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Replies to post #252982 on Biotech Values
By the time Lisa started breaking open her Mounjaro pens with pliers, she had run out of other ideas. She was 300 pounds. She had already tried bariatric surgery. (It had limited success.) She had tried getting her insurance company to cover Mounjaro. (It stopped after a month.) She had tried a cheaper copycat version from a compounding pharmacy. (It didn’t work as well, and she worried about what she was actually getting.) “I was absolutely desperate to stay on,” she says, but she could not afford the sticker price.
That’s when she learned online about a money-saving loophole: She could split a maximum-strength Mounjaro pen into the smaller doses she needed. (The single-use injection pens come in multiple concentrations that cost the same.) One pen became as many as six. A year of dose-splitting later, she has lost 75 pounds—at a fraction of the original cost.
Lisa is among a small number of patients who have taken to hacking their injection pens. (I’m identifying Lisa and other patients in this story by only their first names to protect their medical privacy.) As new drugs used for weight loss—which go by the brand names Mounjaro, Ozempic, Zepbound, Wegovy—have skyrocketed in popularity, patients have sometimes found that the one-size-fits-all dosing does not, in fact, fit all. Most dose-splitters are trying to save money, but others are managing side effects. They swap tips online. They take risks because they want to stay on a medication that is, by many accounts, utterly life-changing…
Even putting costs aside, fixed-dose injection pens are not ideal for patients. After Ozempic was approved in 2017—the first of these drugs to be—doctors noticed that the standard regimen of increasing doses in four-week increments did not work for every patient. Some patients had debilitating side effects of nausea, diarrhea, or constipation at even the lowest, 0.25 mg, dose; they might need to start at only half or a quarter of that. Some needed to go up more slowly with in-between doses. And some might be “super responders,” losing weight so quickly that they never need the full dose at all.
Ozempic doses are actually quite easy to adjust, even if patients aren’t technically supposed to. Unlike subsequent drugs, Ozempic is packaged in multidose pens with dials. Only the official dosages are labeled—0.25 mg, 0.5 mg, 1 mg, 2 mg—but people quickly reverse-engineered how many dozens of clicks correspond to one milligram. Novo Nordisk officially cautions users to “not set the dose by counting the number of clicks.” But doctors told me they consider counting clicks to be pretty safe, and some even advised their patients on Ozempic to do so if a dose needs adjusting. “I don’t have a problem with it,” Davisson told me. Novo Nordisk uses the same pen for its insulin, allowing people with diabetes to choose the amount of insulin they need.
But a deeper look at the announcement suggests the new offering may not expand access as much as the company indicates.
Doctors noted that the price of the vials will still be out of reach for many patients, and only the starter doses will be offered in the vials, not the higher doses that many patients need to achieve significant weight loss. Additionally, not all patients will be able to pick up vials; they will only be available to patients who are paying for their own medication without insurance and who exclusively order through Lilly’s online portal.
On the same day Lilly launched the vials, it also quietly increased costs for other patients. Before, people who have commercial insurance but don’t have coverage for Zepbound could apply for a savings coupon to get the pens, at whichever dose, for $550 a month, but on Tuesday Lilly raised that price to $650 a month — a move that wasn’t mentioned in the press release.
Lilly also appeared to have made a similar change to its savings coupon for Mounjaro, the sister diabetes drug, based on changes made to its webpage.
Experts said that, while the price of the new vials is a good step, Lilly’s actions, taken together, signal its primary interest is in expanding its market share and reaching patients it previously could not. In this case, the company is specifically aiming to draw in patients on Medicare, who have to pay for Zepbound on their own since Medicare doesn’t cover weight loss treatments and doesn’t allow beneficiaries to use drug coupons.
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