Considering Ozempic-type meds but I have questions

July 31, 2024 7:19 AM

Because of (medical reason), my doc has asked me to consider taking Ozempic-type meds (we have not gotten down to which particular one she might prescribe). This is not a high-pressure sell, and she's not insisting on it. She'd like me to think about it and read about it, etc. Right off the bat I have three questions:

1: How much does it cost without insurance? This will not be covered by my insurance, which only covers it for diabetes treatment. I do not have diabetes.

2: Does it work for folks whose eating might typically be described as "I eat when I'm not hungry"?

3: I am already planning to discuss it with my (medical reason) specialist, so I won't move forward at all until I hear his opinion in terms of my (medical reason). Are there other things I should consider? Are there sources I should be reading/looking to for more information?

posted by anonymous to Health & Fitness (20 answers total)

I'll be following here because I'm in a similar boat. My doctor's office asked my insurer about Ozempic but it was rejected. So the doctor advised me to check about other drugs in the GLP1 family: Wegovy, Mounjaro, and Zepbound. That was last week, I haven't made the second call to the insurer yet but it's on my to-do list.
posted by The Pluto Gangsta at 7:27 AM on July 31

I've only skimmed it but this article in the Guardian this morning talks about cost and risks.
posted by Glinn at 7:30 AM on July 31

I can't answer the first, although I believe Zepbound is the 'cheaper' one and I've definitely seen ads for around $200/month for some kind of access. There's still a shortage issue.

Regarding #2, very much so in my experience. It shuts up the food thoughts.

The only other thing I'll add is: if one has GI problems get ready for them to be worse or at least different.
posted by cobaltnine at 7:34 AM on July 31 [1 favorite]

When you lose weight, you lose both fat and muscle and on these drugs you might lose a little more muscle than is ideal. But you can combat that with some resistance training - weightlifting or even just some bodyweight exercises like https://www.hybridcalisthenics.com/routine
posted by congen at 7:34 AM on July 31 [1 favorite]

If it is not covered by insurance, there are two paths to explore. One, is paying for the brand name drug itself. Using GoodRx, they are about $1,000/month. The other avenue to explore is going to a compounding pharmacy either locally or on the web. There is one near me that charges about $350. On the web it is a range, but about $500. This is in the NY area.

Zepbound is the one approved for weight loss only. It is the same as Mounjaro. Studies have shown it has a slightly better weight loss percentage (of starting weight) than Ozempic and Wagovy.

My relative was told that the compounding pharmacies get around the patent by adding B12 to the formula. I have no confirmation of this other than I believe my relative is accurately reporting what their doctor told them.

Anecdotally, even if you emotionally eat or eat when you are not hungry, these drugs seem to make you feel full to the point that you will curtail your eating or even eliminate it.

Relative's doctor also pointed out that they are successful (non diabetes users lose weight) in about 80% of patients. That is pretty high success rate, but if I were taking it with the known side affects, I would want the success rate to be higher.

My relative decided to take the brand prescription over the compounding pharmacy version, and decided to give it 3 or 4 months to see how effective it was. They stopped after 4 months because they were not losing enough weight in their mind to justify the expense. YMMV.

Also anecdotally, the stomach issues are real. I have diabetic friends who take Ozempic legit, and will text me at 2:00am while on the shitter. He says that instead of waking to pee, he will wake to shit.
posted by JohnnyGunn at 7:46 AM on July 31

Lilly has coupons for Zepbound that bring the price to $550 if you have commercial insurance, but your insurance doesn't cover it: https://zepbound.lilly.com/coverage-savings
posted by mcgsa at 8:00 AM on July 31

I've been on Wegovy for a year and have lost about 60 pounds without counting calories. I love this stuff, and have another 40 to lose. I had gained a bunch of weight due to a thyroid issue. Even after the thyroid issue was resolved, I couldn't lose the weight. Wegovy has been the only thing that has helped me.

