Diabetes Patients Also Struggle to Access GLP-1 Agonists

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Last fall, Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center in Boston, got a message from her patient with type 2 diabetes. His pharmacy had one semaglutide (Ozempic) pen left, and they could only hold it for five minutes.

Dushay would have to request a refill right away, otherwise the patient would lose a week’s worth of medicine, since Ozempic is a once-a-week injection.

Demand for GLP-1 agonists like semaglutide has increased as their reputation for helping patients shed pounds has taken off. Like obese patients, patients prescribed these drugs for type 2 diabetes have difficulty accessing their medications.

Patients cross state lines and order from abroad to keep up with their regimens. Doctors jump through hoops for their patients. Pharmacies are faced with an unpredictable supply.

“It’s like gold,” Dushay shared MedPage Today. “This is reality. It’s crazy.”

It’s not uncommon for her patients to run out of medication, Dushay said. They may have to check multiple pharmacies or else wait. She also tells patients to look up Canadian pharmacies who can mail their meds.

Gitanjali Srivastava, MD, an internist and director of the obesity medicine program at Vanderbilt University Medical Center in Nashville, Tenn., said her patients have also resorted to using Canadian pharmacies and sometimes pay for their medications in cash.

“Our clinic has been inundated with messages and calls,” Srivastava said MedPage today.

Ethan Melillo, PharmD, an outpatient diabetes pharmacist who works with primary care practices in Rhode Island, said his patients feel a significant impact, and sometimes calling several pharmacies or substituting one drug for another isn’t enough.

For example, if a pharmacy is out of 3 mg doses of dulaglutide (Trulicity) but has 1.5 mg doses in stock, insurers may not authorize a patient to double the lower dose of injections.

“So they pretty much let the patient go without,” he said, adding that patients have called him after going weeks without taking a GLP-1 agonist and “their sugars are in the four hundred.”

“I really want this to end,” Melillo said. “But it’s like we have a patient a few times a week who says, ‘I need help.'”

Robert Gabbay, MD, PhD, the chief science and medical officer of the American Diabetes Association (ADA), said in an email to MedPage Today that the ADA “strongly believes that people with a medical condition should have access to treatment. We are deeply concerned about anything that limits access to effective treatments for diabetes and for those at risk of being diagnosed with diabetes. “

All three of the most popular GLP-1 agonists are listed as “currently in deficiency” on the FDA drug shortage list: semaglutide, dulaglutide, and tirzepatide (Mounjaro), the latter of which is a dual GLP-1/GIP agonist which is showing even more dramatic weight loss effects and is expected to receive approval for that indication later this year.

As of December 2021, Novo Nordisk has struggled to produce enough semaglutide to keep up with demand for its obesity indication. Problems with the manufacture of the syringes used in their pens caused massive shortages, and the company didn’t announce that all doses would be available again until late 2022.

Novo Nordisk wrote in an email to MedPage Todaythat Ozempic .25-mg and .5-mg pens continued to have supply interruptions,” due to the combination of incredible demand coupled with general global supply constraints. While the product is still being manufactured and shipped, patients in some parts of the country will experience delays with these doses. Anyone with concerns about continuity of treatment should contact their healthcare provider.”

Eli Lilly wrote in an emailed statement to MedPage Today that “strong demand for Trulicity and Mounjaro, amplified by global incretin shortages from competitors, is resulting in potential short-term delayed supply and restocking of supply at some pharmacies and wholesalers.”

The company said it “continues to invest in and add manufacturing and supply capabilities around the world. With the addition of our manufacturing facility in North Carolina, coupled with additional promotions and expansions in other locations, we expect to increase the incretin capacity of Lilly by the end.” from 2023.”

As for the risks to patients, going off a GLP-1 agonist for type 2 diabetes can certainly lead to an increase in blood sugar and “over time, this is shown to lead to a greater risk of diabetes complications,” Gabbay said.

Overall, Srivastava said that patients who stop taking a GLP-1 agonist “can pick up where they left off because the drug stays in their system for a while, so I think it’s important that patients understand this,” she said, noting that it could take “several weeks.”

“While rapid withdrawal of insulin therapy can be disastrous for a patient, [this] is not necessarily the case with this particular class of drugs,” she noted.

Experts say that while it may be tempting to blame celebrities for a shortage of crash diets, people who don’t follow clinical guidelines get the drugs off-label and out-of-pocket for more than $1,300 a month, or even for obese patients and their caregivers to turn to diabetes medications, the reality is more complex than any of those factors. (Click here for a sidebar exploring the reasons behind the shortages.)

“I think it started with the semaglutide because of the interchangeability and because of the efficacy of these drugs,” Srivastava said, “and it’s trickled down to pretty much all GLP-1 agonists.”

  • Sophie Putka is a business and research writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire and more. She joined MedPage Today in August 2021. Follow

Disclosures

Stanford disclosed consulting and other financial relationships with Novo Nordisk, Currax, Eli Lilly, Boehringer Ingelheim and Rhythm.

Srivastava has reported advisory and other financial relationships with Novo Nordisk, Eli Lilly and Rhythm.

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