Are You Paying Too Much For GLP1 Therapy (Semaglutide, Tirzepatide)

What are the top reasons for cost variation in weight loss medication and management among clinics?

1. Dosage/Dose concentrations
2. Additional Services /Provider fees or Customization 
3. Brand vs. Compounded Medication / Insurance Coverage

Key Concepts of Dose Concentration:

1. Dose: This is the total amount of a drug or substance that is administered or consumed. For example, a 10 mg dose of medication means that 10 milligrams of the active ingredient is being taken.
2. Concentration: This refers to how much of the drug is in a given volume of the solution or medium. For example, a 5 mg/mL concentration means there are 5 milligrams of the drug in every milliliter of solution.
3. Relationship Between Dose and Concentration:
   • If you need to administer a certain dose (e.g., 50 mg of a drug), and the concentration is known (e.g., 10 mg/mL), you can calculate the volume needed (in this case, 5 mL).
   • Higher concentrations mean you need less volume to achieve the same dose, while lower concentrations require larger volumes.

Practical Example:

If you are administering an IV medication with a concentration of 20 mg/mL, and the prescribed dose is 100 mg, you would need to administer 5 mL of the solution because:

Volume needed=Desired DoseConcentration=100 mg20 mg/mL=5 mL

Understanding dose concentration is crucial in medicine because it helps ensure that the correct amount of a drug is administered safely and effectively based on the desired dose and the concentration of the available solution.

• Standard Semaglutide dose concentration is 2.4 mg/ml- however, we have seen it  be compounded to be as low as 1 mg/ml….
• Standard Tirzepatide dose concentration is 10 mg/ml- however, we have seen it be compounded as low as 5 mg/ml and as high as 40 mg/ml

On an insulin syringe (the syringe most patients are injecting their medication with)- 100 units = 1 ml. For every 10 units on the syringe= 0.1 ml. 

Volume and dose concentration should not be interchangeably used as dose concentration varies!

Additional Services /Provider fees or Customization 

The Difference Between Personalized Weight Loss Clinics and Prescription-Only Clinics

In today’s world, weight loss programs are more varied than ever, ranging from quick-fix prescription services to comprehensive, personalized approaches. While both methods aim to help patients achieve their weight loss goals, the difference between a clinic that tailors a weight loss program with ongoing support and one that simply prescribes medication without follow-ups is significant.

Here’s why choosing a clinic with customized care and follow-ups can make all the difference in your weight loss journey.

1. Personalized Approach vs. One-Size-Fits-All

Tailored Weight Loss ProgramsClinics that offer personalized weight loss programs take the time to understand your unique needs. They often begin with a comprehensive evaluation of your medical history, lifestyle, metabolic rate, and any underlying health issues that may affect your ability to lose weight. This information allows the provider to tailor a program that works best for you, including the appropriate dosage of weight loss medication, nutritional guidance, and exercise recommendations.

Customized programs recognize that no two patients are the same. One patient may benefit from a GLP-1 agonist like semaglutide at a lower dose due to their medical history, while another may require a higher dose in conjunction with dietary adjustments. By focusing on the individual, these programs offer better long-term results because they adjust to your body’s needs over time.

Prescription-Only ClinicsIn contrast, a clinic that primarily offers weight loss by calling in a prescription without any tailored follow-up may provide a one-size-fits-all solution. These clinics typically focus on prescribing medications like semaglutide or phentermine without conducting an in-depth evaluation of your personal health or progress.

While the medication itself may help with weight loss, the lack of individualized care can make it difficult to address specific challenges you may encounter along the way. These clinics often rely on the medication alone to achieve results, leaving patients without the tools or guidance to develop sustainable habits.

2. Ongoing Support and Follow-Ups

Clinics with Customized Follow-UpsOne of the key advantages of a tailored weight loss program is the ongoing support you receive. Providers at these clinics schedule regular follow-ups to monitor your progress, adjust medication dosages, and make recommendations based on how your body is responding. They track changes in your weight, body composition, and overall health, ensuring that your plan evolves as needed.

