Reuters World News - Who gets the weight loss drugs when supply doesn’t meet demand?

Episode Date: November 18, 2023

A revolutionary new class of drugs is transforming weight loss. But around the world, demand is skyrocketing for diabetes drugs because they also help people shed pounds. Join our global health journalists as we explore access to drugs like Wegovy and Ozempic and the transformation of the way we understand weight loss. Learn more about your ad choices. Visit megaphone.fm/adchoices

A revolutionary new class of drugs is transforming weight loss. But around the world, skyrocketing demand has been accompanied by shorter supply. On this special podcast episode, we explore how drugs like OZempic and Wagovi are leading to a global debate. Who should get these medicines? For what purposes and what do we really know about managing weight? I'm your host, Christopher Waljasper in Chicago. I'm Michelle Gershberg, Global Health and Pharma editor based in New York. And I'm Maggie Fick, European Pharmaceuticals Correspondent in London.

I'm joined today by two reporters who've covered health care on both sides of the Atlantic. Our global health editor, Michelle Gershberg, has led Reuters' health care and pharmaceutical coverage for more than a decade. And Maggie Fick has reported in the Middle East and Africa since 2010 before becoming our European Pharmaceuticals Correspondent. Michelle, Maggie, thank you. both for being here. Thank you, Chris. Thanks for having us. Maggie, your story that's out today. Tell me about some of the people you've spoken to who are trying to get Ozempic in the UK. So one of the people I spoke to is a 44-year-old man in London, who's a tech executive, and we've identified him in the story as John, by his middle name to protect his privacy.

And he's someone who's battled weight gain since his 30s. And he actually had testicular cancer and had surgery for that more than a decade ago. But early this year, finally cancer-free, he decided to try OZMPIC because he wanted to lose weight and tackle his obesity. And the way that he managed to get that medication was by buying it from private online pharmacies. And through that method,

was able to build up a nine-month supply of it in his refrigerator. And that's in contrast to folks who are trying to get, the medication for diabetes? Another person I spoke with is Kim Gradwell, who's a retired receptionist in the city of Newcastle upon time. And Kim has type 2 diabetes, was diagnosed nearly 20 years ago. And she's in a different situation than John.

She gets her OZMPIC prescription through her doctor and through the country's state-run National Health Service. but she struggled in the past few months to get her government-paid prescriptions filled because a shortage of this medication has emerged in the United Kingdom, and Kim doesn't have the means like John does to buy it privately. So back in July, when she went to the pharmacy to get her O-Zemic prescription filled, she was told that the dose strength that she takes wasn't available. So she was given a half strength. And that really caused Kim's type two diabetes to, suffer. Her blood sugars surge and some of the complications she suffers from the disease came back.

And importantly, she also had to increase the amount of insulin that she injects herself with daily. And luckily for her in late September, her pharmacy was able to fill her prescription for the appropriate dose again. But she told me, you know, that she lives in fear when she goes to the pharmacy to get her prescription filled because she doesn't know if it will be available. So are regulators doing anything to try to address this? The reporting we've done over the past couple of months sheds light on this sort of two-tier access system, where people who are able to afford to buy it through private systems are able to get the medicine, while people who are getting it through the NHS for their type 2 diabetes are sometimes unable to.

And the British government did attempt to address this issue in the summer, July, they declared a shortage of the active ingredient in OZemphic, which is called semaglutide, and they instructed prescribers, so both doctors through the NHS, but also these private online pharmacies, to only prescribe OZemPEC for its approved use. But we found that people like John were able to pay hundreds of pounds to effectively stockpile the medication for weight loss, but in fact, at the moment, only one of the four pharmacies that John bought from this year is still selling it on, selling Ozempic on its website. And that's partly because in September, Novo Nordisk, the drug maker that makes Ozempic, launched Wagovi, which contains

the same active ingredient, but is approved for weight loss. So now those private online pharmacies are offering Wagovi but have stopped offering OZemPEC for weight loss. Now, Novo Nordisk, which produces OZempic, says it's acutely aware of the shortage and the uncertainty and concern that patients and healthcare professionals are experiencing. Novo recommends that anyone who believes they may be affected should speak to their clinician. And the pharmacies say that they are within their rights to continue prescribing OZEmpic for weight loss. Now, to be clear, what John is doing, what these pharmacies,

are doing, and none of that's illegal, right? Absolutely. John was doing nothing illegal or wrong since these private online pharmacies are all regulated by the country's pharmaceutical counsel. And so the way he put it to me is that it's sort of a matter of dancing between pharmacies to maintain supply. And he actually, he saw the government issue the alert in July, and he worried that he wouldn't be able to continue on the medicine, which had.