1. My insurance only covered it once I had met my $4000 deductible. This was about 3.5 months of the meds. My sister is on Zepbound and I think she pays $800/mo out of pocket but she's had a ton of trouble finding a pharmacy to fill it.

2. I used to experience a lot of "food noise" which was just constant thoughts about what I was going to eat for my next meal or snack, which resulted in a lot of eating when I wasn't hungry. Wegovy virtually eliminated the anticipation of food. No food noise, I just didn't want snacks and barely wanted meals. The meds causes very slow digestion, so I felt full on very small meals which further curbed snacking and food noise.

3. Please pay attention to the dosing schedule. A lot of the horrible side effects are due to people starting at too high of a dose or moving up too fast. If your doctor wants you to start at a higher dose because it's more readily available, get a new doctor. Don't move to a higher dose until you've got a handle on any side effects. I stayed on the minimum dose that was moving the scale and only experienced minor pooping issues.

I joined a bunch of subreddits to see people talk about their experiences. There was a ton of advice about how to deal with side effects, tips on the dosing schedule, even resources for getting generic compounded meds. Search for your chosen medication by both brand name (Wegovy/Ozempic/Zepbound/etc) and generic name (GLP-1/semaglutide/tirzapeptide/etc). I would also suggest building up a buffer of a month's worth of medication if possible. There is still a shortage and it can be hard to find a pharmacy that reliably has stock. Amazon pharmacy has worked for me, though I did have a few weeks where I was very grateful for those buffer meds.

Drink a ton of water. More than you want to. Wegovy curbed my hunger, but it also seemed to eliminate my thirst. I ended up super dehydrated and that wasn't fun. Gatorade or other electrolyte drinks are great.
posted by little king trashmouth at 8:01 AM on July 31 [6 favorites]

Some patients report such overwhelming nausea (described as worse than morning sickness) that even though they lost weight, they couldn't continue taking it. The only way to find out is to try it, unfortunately. Nausea, but not vomiting, is miserable.
posted by honey badger at 8:07 AM on July 31 [2 favorites]

Family member is on Mounjaro. Similarly, insurance didn't cover it when they started. They were paying $1000 a month out of pocket. Once they were on it for a while, and testing show medical benefits across the board, their doctor petitioned insurance to have it covered, and it was accepted. Current payment is $25 a month.

Oddly, you might get different pricing by pharmacy, especially if trying to use manufacturer or other third-party discounts. Walmart Pharmacy seems to be the most accommodating / lowest priced.
posted by NotMyselfRightNow at 8:23 AM on July 31

This article helped me tip the scale towards getting onto it (I've been on since early June and have lost over 10% of my body weight in that time, which is MIND BLOWING to me as someone who's never been able to lose without hyperfocusing on it).

Agree with the above advice to check out the subreddits; r/antidietglp is really good.

2: Does it work for folks whose eating might typically be described as "I eat when I'm not hungry"?

I was trying to describe what being on this drug is like to a friend, and I described it as "like someone copied and pasted a new set of hunger and full queues and preferences over my old ones", like a computer reset of what I desire to eat. In the past month I haven't had more than a single drink in a whole evening. I don't miss or want the foods I used to overeat, or if I do it's more in a "oh, that could be nice" way, zero obsession or craving of foods. It's amazing. The way food noise has reduced for me is making this feel pretty effortless. It just doesn't occur to me to eat as a solution to boredom or sadness. I do notice I need something else to replace this and haven't quite figured out what that is yet).

You will change what you eat when you're on it because it gives you very strong (physical) feedback about what works and what doesn't. I've found like many people on it that I've had to really up my fibre and protein and because you'll want to eat so little, this doesn't leave a ton of space in your diet for anything else.