This constant interaction allows providers to address issues like plateaus, side effects from medications, or fluctuations in energy levels. It also creates accountability, which is a critical component of long-term success. These regular check-ins ensure that you stay motivated and receive expert guidance on overcoming any obstacles that arise during your weight loss journey.

Prescription-Only Clinics with No Follow-UpIn a clinic where the provider only calls in a prescription, the ongoing support and adjustments are missing. After the initial consultation or prescription, you may not hear from the provider again unless you proactively seek out help. This lack of follow-up can lead to problems like:

• Incorrect or suboptimal dosages
• Inadequate management of side effects
• Lack of motivation and accountability
• Plateauing without knowing how to adjust your plan
• Running out of medication before receiving it from the pharmacy again as often there can be delays in production

Patients may feel left to their own devices, which can make it more challenging to stay on track or know when to make adjustments to their medication or diet.

Individuals who are not managed or closely monitored while using GLP-1 receptor agonists (such as semaglutide or tirzepatide) may be more likely to experience adverse effects. This is because GLP-1 medications require careful dose titration, lifestyle adjustments, and monitoring to mitigate potential side effects. Here’s why proper management is crucial:

1. Dose Titration

• GLP-1 receptor agonists often need to be introduced at a low dose and gradually increased to prevent or minimize side effects like nausea, vomiting, diarrhea, and gastric discomfort. Without appropriate titration and supervision, patients might experience more pronounced gastrointestinal symptoms.

2. Monitoring for Adverse Reactions

• Some common adverse effects, like gastrointestinal discomfort or hypoglycemia (particularly when used in combination with insulin or sulfonylureas), need close monitoring to ensure patient safety.
• Pancreatitis, although rare, is a serious side effect. Proper management involves being aware of and responding to early warning signs, such as severe abdominal pain.

3. Managing Underlying Conditions

• Individuals with underlying conditions such as kidney disease or gastroparesis are at higher risk for complications from GLP-1 medications. Without proper medical management, these conditions can worsen.
• Regular follow-ups allow healthcare providers to assess the patient’s response and adjust the treatment plan accordingly, potentially reducing adverse effects and improving outcomes.

4. Lifestyle and Dietary Adjustments

• GLP-1 agonists typically work best when combined with dietary and lifestyle changes. Patients who aren’t managed properly might not receive adequate guidance on how to adjust their diet (e.g., eating smaller, more frequent meals to minimize nausea) or exercise routine, increasing their risk of discomfort or other side effects.

5. Medication Interactions

• Without proper management, patients may not be aware of potential drug interactions with other medications they are taking, which could exacerbate side effects or reduce the efficacy of GLP-1 medications.

3. Holistic and Sustainable Results

Personalized Clinics Focus on Holistic HealthIn addition to weight loss medication, clinics that offer tailored programs often provide holistic health support. They may include nutrition counseling, lifestyle coaching, or fitness guidance to ensure you not only lose weight but also develop long-lasting healthy habits. The combination of personalized medication, diet, and exercise creates a well-rounded approach that addresses both the symptoms and the root causes of weight issues.

The ultimate goal of these programs is sustainable, long-term success. They aim to help you lose weight in a way that improves your overall health and prevents future weight gain.

Prescription-Only ClinicsWhile prescription-only clinics may help you shed pounds quickly with medication, they often do not focus on the holistic changes necessary to maintain that weight loss. Without a comprehensive plan that includes nutrition and lifestyle coaching, it’s easy for patients to revert to old habits once the medication is stopped.

This lack of a long-term strategy can result in temporary weight loss, followed by regaining the weight once the medication is discontinued.

4. Individual Accountability and Motivation

Regular Check-Ins Build AccountabilityWith customized programs, having regular check-ins and ongoing support from your provider keeps you accountable. Whether you meet with your provider weekly or monthly, these touchpoints help reinforce your commitment to the process and allow you to track your success. Providers can also offer encouragement, guidance, and solutions when challenges arise, which boosts your confidence and helps you stay motivated.

