are turning to: a medical spa. Medical spas and some online companies are offering compounded semaglutide, which is the active ingredient in Ozempic and Wegovy, at a much lower cost than the brand-name drugs. Yet getting the semaglutide at a med spa is still typically hundreds of dollars per month, which is not affordable for many people.
Mounjaro, like Ozempic, is only indicated for people with Type 2 diabetes, which Taylor doesn't have, though her blood sugar levels are high enough that she has been diagnosed with prediabetes. She has other health problems, too. She needs a hysterectomy, but her doctors told her she would need to lose 40 pounds before she would be eligible to have the surgery.
For Taylor, the benefits after three weekly semaglutide injections have included losing nine pounds and two inches from her waist, though there has been a downside, too. She's had extreme constipation, menstrual problems, nausea, low energy and searing headaches while on the medication, though the side effects improved somewhat after she got the injection in her leg rather than her stomach, she said.
"People say after two months or so the side effects subside. I want to stick it out," she said. "Both my biological parents died at a young age, at 60 and 61, and they were both diabetic. One was Type 1, the other Type 2 and neither one took very good care of themselves."
Taylor says she has been tormented by "food noise" since she was a child and has long had weight problems. But the semaglutide has tamed what Taylor calls a "beast" inside herself that was always hungry, and made her just want to "eat and eat and eat," she said.
"I could eat a full meal and then say to my husband 'I'm hungry,' daily, all the time," she said. "I'm so petrified of that 'I'm hungry, I'm hungry, I'm hungry' voice coming back and basically eating away all my progress."
Doctor: 'There's a huge class divide' in accessing the new drugs
All three of the newer injectable drugs are much more readily available to people with the disposable income to pay for them. Providers who treat people with obesity say that many of the people who need or want Ozempic are not able to get it due to cost and insurance companies are routinely denying to cover most or all of the price. The same goes for Wegovy and Mounjaro.
Arizona's Medicaid program, which is called the Arizona Health Care Cost Containment system, does not cover weight-loss drugs, spokesperson Heidi Capriotti wrote in an email. Medicare doesn't cover drugs prescribed for weight loss, either. A2003 lawthat established the Medicare Part D prescription drug benefitprohibits Part D plans from coveringdrugs used for weight loss, according to KFF, an independent nonprofit health policy research organization.
In the event of an insurance denial, the newer drugs' list prices are costly. Few patients can afford to pay upward of $900 per month, especially because patients may have to remain on the drugs indefinitely.
"The meds are creating a huge class system where a large segment of the population just can't have that option of treatment, which we think is really unfortunate," said Dr. Farah Husain, a bariatric surgeon who is division chief of bariatric surgery at Banner-University Medical Center Phoenix. "There's a huge class divide. ... Coverage for the meds is very minimal."
Husain said there's still not enough recognition among insurers that obesity is an unrelenting disease with a risk of long-term health implications such as diabetes and certain cancers. Treating obesity with medication and surgery is not about cosmetics, she said, it's about improving overall health.
"I think the one thing about this Ozempic debate that's come up is it makes people with obesity feel bad that they would seek a medication to treat their disease and I don't think that's very fair," Husain said.
Obesity is often due to factors that people cannot control, among them genetics and socioeconomic conditions such as access to healthy food and safe places to get exercise, she said. It took insurance companies years to begin covering bariatric surgery, and now there's a reluctance to cover drugs prescribed for weight loss.
"I'm a bariatric surgeon, I love doing it. But I think for my patients, the most equitable care would be to try medications first," Husain said. "It's really interesting that the same medication, slightly different dosing, might be covered if a patient has Type 2 diabetes, but if they only have obesity, it's nixed completely. So, our patients really have quite often almost no medical options because the insurances just don't cover their medications."
Ozempic and Wegovy are the same drug: Semaglutide
Ozempic, Wegovy and Mounjaro are glucagon-like peptide-1 (GLP-1) receptor agonists and part of a class of medications that the U.S. Food and Drug Administration first approved to control blood sugar levels in Type 2 diabetes patients in 2005. Some other drugs in the growing class include Byetta, Victoza, Trulicity and Saxenda. The difference with the newer GLP-1 receptor agonist drugs like Ozempic is that they can be injected once per week instead of once or twice per day and they have modifications that appear to be even more efficient than other drugs in helping patients to lose weight.
Receptor agonists essentially mimic the substance that normally binds to a receptor inside a cell or on its surface. Among other effects, higher levels of GLP-1 are associated with lower blood sugars, and more of a full and less of a hungry sensation. Evidence shows that GLP-1 has the effect of slowing down the gastrointestinal tract, meaning food takes longer to empty from the stomach.