helped him to lose about 20 kilos and he wants to continue. But he was interested in sharing his story with us because, as he put it, it's sort of a Wild West situation, or it has been, where he was able to get the medicine from multiple pharmacies, but nothing stopped him from stockpiling. Now, Michelle, the UK is not the only place we're seeing these shortages. So in the United States, we have some similar dynamics. We do have a short supply. We do have a short supply, of Ozempic. But the situation is a little bit different because once a drug is in short supply in the United States, there is a sizable industry of compounding pharmacies that are then allowed to produce the drug. So what's happened in the U.S. is you have this proliferation of pharmacies that are

making versions of Ozempic or Wagovi, right? It's the same active ingredients, samaglutide. And they're selling it through online pharmacies and med spas and all kinds of outlets, right? But from there, it starts to get murky where you may not know really the quality of the drug that you're buying. So there is a shortage in the United States, but there's also a proliferation of outlets that are offering the drugs. So the dynamics are a little bit different. This is certainly not a problem that's unique to the United States or the UK. And just this week, we saw Germany's drug regulator saying that it's considering an export ban on Ozempic, since they know some of their supply is being exported from Germany.

And last month, Belgium's health minister said that the government was going to consider temporarily banning the use of OZempic as a weight loss treatment because they had seen that simply telling doctors to reserve the drug for type 2 patients wasn't working as a way to tamp down demand. Now, it might be worth a quick explainer here. We've mentioned Wagovi, OZempe, but there are other brands that fall into this category of treatment. The main competitor to the Wigobi-Ozimic product lines is a drug that works in a similar way from Eli Lilly. It's known as Mungaro for the diabetes treatment. And then a slightly different version of it was just approved in the United States called Zepbound. And that is going to treat patients seeking to lose weight. And we're expecting that to become available in the coming weeks.

I think some people have said right after Thanksgiving, which many of us may think is an appropriate time to start some new regimen. and around weight loss. Maggie, could you briefly just walk us through how these medications work, both for diabetes and for weight loss? So, OZempic, Wagovi, Woonjaro, Zepbound, they are all part of a class of drugs called GLP1 receptor agonis, and these drugs mimic a hormone that's produced in the gut in the stomach that helps to regulate blood sugar and appetite.

So people who are taking these drugs have told us that, it's dramatically changed their relationship with food and their ability, quite simply, to consume as much food as they used to. And one of the main side effects of these drugs is nausea, because these are drugs that, as I said, mimic the hormone that regulates appetite. I just want to jump in there, too. When we cover these drugs, this is a story for patients. It's a story for businesses, for regulators. But we are really looking at this is just the very beginning of what is

going to be a process of discovery. So as Maggie is saying, right, the drug mimics a hormone and that helps the communication lines between the gut and the brain. And part of the research and the science around this is finding out many new interesting things

and is looking for new interesting clues that will help us understand better what contributes to obesity. We don't have good answers about that. And we know that there are many other drug makers that are working on a new generation of the same class of drugs. And the thinking is that over time, we're going to get a lot more information of how do different patients respond to these drugs. Not all of them have the same benefits. Others experience very debilitating side effects.

Will it work differently in different populations? Is it something that's appropriate for younger patients, for adolescents and children? So we're really at the very beginning of what looks like this process, this journey of discovery. I should also say that this same class of drugs is being tested in a number of other diseases, again, raising really interesting questions about what is that interaction and communication around between the gut and the brain? They include Parkinson's disease, Alzheimer's, and even questions around substance abuse. So really interesting days to come.

Yeah. And speaking of which, there's now new research. about how these medications could be used to treat heart disease. Could that exacerbate the shortages? You know, I'm so glad you brought that out because, yeah, we and others covered the results last weekend of a trial that Novo Nord has conducted showing a heart benefit, that Wagovi was providing a protective benefit against heart attack, stroke, and even death from heart disease.