Prescription-Only ClinicsWhen patients don’t receive regular follow-ups or check-ins, accountability can be harder to maintain. Without a provider monitoring your progress, it’s easy to lose focus, especially when life gets busy or stressful. This can lead to inconsistent medication use, reduced motivation, and eventually, stagnation in your weight loss journey.

Why Personalized Weight Loss Clinics Make the Difference

While both types of clinics may help you lose weight initially, the long-term benefits of choosing a clinic that customizes your program and provides ongoing support are undeniable. By tailoring the treatment to your specific needs, adjusting your plan as you progress, and offering holistic care, personalized clinics are better equipped to help you achieve lasting results.

If you’re serious about long-term weight loss and improving your overall health, working with a clinic that offers individualized care, follow-up support, and guidance is the key to success. Your weight loss journey deserves more than just a prescription — it deserves a plan tailored to you.

Brand vs. Compounded Medication / Insurance Coverage

The most common qualifying conditions for Ozempic, Wegovy, or Mounjaro to be covered by insurance depend on the intended use of the medication (weight loss vs. diabetes management). Below are the key conditions for each:

1. Ozempic (Semaglutide)

• Primary Use: Type 2 diabetes management.
• Common Qualifying Conditions for Insurance Coverage:
  • Type 2 Diabetes: Ozempic is FDA-approved for managing blood sugar in adults with type 2 diabetes.
  • Cardiovascular Risk Reduction: Some insurance plans cover Ozempic for patients with type 2 diabetes who also have established cardiovascular disease, as it is shown to reduce major cardiovascular events (heart attack, stroke).
  • Off-Label Use for Weight Loss: While Ozempic is sometimes used off-label for weight loss, insurance typically does not cover it for this purpose unless it is explicitly written for diabetes management.

2. Wegovy (Semaglutide)

• Primary Use: Chronic weight management.
• Common Qualifying Conditions for Insurance Coverage:
  • Obesity: Wegovy is FDA-approved for chronic weight management in adults with a BMI of 30 or higher.
  • Overweight with Comorbidities: Insurance may cover Wegovy for adults with a BMI of 27 or higher who also have weight-related comorbid conditions such as:
    • Type 2 diabetes
    • Hypertension (high blood pressure)
    • Dyslipidemia (abnormal cholesterol levels)
    • Obstructive sleep apnea
    • Cardiovascular disease

Some insurance plans still restrict coverage for weight-loss medications, and it may be necessary for the prescribing doctor to demonstrate medical necessity or submit a prior authorization.

3. Mounjaro (Tirzepatide)

• Primary Use: Type 2 diabetes management.
• Common Qualifying Conditions for Insurance Coverage:
  • Type 2 Diabetes: Mounjaro is FDA-approved for improving blood sugar levels in adults with type 2 diabetes. Insurance plans typically cover it for this condition.
  • Off-Label Use for Weight Loss: Although Mounjaro is showing promising results for weight loss, it is not yet FDA-approved for weight management. Therefore, insurance generally does not cover it for weight loss unless the patient has type 2 diabetes or specific comorbid conditions that justify its use.

Key Factors for Insurance Coverage:

• Diagnosis of Type 2 Diabetes: For Ozempic and Mounjaro, having a diagnosis of type 2 diabetes is the most common qualifying condition for coverage. Insurance companies are more likely to approve these medications for managing blood sugar in diabetic patients.
• Weight-Related Comorbidities: For Wegovy, insurers may approve coverage for patients with obesity or overweight if they have weight-related comorbidities, as weight loss can improve these conditions.
• BMI Requirements: For weight-loss coverage, insurance companies often have specific BMI thresholds (typically 27 with comorbidities or 30 without) as a qualification.
• Prior Authorization: Many insurance plans require prior authorization, where the doctor must submit documentation to justify the use of the medication based on the patient’s health history and needs.