Increasing your dose slowly is good; you'll lower your side effects, and if you're paying out of pocket, it costs less too. If you do go with a brand name GLP1, you can ask your pharmacist about "clicks" to get smaller doses out of the larger sized pen; the pens (at least in Canada) cost the same no matter how much drug is in them, so dosing out the smaller amounts from the bigger pens makes it last longer.
posted by Sweetchrysanthemum at 8:25 AM on July 31 [6 favorites]

I was on liraglutide for a while but had to stop because the giardia-grade eggy burps, nausea and general depressive misery became intolerable. Since stopping, my appetite rebounded with a vengeance and I rapidly stacked on twice what I'd lost.

It's been about a year since I stopped, my bodyweight is at last coming back down toward its pre-liraglutide set point, and the intermittent fasting regimen that the availability of liraglutide interrupted has stopped seeming completely out of the question, so that's probably what I'll be resuming soon.

I had followed the manufacturer's recommended dosage ramp-up, and my side effects did indeed only become apparent a couple of steps up from where I first started noticing definite appetite suppressant effects, so it's entirely plausible that the burps and nausea were due to dosing more than I actually needed. But the fact that it's taken a year even to start getting over that experiment has left me less than keen to give it another go.
posted by flabdablet at 8:57 AM on July 31 [5 favorites]

I'm a type two, so am on Ozempic. I'm on a relatively low dose and have just been hanging out here for a bit, although I wonder if it's time to bump up. I'm a little reluctant to because I am susceptible to nausea and that's one of the major side effects of the medication.
I'm also a kind of mindless snacker, and while it's cut down on it, it hasn't eliminated it completely. I think about food a little less but I'm still able to go and get a bag of chips and eat some when I'm not really hungry. And eating small quantities hits the "fullness" trigger more slowly than with things like eating a full meal - I can't eat most restaurant portions all in one sitting these days. However, the quantity I would eat while snacking is far, far less than I would have otherwise. I'm not polishing off bags and can't down a pint of Ben and Jerry's, which in the past I would have been able to do. (The idea of letting ice cream hang around until it got freezer burn was laughable, but it's happened to me a few times now.)
posted by PussKillian at 9:00 AM on July 31

Oh, another thought - while the various subreddits are definitely useful for dealing with side effects, I don't love how they tend to focus on major weight loss. I've lost about thirty pounds (and with it some muscle - I lift things at work pretty regularly and it's a problem that I'm not as strong as I was, and I need to get on some weightlifting to get that back). But a quick look at places online may make you think you're going to drop 100 lbs in a week and if you don't, you're a failure. My real win with the meds has been found in my bloodwork results, particularly my A1C levels.
posted by PussKillian at 9:04 AM on July 31 [1 favorite]

Semaglutide has been life changing for me in much the way Sweetchrysanthemum describes - it's basically completely overwritten the way my brain reacts to and understands hunger, satiation, and food in general. Including, yes, a huge reduction in any thought/desire to eat when not hungry. It's pretty wild. Side effects have been minimal, rare, and more than offset by the benefits.

I can't speak to the insurance piece, as it is covered for me with a preauthorization due to multiple medical conditions.
posted by Stacey at 9:14 AM on July 31 [1 favorite]

2nding everything Sweetchrysanthenum said.

Reading these kinds of discussions, it always seems to me that there are three kinds of people. Those who will observe side effects/mainly digestive discomfort, experiment and figure out how to minimise/avoid these side effects and have an overall positive experience, those who find the side effects intolerable and/or lack any willingness/patience to explore ways to manage and avoid them. You need to figure out where you fall.

One things the drugs have taught me is that you need to be patient and observe and adjust. That’s because it takes several hrs to get from consuming food to eliminating. You can still overeat on these drugs. But because they slow down passage of food through your digestive tract, you will feel miserable and stuffed for a lot longer than without the drugs. So once you’ve taken the drugs and experience side effects, it’ll take a few hrs to counteract. And it will take trial and error to figure out the most effective strategies for you.

I had hardly any side effects on the lower introductory doses but three years in I still can’t tolerate a full dose of Wegovy. And the higher the dose the more important it becomes that you modify your diet and behaviour to avoid side effects.