"Your GI tract has a huge number of nerves and communications that are happening in there. And those nerves and those hormones communicate with our brain as well," Husain said. "It's (GLP-1) a pretty complex hormone and it likely operates in other areas too that we don't fully understand. GLP-1 is just one that we know. There are likely 50, 100 other hormones that are altered when we alter the GI tract that we're still trying to figure out."
Ozempic and Wegovy are actually the same drug marketed under different names, though they have different doses and are indicated for different purposes. The U.S. Food and Drug Administration approved Ozempic in 2017 and Wegovy, which has higher doses of semaglutide, in 2021.
Of the newer GPL-1 receptor agonist drugs that are getting so much attention, only one ― Wegovy ― is actually indicated for weight loss, and only for people with a Body Mass Index (a controversial yet common measure of body fat based on height and weight) of at least 27 or higher. The clinical definition of obesity is a BMI of 30 or more, but Wegovy is indicated for certain patients with a BMI of 27, including those with co-occurring health problems, often known as comorbidities, such as high blood pressure, or for patients with a BMI of 30 and above if they have no comorbidities.
Nearly one in three Arizona adults, or 31.1% of the state's adult population, is considered obese, the U.S. Centers for Disease Control and Prevention says.
Ozempic, Wegovy and a daily pill form of semaglutide called Rybelsus, which the FDA approved in 2019, are all manufactured by the Danish drug company Novo Nordisk.
The FDA approved Mounjaro, manufactured by Eli Lilly, in May 2022 and it's indicated for the treatment of Type 2 diabetes. The active ingredient in Mounjaro is not semaglutide but tirzepatide, which according to some early studies is already showing more effectiveness with weight loss than Ozempic or Wegovy. Tirzepatide is engineered to activate the GLP-1 receptor and work in concert with an added hormone receptor called GIP (glucose-dependent insulinotropic polypeptide).
"Mounjaro in the head-to-head studies is looking superior so far in outcomes with weight loss," Husain said. "Our preference now would be to shift to the Mounjaro if we could, but the coverage of the meds is minimal, so it's pretty hard to get coverage outside of the diabetic indication."
Tucson family physician Dr. Serign Marong said in his experience, insurers typically won't approve using Ozempic for weight loss unless the patient has Type 2 diabetes.
"With Ozempic, it doesn't even matter now if you have a BMI of like 45; unless you have diabetes, they are not going to approve it," he said. "Patients always ask me what their insurance is going to do. I don't know. All we can do is send it in and try."
Med spas offer cheaper, compounded versions of Ozempic
Kelci Hunter, a nurse practitioner who is medical director of the Vida Bella Med Spa & Weight Loss Center in Glendale, frequently sees clients who wanted Ozempic, Wegovy or Mounjaro for weight loss but either couldn't get it prescribed, or couldn't get it covered by their health insurance. She will write prescriptions for people with BMIs starting at a minimum of about 25 to 27 BMI, she said.
"If their insurance isn't going to cover it and their doctor is not going to be willing to prescribe it, they just seek it out on their own because they are desperate enough to find something to help them lose weight," Hunter said.
Vida Bella offers compounded semaglutide, the active ingredient in Ozempic and Wegovy, which the med spa gets from an Arizona compounding pharmacy. Vida Bella also offers compounded terzepatide, the active ingredient in Mounjaro. Since terzepatide is considerably more expensive, Hunter said Vida Bella is mostly prescribing semaglutide, and demand for it is high ― the med spa sees at least 50 patients or more per month for the drug, when new consultations, consultations and follow-ups are included, she said.
"We are super busy with semaglutide. ... It's bringing in a whole new clientele for us," Hunter said.
The Glendale med spa offers semaglutide injections at a starting cost of $400 for the first month and $450 for subsequent months, which is considerably cheaper than the list price for Ozempic.
As a licensed nurse practitioner, Hunter is authorized to write prescriptions in Arizona. To get semaglutide, patients at Vida Bella must get lab work, and then have a consultation with Hunter to review the patient's health history, medication history, and allergies. If she decides to write a prescription, she continues to monitor the patients once per month.
Semaglutide should not be used if people have a history of pancreatitis, nor if they are pregnant or breastfeeding, she said. Hunter is hesitant to give a prescription to anyone who is already taking another blood sugar medication. If any patient has a history of thyroid cancer or a family history of multiple endocrine neoplasia, they are not candidates for the medication, she said. Hunter advises patients not to get the medications from online companies without lab work and medical supervision.