The interesting finding in particular that they presented was that patients who were experiencing this heart benefit began to experience that benefit even before they lost weight. That was a real question. If there is a heart benefit is because somebody has shed pounds and that helps the cardiovascular system. And in this case, the indication here, the hint is that, no, it was doing something in the body that was protective of the heart directly. So that is really fascinating. And then to your question of would that exacerbate shortages, it's not yet clear to us how this data is going to affect prescribing practices. Already there's insatiable demand and the drug makers cannot keep up with it in terms of production. Both Novo Nordisk and Ili have announced all kinds of plans and multibillion dollar investments

to increase production. And as I said, there are other drug makers in the coming years that may be successful with similar products. So I think we're looking at a supply constraint for quite a while. Maggie, do you agree with that? Absolutely. I mean, just last week, Novonors announced $6 billion, to boost production in Denmark. But the company has been very clear, repeatedly saying this year that they don't know when they're going to be able to satisfy demand for Wagovi and OZempic. It's going to be the short, medium turn, but they won't say because I don't think they know. But yes, really, it's a story of absolute runaway demand.

Is there a possibility that the competing uses for this drug could actually worsen health disparities, especially when it comes to race or class? I'd say so far what we came to understand through this reporting is that there is sort of a two-tier access situation, the haves and the have-nots here in the UK, where this year there has been a route for people who have money to buy it privately, and that has affected the ability of people who need to get it for free through the state health system. And I think the cost of these medications for now, if you're listening to this podcast in the U.S., and you hear that the price here in the UK is 300 pounds, you know, that's less than $400. That doesn't sound so bad because in the U.S., the list price for Wagovi, for example, is $1,300 for OZMPIC. It's less than 1,000. But even so, I think it's clear that equality issues might emerge over time as we see demand continuing. What do you think, Michelle? In the United States, what we know is that if you are uninsured or underinsured, the

of a medication like Wagovi or Zep bound may well be out of your grasp. And we know that there is overlap between people with obesity in the United States and populations who are underinsured or not insured or who have insurance coverage, but we do see an increasing trend among various health plans not to cover these drugs or to put all kinds of restrictions on their use. So it is, it's an emerging problem. I think that is fair to say. And also, yeah, I mean, in the UK, from the doctors I spoke to around the country, it was clear to me that many of their patients wouldn't be able to pay for it out of pocket. They do depend on being able to get it for free through the NHS. There's this characterization happening, comparing one group of people who need

this drug to live, while others are using it for maybe cosmetic reasons. Is that a fair comparison? These drugs sort of exploded into the public consciousness, I guess last year when celebrities and well-known public figures like Elon Musk and the Kardashians began talking about how they appreciated the weight loss that they were enjoying as a result of taking it. And it's come out more this year that these drugs clearly are approved for type 2 diabetes and obesity and the company and doctors, you know, kind of stress the point that obesity itself is. is a chronic disease. And so certainly it came into public awareness more as sort of a lifestyle drug.

But certainly people that I've interviewed who are taking it and doctors who are prescribing it say, no, no, these are for serious health conditions. And certainly the priority should be for those people getting it. But for now, the story seems to be that people with means are able to get it. and some of them are unlike John, who I spoke to, who was taking it for his obesity, but some people are getting it and taking it to lose weight for cosmetic reasons. I'm struggling with that a little bit, to be honest, because I think it's true the very first waves of use of this drug were among people of means,

right? Sometimes of extraordinary means and wealth. But over time, we are seeing more and more prescriptions being written every week for new patients, and these are patients who are covered by commercial insurance plans. and they are in conversations with their doctors about their risk, what risks are opposed to their health by having additional weight on their bodies. And so that's where I think we're struggling a little bit to make a very clear characterization. But I think to your point, we know diabetes prevalence among black Americans is higher than other groups in the United States.

Obesity rates are also higher among black adults, for example, but it's still very high among other communities as well. So I think that's where we struggle a little bit, Chris, and saying, I think that more of the question is what kind of insurance do you have? And there is, we do know that within among the insured, you know, uninsured and underinsured, there are, there is a higher prevalence among black Americans, among Latinos. We know it's a problem, but we can't yet quantify it, I don't think. Obesity has long been seen as a sort of moral issue, right? There's these long-standing, I think, misunderstandings about weight gain that are sort of being confronted by the use of these drugs. It's so interesting because one person that I spoke to over the course

of this coverage was saying, you know, all my life I've been told, just eat normal portions and you will arrive at a normal weight. Now that I'm using this drug, I understand that now I know what it means to eat a normal portion because I'm no longer hungry. And that's a huge change and is part of the conversation that I think gets people away from making it a moral issue or a question of willpower, that there's something about these treatments that address a need in the body and alter it for some people, maybe not for all patients, some patients don't do well on this drugs, but there are increasing sort of testimonies from patients saying, I feel different, I eat differently, and that's part of what's contributing to the weight loss. So that it opens up all of