In terms of diet, the focus for me has to be light things - fruit and veg, protein with every meal, small portions because that helps avoid the side effects like nausea and stomach pain. As does regularly getting up and moving around to avoid bloating. Adding fibre like psyllium husks avoids the effects JohnnyGunn’s friend is experiencing.

I can avoid and manage side effects without additional medication to treat the side effects. But it took trial and error and sometimes I get it wrong or ignore what I have learned about my body and suffer the consequences.

I would also like to add that even moderate weight loss can have significant benefits e.g. in terms of reducing high blood pressure so these drugs may not result in losing all excess weight but depending on where you start even 30-50 pounds can have significant positive health effects.
posted by koahiatamadl at 9:23 AM on July 31 [3 favorites]

Here's another article/set of studies about the risks.

I've been dealing with chronic stomach issues for a year or so now and in that time I've spent a bunch of time in forums for chronic nausea/vomiting and gastroparesis. There are a lot of people turning up to talk about how miserable they are on these drugs, with side effects lasting long after they discontinue them. Definitely keep in mind that while the side effects and major issues are rare, they are significant. Gastroparesis, even mildly, is not a fun thing to experience.
posted by fight or flight at 9:39 AM on July 31 [3 favorites]

Does it work for folks whose eating might typically be described as "I eat when I'm not hungry"?
It does for me. Before Mounjaro/Zepbound, I wanted to eat most of the time when not at all hungry. I’m now using it every 3-4 weeks and when it’s wearing off, my body and mind go straight back to their normal patterns. But when it’s working I don’t think about food till several hours have gone by since my last meal.
posted by wryly at 4:39 PM on July 31 [1 favorite]

I have been on the oral form of semaglutide, Rybelsus, for a couple of months for Type 2 diabetes. I started with a month of 3mg daily, moved up to 7mg daily, and have had unpleasant gastrointestinal side effects: general low-level stomach discomfort and a couple bouts of nausea that caused me to come home from work. However, it did lower my blood sugar and curb my appetite. It's quite expensive, listing for about $1,000 a month, though with my insurance and pharmacy I've been spending only $25 a month (this is after meeting my deductible, not sure what it would be like without it). I'm going to try to get off it; I don't like the side effects at all.

I've tried to characterize the appetite curbing effects. I used to have a yogurt and a Kind bar first thing in the morning, now I can barely force down the yogurt and the Kind bar is totally unappealing. I have a granola bar or piece of fruit mid-morning, and a lunch just like I always have had. Before Rybelsus I'd have a small afternoon snack which I don't anymore. I eat a bit less dinner. I've lost 5 pounds or so over the last couple of months.

I find it interesting that Rybelsus is never mentioned in any of these discussions. My doctor never recommended anything else and didn't tell me it was another form of Ozempic (from Norvo Nordisk).
posted by lhauser at 5:50 PM on July 31

I’d like to jump on the description bandwagon. The best way I can describe how it changes your brain is to first, think of how food tastes when you’re super baked. Like the best munchie meal enjoyment ever. Then take the difference between how food feels when you’re high from your normal food desires and thoughts. Then subtract that from your normal food thoughts. It’s the first time in my life I can be completely intellectual about my food choices.

One caveat is I lost my normal hungry cues. I had a few occasions where I’d get mildly hypoglycemic and I’d feel shaky, weak and pukey for a bit because I’d realize I hadn’t eaten in 12 hours since breakfast.
posted by lizjohn at 7:15 PM on July 31

With regard to 3., I listened to this interview today and found alot of food for thought. Take it with a grain of salt, as many people find that practitioners involved in chiropractic to be unreliable narrators. But given western medicine’s history of clobbering folks with megadoses of new medicines in excess of their actual need, I thought it worth consideration.
posted by Rube R. Nekker at 7:27 PM on July 31