"It's not something I like to just hand people and say, 'Good luck, go ahead,'" Hunter said. "We really need to go over the health history."
Hunter frequently talks about semaglutide as both a prescriber and as someone who uses the drug on both TikTok and Instragram via her social media handle The Arizona Injector (@the.arizona.injector). She has an autoimmune disorder called Hashimoto's disease as well as Polycystic Ovarian Syndrome, which can cause weight gain.
"With hormone issues, if you are gaining weight, usually it's around the midsection and it's a snowball effect of making it really hard to lose weight," she said. "It can get a bad rap that everybody is using it for vanity purposes, but for a lot of people this is very preventive. They can prevent gaining a lot of weight or developing diabetes and a lot of these issues that come with being overweight."
It's possible there could be crackdowns on some compounded versions of the weight-loss drugs. Novo Nordisk, the maker of Ozempic and Wegovy, says it is the only company in the U.S. with FDA-approved products containing semaglutide, and that "no FDA-approved generic versions of semaglutide currently exist. We do not sell semaglutide for the purposes of compounding."
The company says it is taking action, including cease-and-desist letters against entities that are "engaging in the unlawful sale of compounded semaglutide, disseminating false advertising, and infringing its trademarks."
However, Scott Brunner, who is the chief executive officer for the Alliance for Pharmacy Compounding, has emphasized that since Ozempic and Wegovy are on the FDA's drug shortage list and have been for more than a year now, federal law allows for compounding them.
"Compounded drugs are not 'knock-offs,' as they have been referred to in some recent media stories," Brunner said. "Rather, they are legitimate therapies created from pure bulk ingredients by pharmacies that adhere to the rigorous compounding standards of the U.S. Pharmacopeia, are licensed by state boards of pharmacy, and are inspected by those state boards as well as FDA."
The Alliance for Pharmacy Compounding says consumers should not buy any substance that claims to be semaglutide from an online entity without a legitimate prescription from a licensed prescriber and the seller of the product should be a licensed U.S. pharmacy.
The FDA on May 31 warned that some compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate, which have not been proven to be safe and effective. The federal agency says it does not verify the safety or effectiveness of compounded drugs.
The National Association of Boards of Pharmacy maintains a list of websites known to sell unsafe or fraudulent medications: https://safe.pharmacy/not-recommended-sites/.
'Unprecedented demand' is affecting supply
Ozempic and Wegovy, as well as Mounjaro, have become somewhat of a craze, with entertainment magazines often running articles about who is taking one of the drugs and who is denying using them in spite of having noticeable weight loss. In September, Variety.com ran an article titled "Hollywood’s Secret New Weight Loss Drug, Revealed: The Hype and Hazards of Ozempic." Anecdotal evidence that semaglutide could help curb other addictive behaviors like drinking, smoking and excessive shopping was part of a May 19 article that ran in The Atlantic and has only furthered attention on the medication.
Marong, the Tucson family physician, frequently uses the social media name Dr. Serendipity (@dr.serendipity) to convey health messages. He recently got more than 77,000 views for a TikTok video about the new drugs being touted for weight loss.
He tells viewers that family doctors, not only specialists, are able to prescribe the medications, and that anyone taking them needs medical supervision. His video, filmed while he's skiing, ends by telling viewers that exercise is another great tool for weight loss and for maintaining a healthy weight.
In an interview, Marong said patients ask about the new drugs "all the time," but he doesn't always write those patients a prescription, particularly if they are below a BMI of 30.
"I kind of shy away from prescribing it for someone when they really aren't that overweight and I think that they might be able to make changes on their own. It's not that I haven't given it to people, but I don't want to jump to that," he said. "I'd rather do lifestyle changes first. If somebody cannot make those changes with the appropriate diet, with the appropriate exercise, that's when I start talking about medication."
Also, any rapid weight loss, even without medication, could lead to muscle loss, he cautioned.
In Marong's experience, high demand for Ozempic has led to a problem with supply, something that has also been reported in other parts of the country. As of April 5, the FDA listed Ozempic, Wegovy and tirzepatide (Mounjaro) on its drug shortage list, though all remain available.
"I'd prefer that people who don't really need it aren't on the medication so that people who do really need it are able to get their prescriptions," Marong said.
