Minnesota doctor says FDA weight-loss drug cutoff is ‘devastating’ for patients

NINA MOINI: The amount of weight loss drugs on the market is about to shrink dramatically and cut thousands of Americans off from cheaper obesity drugs as the FDA halts the sale of these copycats. Companies and pharmacies were able to sell cheaper alternatives to weight loss drugs Wegovy and Ozempic because of a shortage of a protein called semaglutide, which helps regulate appetite.

But now, that shortage is over, and the FDA says these companies that provide cheaper alternatives must stop. Some will have to stop production by as soon as tomorrow, April 22. Joining me to break down what this means for patients is Dr. Laurie Sund. She's the medical director for the medical weight management clinic at MHealth Fairview. Thank you very much for being with us, Doctor.

LAURIE SUND: Thank you for having me.

NINA MOINI: Well, I have seen a lot of ads. It's really hard to keep track of all the different weight loss drug ads that are everywhere. Can you just remind folks how they work?

LAURIE SUND: First of all, just letting you know I'm really passionate about this, because obesity is the second leading cause of preventable illness and death, and 42% of our population has obesity. Yeah, the mechanism of the Wegovy and the tirzepatide, these injectables, they mimic a hormone that our bodies make called GLP-1, and then tirzepatide, also GIP, to gut hormones, such as appetite.

And there are receptors in our body at multiple sites. So well, they take away the food noise. And they slow down gastric emptying. So not only mentally are you not thinking about food, but also physically, you're full. You just can't take another bite.

NINA MOINI: Oh, are you there, doctor?

LAURIE SUND: I'm here.

NINA MOINI: Oh, OK. Yeah, well, thank you. Yeah, thank you for just explaining that. I think what's happened is there's so much conversation in the public about, is this something people are taking when they don't need it? How does that impact people that do need it? This FDA decision around this semaglutide, do you think this is a good thing? I mean, it could be good and bad in different ways. Or what are your thoughts on it?

LAURIE SUND: Well, I think 42% of our population has obesity. And the indication for any weight loss medication, whether it's Wegovy or tirpezatide, which is Zepbound, is a body mass index of 27 with a weight-related problem or a BMI of 30. So I don't think there's a lot of people out there who are--

NINA MOINI: We're having a little bit of trouble with your connection. I'm so sorry, doctor. We're having just-- oh. Let's see here. Maybe we should try to get her back. Yeah. Well, we are happy to have Dr. Laurie Sund rejoining us. Sorry about that little snafu we had there, Doctor. Thank you for coming back. [CHUCKLES]

LAURIE SUND: My pleasure.

NINA MOINI: So just to give folks an idea, we were talking about these cheaper alternatives to weight loss drugs, Wegovy and Ozempic, because of a shortage of a protein called semaglutide, which helps to regulate appetite. So essentially, Doctor, it sounds like what's going to happen is that some of these cheaper off brand weight loss drugs are no longer going to be available. What is your understanding of where that places patients who might already be on these or are looking for a cheaper alternative?

LAURIE SUND: Yeah, well, first of all, these medications are life-changing. Patients are, day after day, crying tears of joy. They're saying, oh, I feel, quote, "normal" for the first time in my life. I'm not driven by food and thinking about what's for dinner and the next meal.

And I've had people-- their lives are transformed, their mobility, their fertility. They're able to have their joints replaced, their kidney transplants, their confidence. They're applying for jobs they never would have applied for. And one gal even ran for office. So they are literally life-changing.

So one thing people don't appreciate is that our weight is 40% to 70% genetic, and we don't yet have gene therapy, but we do have bariatric surgery, which is very effective, and then these GLP injectable medications. Now, all of these patients who've been experiencing them, either by prescription or the compounded Wegovy or the compounded Zepbound, have had their lives transformed.

And I think most people have heard when you stop taking them, they gain the weight back. Well-- and that's true. Most people do gain their weight back-- not all of their weight. But we do have other weight loss medications, none as effective as these injectables.

NINA MOINI: So if someone was taking them currently, are they just going to be gone? Or do you know much about how that would work for a patient?

LAURIE SUND: Oh, I live it. Yes. All day, every day, this is what I see. And it's gut wrenching to have somebody who's had their life transformed, and they come in and their question is, now what?

And we do have weight loss medications that we've had since 1959. I mean, we have phentermine. There's a number of oral tablet medications-- phentermine, topiramate, indomethacin, Wellbutrin and naltrexone combination. So we do have weight loss medications that we've used for a long time, and they are safe and effective.

They also have the option to cash pay. Now, these are very expensive. I looked at the prices today, and the semaglutide was $1,200 or $1,300, and the tirzepatide appetite was about $1,100, if you were to just go to the pharmacy with your prescription and say, I want to cash pay.

They do have a program that they just introduced in the last few weeks. You can get Wegovy for $499 for all of the doses, and you can get Zepbound for $499 a month for doses up to 10 milligrams.

That excludes, however, government beneficiaries. So patients on Medicare, TRICARE. Let's see here. Let's see the other government entities. Some of the Medicaid programs that they don't cover it are excluded from the $499 price, and they'd have to pay the full price.

NINA MOINI: Wow. Yeah. I mean, do you think that-- are all of these different drugs, with all the different names, are they all equally safe? It can be confusing when there's so many different names out there. Are they all-- do require a prescription for every one of them? Or what do you think about how the market is working?

LAURIE SUND: The ones I mentioned all require a prescription. So phentermine has been around since 1959. So with all of these, there are indications, contraindications, and a risk-benefit profile that you have to talk about with patients. The stimulants-- a lot of the effective weight loss medications are stimulants. Well, if you have cardiovascular disease, you can't take a stimulant. Or if you're on, say, Adderall and Ritalin or other stimulants, you can't take a stimulant, so that rules that out.

Some of the other things, like kidney stones, might make you less appropriate for topiramate. So by far, these injectables are the most appropriate for people who have heart disease or polypharmacy, meaning they take a long list of medications. Or they don't tolerate or have contraindications to the oral medications.

And back to the question of taking it away, we don't plan on not treating weight. It's genetic. And much like seizure disorders, if you stop the anti-seizure medications, people have seizures. If you stop the anti-migraine medications, people have migraines. So when we start these medications, we don't plan to stop them. And now this is inadvertently happening to a lot of people who were able to get the compounded Wegovy and Zepbound.

NINA MOINI: OK. Thank you for that. I wonder, Doctor, if just lastly, you could talk to someone who is out there who is perhaps thinking about exploring taking these types of drugs or medicines and thinking right now, well, it sounds like it's way too expensive for me. There's also a lot of stigma and misinformation and misunderstanding around it. What do you tell people who may think, if I could just find a solution?

LAURIE SUND: Well, it is expensive. And even with the discounted prices, it's expensive if the insurance isn't covering it. MHealth Fairview is compounding some sublingual semaglutide because the maker didn't formulate a sublingual formula. And that might be very appealing for people who want the semaglutide, and particularly if they don't like needles, because it's not injectable. And it's more affordable. It's about $180 or $200 per month for the sublingual formula. So that's probably the lowest option.

NINA MOINI: OK. So you're basically--

LAURIE SUND: And then the oral medications, too, yeah.

NINA MOINI: Got it. So don't be afraid to ask, at least, and talk to your doctor about it. And there might be different solutions for different people that they've not explored. Dr. Laurie Sund, thank you very much for your time and breaking that down for us. I really appreciate it.

LAURIE SUND: A pleasure. Thank you so much for having me.

NINA MOINI: That was Dr. Laurie Sund, medical director for the Medical Weight Management Clinic at MHealth Fairview.