These new medications are in the news and I am prescribing them for appropriate patients. What these medications do includes modifying insulin sensitivity (glucose/sugar levels), reducing appetite, helping you to feel full earlier, and slowing digestion. The net effect is better sugar control and often significant weight loss. There are potential side effects, like any medications, so these medication should be used when someone has tried other means and cannot lose weight. That patient should be significantly overweight. This is not for those trying to lose the final ten pounds. It is for people trying to lose the first thirty to fifty pounds (or more). These medications are also helpful in diabetes, when other simpler medications (like metformin) are not doing the job (along with diet and exercise).
The chemical names are semaglutide and tirzapatide. The brand names are Ozempic, Wegovy, and Mounjaro. Studies have come out showing benefits not only to sugar and weight loss, but even to heart failure associated with obesity. The medications are currently available in injectable form; the patient injects once a week (subcutaneously). Close monitoring by the physician of any side effects, of weights, and of blood pressure and other vital signs is crucial. I see everyone on these meds once a month for monitoring; ideally in the office for each visit to maintain a standardized weight (office scale). I typically start a patient on the lowest dosage for that medication and go up if needed to get the desired weight respond or glucose effects.
The big downside to these medications is cost. They are currently ‘retailing’ at $1000 per month. However, some patients have insurance coverage for these meds for diabetes, a smaller number have coverage for obesity, and there are discount programs. The mounjaro website offers a coupon. I have found at least one pharmacy that honors the coupon at a self-pay rate of $550 per month. Again, some of you will have insurance coverage for one or more of these medications. What I advise you to do, if you believe you may benefit from these medications, is to check with your insurance carrier or HR department even before and certainly after your visit with me. Armed with this information, I can determine if one of these medications is appropriate and the risk to benefit ratio is appropriate. Also, I’ll be better able to decide which medication to prescribe if you know your coverage.
Losing weight for health reasons is one of the most challenging tasks for a patient and their physician. Behavioral approaches work for many people. I advise caloric restriction, lowering carbs, and exercise for all my overweight patients. However, some do not respond to these approaches. A medication that is effective and usually safe (nothing is safe for everyone, for all times, and forever), would be a huge benefit to patients and to society.