Officials with Novo Nordisk in a May 30 email to The Arizona Republic said that pharmacies may experience "normal delays" in getting Ozempic given both geographic variabilities and the time required to order the product from their local distribution center. The company described a more acute supply problem with Wegovy. Prescribing trends "continue to increase at a substantial rate and indicate that demand for Wegovy in the U.S. will exceed our current supply capacity," a company statement says.
In a June 2 statement, Mounjaro manufacturer Eli Lilly wrote that the drug's launch has been "unprecedented in the diabetes space" and that wholesalers and pharmacies may experience short-term back orders.
'There's a tremendous amount of pressure to take them'
Much of the mainstream media coverage about using the new medications for weight loss focuses on aesthetics, which is frustrating for Tigress Osborn, a Phoenix-area resident who is chair of the National Association to Advance Fat Acceptance. Osborn characterizes news coverage about Ozempic and the other drugs as "relentless" and stifling to the "fat joy" that she encourages society to celebrate. Her perspective suggests that in addition to a class divide, the drugs are causing a cultural rift.
Osborn's organization has a campaign called "Equality at Every Size" and supported a new law recently signed by New York City Mayor Eric Adams that bans discriminationbased on a person’s weight. The appearance-focused hype around drugs like Ozempic is working against efforts to reduce shame and bias around bigger bodies, said Osborn, who maintains that being fat does not equate with being unhealthy.
"There are all kinds of reasons people will choose not to take these drugs, but there's a tremendous amount of pressure to take them, whether you think they are safe or not," Osborn said. "There's literally nowhere you can go where you can escape having to hear about how your body is wrong, how it's probably going to kill you and how you could easily change it with this new miracle."
Osborn noted that there was at least one other point in recent history when a diet drug became wildly popular with promising results. The anti-obesity treatmentfenfluramine/phentermine, more frequently called fen-phen, gained rapid public approval in the early 1990s but was eventually taken off the market due to evidence that it caused heart valve problems.
While there have been studies on how Ozempic and the other new drugs affect people over months and even several years, there's no data that shows the effects of taking the drug over longer periods of time, Osborn said.
Health providers say that going on Ozempic or one of the other drugs for just one or two months probably isn't going to be effective. Hunter advises her patients to stay on semaglutide for at least six months.
"This isn't a magic pill that's going to make you stay 'skinny' forever. You have to put in the work. It's a great jump-start for people. It's motivation to eat better and start exercising. If you are heavier, it's harder to start exercising." Hunter said. "You really need to give your body and your metabolism that time to adjust. This is not something that you want to be on one to two months, drop 10 or whatever pounds and then just stop. That is where that yo-yo weight is just going to jump back up."
Osborn questions what will happen if people take the drugs as a "jump-start" yet ultimately fail to lose weight in the long term. Lifestyle changes with the sole goal of losing weight can turn into disordered eating, she said. Eating disorders affect about 9% of the U.S. population and directly cause about 10,200 deaths per year, the Virginia-based Academy for Eating Disorders says.
Osborn encourages "weight neutral" health improvement practices regardless of whether they help shed pounds. For example, someone who decides to go for a walk every day shouldn't quit if the number on the scale doesn't change, she said.
"Imagine just continuing going for that walk every day, or whatever that health-enhancing behavior might be for you," she said. "Those are the lifestyle changes we want to see."
Husain, the bariatric surgeon at Banner Health, says that since obesity is a chronic complex disease, the people who take the newer medications for weight loss typically won't be using them over a short period of time.
"In this world of the Ozempic craze and the rush, a lot of people have this image that you use it to lose weight and then you stop it," Husain said. "If you start the medication, you need to anticipate that you need to stay on it. ... If you stop it, your body will likely revert to what it was doing prior to the medication and likely you'll have weight regain without it."
Linzy Taylor, the Surprise resident who is taking semaglutide she gets from a med spa, as of June 2 wasn't sure how long she would stay on the medication. She is part of an active TikTok community ― she's got nearly 2 million followers ― that regularly talks and shares experiences with the drugs. Taylor was concerned about some users' reports of mental health side effects from semaglutide, including panic attacks and anxiety.
But she also doesn't want to regain the weight she's lost.
She stopped taking the drug for one week when she traveled because she was worried about side effects. During that week, she felt her hunger come back, she said.
"I would love to see myself on this for six months or something and then get off of it and be able to eat healthy and exercise," she said. "I don't want to die young like my parents did. ... I'm 38 and I'm married to a 56-year-old man, and I think he's healthier than I am, and that's not really great for my kids."
Reach health care reporter Stephanie Innes atStephanie.Innes@gannett.comor at 602-444-8369. Follow her on Twitter@stephanieinnes.