Summary:

• Understanding dose concentration is crucial in medicine because it helps ensure that the correct amount of a drug is administered safely and effectively based on the desired dose and the concentration of the available solution.
• People who are not managed by a healthcare provider while taking GLP-1 receptor agonists are more likely to experience adverse effects due to improper dosing, lack of monitoring, unaddressed contraindications, and insufficient lifestyle guidance. Proper medical supervision can greatly reduce the risk of side effects and ensure the safe and effective use of these medications.
• Off-label uses, such as weight loss without diabetes, typically face coverage challenges, but some patients may get approval with physician documentation and prior authorization.

The average cost of semaglutide or tirzepatide covered by insurance is approximately $150 per month. This does not include provider fees. Without insurance, the list price for Wegovy and Ozempic can range from $1,200 to $1,500 per month.

At Nervana Medical, we are committed to helping YOU live YOUR best life. If this means you are able to obtain medication covered by insurance or through a pharmacy for cheaper , we absolutely advise you to do so- we are here to support you in additional ways should you need it (i.e. nutrition counseling, provider tele health guidance etc.). Our providers have over a combined experience of over a century in healthcare and have been trained to provide the best customized care tailored to YOUR weight loss needs. We do believe in a holistic , multi modality , comprehensive approach to ensure the highest rate of sustained success.

References

American Diabetes Association. (2020). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2020. Diabetes Care, 43(Supplement 1), S98–S110. https://doi.org/10.2337/dc20-S009

Drugs.com. (.d.). Ozempic prices, coupons, and patient assistance programs. Drugs.com. Retrieved October 9, 2024, from https://www.drugs.com/price-guide/ozempic

Drugs.com. (.d.). Mounjaro prices, coupons, and patient assistance programs. Drugs.com. Retrieved October 9, 2024, from https://www.drugs.com/price-guide/mounjaro

Drugs.com. (.d.). Tirzepatide side effects. Drugs.com. Retrieved October 9, 2024, from https://www.drugs.com/sfx/tirzepatide-side-effects.html

GoodRx. (.d.). Mounjaro prices, coupons, and savings tips. GoodRx. Retrieved October 9, 2024, from https://www.goodrx.com/mounjaro

GoodRx. (.d.). Ozempic prices, coupons, and savings tips. GoodRx. Retrieved October 9, 2024, from https://www.goodrx.com/ozempic

GoodRx. (.d.). Wegovy prices, coupons, and savings tips. GoodRx. Retrieved October 9, 2024, from https://www.goodrx.com/wegovy

Mounjaro. (.d.). Mounjaro® (tirzepatide) injection: For type 2 diabetes management. Mounjaro. Retrieved October 9, 2024, from https://www.mounjaro.com/

Mayo Clinic. (2022). Semaglutide (Subcutaneous Route) Side Effects. Mayo Clinic. Retrieved October 9, 2024, from https://www.mayoclinic.org/drugs-supplements/semaglutide-subcutaneous-route/side-effects/drg-20410771

Novo Nordisk. (.d.). Ozempic® (semaglutide) injection 0.5 mg or 1 mg: For type 2 diabetes management. Ozempic. Retrieved October 9, 2024, from https://www.ozempic.com/

Оzеmрic (ѕemаglսtide) [product monograph]. Mississauga, Ontario, Canada: Novo Nordisk Canada; August 2023.

UpToDate. (.d.). Semaglutide: Drug information. UpToDate. Retrieved October 9, 2024, from https://www.uptodate.com/contents/semaglutide-drug-information

UpToDate. (.d.). Tirzepatide: Drug information. UpToDate. Retrieved October 9, 2024, from https://www.uptodate.com/contents/tirzepatide-drug-information

Wegovy. (.d.). Wegovy® (semaglutide) injection 2.4 mg: The first and only FDA-approved once-weekly weight management medication. Wegovy. Retrieved October 9, 2024, from https://www.wegovy.com/