those questions and assumptions. Could I just add something from John, the mid-40s Londoner? As I said, he had testicular cancer, and in his words, it really messed with his hormones. And that caused a lot more weight gain that he was already suffering from. So I think Michelle said, we're just at the beginning of understanding obesity and these drugs are helping to further understanding and take it in different directions. And so I think the more and more people who are taking them, the more nuanced information will also come to light. Now, as these drugs boom in popularity, I imagine that pharmaceutical companies are eyeing big profits. How are these medications impacting these companies? Right. So, I mean, clearly this extraordinary demand is driving these two companies. We've mentioned

Novo Nordisk and Eli Lilly to record profits, but is also creating new issues. One issue that I reported on with a colleague in New York last month is this global surge in counterfeit versions of the drugs. And Novo Nordisk has said that this is a concern for them and that they encourage anyone to report counterfeit versions to the authorities. We've seen the UK drug regulator warn, caution the public about the dangers of buying fake weight loss pens. They said there were a very small number of hospitalizations as a result of that. Similar thing happened in Austria, where some hospitalizations were reported due to people using fake versions of semaglutide. So those are some emerging issues. In the course of this reporting in the UK,

I did speak to about half a dozen doctors and type 2 diabetes patients who told me stories of ways that people are buying what they believe to be semaglutides through, as Michelle mentioned, these sort of beauty spas they're called, sometimes on pop-up websites that are advertised through Instagram or talked about on Reddit, but we weren't able to independently verify these accounts. Now, Michelle, we've seen over the last few decades instances of medicines becoming effective and then blowing up in popularity and then instances of abuse or overprescription. Is there a concern here with these medications? I think at this point, when you look at the rates of people living with obesity or who are

overweight in the United States and at risk of other illness because of their weight. We're still at the very beginning of prescribing. I think it's fair to say there are questions about how liberally should these drugs be prescribed at this point when we know they are in shortage, when we know that diabetes patients may be affected and will find it harder to get their medications for diabetes, and how do we identify the patients who are likely to benefit the most, Right now, in the United States, there aren't limits like that being put on prescribing. In the UK, however, through the NHS, there are stricter criteria for who should get the drug right now. These are people with a higher BMI and who are at greater risk of other illnesses, heart disease, diabetes, and the like.

And so I think it's fair to say there's a question of how liberally should this go on. We also know that these drugs are sort of under scrutiny by regulators in Europe and the United States for some rare reports of people who began to have suicidal thoughts as soon as they began taking the drug. And we've reported on this and the feedback we got from experts in the field is those reports at this point don't mean you shouldn't use the drug, but it may require a closer look at each patient and whether or not they have any risk factors before starting the drug for suicidal thoughts and close monitoring after they begin taking the drug to see if anything develops. And

there's already some conversation around that, but the question would be should those warnings be perhaps even more explicit. Now you mentioned suicidal ideation, and I think earlier we mentioned abdominal pain, nausea. These are new drugs. They've been around for less than a decade. What do we know about the long-term side effects? We don't really have long-term data. Yet. That's going to take a while. It's going to take several years to track and understand. And also, as the drugs are being used by millions of people, there may be things that come up that aren't seen in clinical trials. So the long-term risks, to the extent that they exist, aren't fully known, and certainly something that people will want to track. One thing that I found interesting is the fact that when you stop taking these medications, the clinical trials to date show that you regain the weight. And sort of an interesting question for investors is how long will people stay on these weekly injection drugs?

Fascinating. It's kind of a stark reality, right? If you want to continue enjoying the weight loss, you're going to have to keep using the drug. Indeed, and that seems to be one of the things, obviously, that's of interest to investors, that these could become long-term medications for large, large numbers of people. That's it for this special weekend episode. Thanks to Maggie, Michelle, and the entire health reporting team that made this episode possible. Reuters World News is produced by Jonah Green, Tara Oaks, David Spencer, Kim Vennel, and myself. Our senior producer is Carmel Crimmons.

Lila Dekretzer edits the show. Engineering and sound design is by Josh Summer. To make sure you know what's going on in the world, listen in for 10 minutes every weekday. And don't forget to subscribe on your favorite podcast player or download the Reuters app.