The insurance side of the ongoing Ozempic shortage

There's a worldwide shortage of diabetes management drug Ozempic, and health plans may be playing a key role, BuzzFeed News reported Jan. 13.

"Everybody is either on it or asking how to get on it," Paul Jarrod Frank, MD, a New York City dermatologist, told the New York Times Jan. 24. "We haven't seen a prescription drug with this much cocktail and dinner chatter since Viagra came to the market."

Danish drug manufacturer Novo Nordisk sells semaglutide under several different brand names, including Ozempic and Wegovy. The two medications are nearly identical, but Wegovy is officially used to treat obesity and Ozempic to manage diabetes. 

Because of the similarity, the use of Ozempic as a weight loss tool has exploded across social media and among celebrity circles over the last year, leading to demand far greater than the manufacturer anticipated.

Most payers don't cover modern weight loss drugs because they're expensive, but they do usually cover medications meant to treat diabetes. 

"Evidence suggests that patients may not be able to maintain their weight loss once they stop taking the drug," an AHIP spokesperson told NBC News Feb. 2. "There is also limited long-term evidence to show that patients on these medications see lasting benefits in reducing risk of co-morbidities like diabetes or cardiovascular disease."

Without insurance, monthly out-of-pocket costs for Wegovy can be anywhere from $1,350 to $1,500, while Ozempic is around $900. For patients seeking to get a prescription for weight loss and to have it be covered by insurance, some physicians have turned to prescribing Ozempic off label, or prescribing an approved drug for an unapproved use, according to BuzzFeed. 

Sometimes, payers will cover Ozempic for patients that don't have diabetes. If documentation is needed from the payer, the physician can usually provide blood tests that show "poorly regulated blood glucose levels or prediabetes," BuzzFeed reported

On Feb. 15, CBS News reported that Novo Nordisk said it is experiencing "intermittent supply disruptions" for Ozempic, which is expected to last through mid-March.

According to the FDA, 1 and 2 milligram doses of Ozempic are currently available, but the 0.25 mg and 0.5 mg injectable versions remain in short supply. Wegovy faced supply issues last year but is widely available now.

"While we recognize that some health care providers may be prescribing Ozempic for patients whose goal is to lose weight, Novo Nordisk does not promote, suggest or encourage off-label use of our medicines," the manufacturer told CBS. 

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