HomeFinancial Implications of Ozempic, Wegovy and MounjaroBlog PostFinancial Implications of Ozempic, Wegovy and Mounjaro

Financial Implications of Ozempic, Wegovy and Mounjaro

Financial Implications of Ozempic, Wegovy and Mounjaro

By: Eric Bricker, MD

The newer diabetes and weight loss medications have profound implications for patient health, patient out-of-pocket costs and employee health plan costs.

Ozempic is a popular diabetes medication that also helps with weight-loss. Another name for Ozempic is Semaglutide. At higher doses of 1 mg per week it suppresses appetite and can lower weight by 10-13lbs.

Ozempic is only approved for Type 2 Diabetes, NOT weight-loss. Ozempic costs about $995 per 8 mg pen, which could potentially last you almost 2 months.

Wegovy is the same medication as Ozempic–i.e. Semaglutide–just at a higher dose of 2.4 mg per week. It suppresses appetite even more and can lead to 35lbs of weight loss.

Wegovy is approved for weight-loss. Wegovy costs about $1,432 per month.

Mounjaro is a different medication. It is Tirzepatide. It is also approved for Type 2 Diabetes and may soon be approved for weight-loss. Mounjaro can lead to 52lbs of weight-loss.

Mounjaro has a similar mechanism of action to Semaglutide–it suppresses appetite.

Mounjaro costs about $1,087 per month.

An employer group with 1,000 members on its plan could expect to see a $1.9M increase in pharmacy costs if 50% of the plan members with obesity take these medications.

Cost mitigation strategies include:

  • Moving from a traditional PBM to a transparent/pass-through PBM
  • Prior-authorization requirements
  • Specialty Rx carve-out vendors
  • Greater use of 8mg Ozempic pen
  • Inventory control so people do not lose their $1,000 pens

Where the prescription is filled can impact the price as well. For Ozempic, some pharmacies are as low as $905 for a 2mg pen and other pharmacies are as high as $1,041, approximately a 10% difference in price. For Wegovy, some pharmacies are as low as $1,302 for a pack of 4 pens and other pharmacies are as high as $1,619, approximately a 20% difference in price. Finally, for Mounjaro, some pharmacies are as low as $989 for a pack of 4 pens and other pharmacies are as high as $1,227, approximately a 19% difference in price.

Coupe Health financially incentivizes members to fill their prescriptions at lower cost pharmacies. The copay for the exact same medication will be lower at a lower cost pharmacy and higher at a higher cost pharmacy.

Being good stewards of an employee health plan’s resources requires alignment…alignment that Coupe Health provides with easy-to-understand, up-front-copays on prescriptions and medical services.

To learn more set up a meeting with our team today by visiting https://www.coupehealth.com/contact/

 

Sources:

https://www.nbcnews.com/health/health-news/ozempic-wegovy-diabetes-weight-loss-side-effects-rcna66493

https://www.ozempic.com/why-ozempic/diabetes-medicines-comparison.html

https://www.wegovy.com/taking-wegovy/dosing-schedule.html

https://www.drugs.com/dosage/wegovy.html; https://www.mounjaro.com/hcp/a1c-weight#mounjaro-weight

https://investor.lilly.com/news-releases/news-release-details/lillys-tirzepatide-delivered-225-weight-loss-adults-obesity-or