Prolonged shortages of popular new weight loss drugs including Zepbound and Wegovy are causing frustrations for patients, pharmacists and medical providers, and there’s no immediate relief in sight.

A revolution in weight loss drugs began in recent years when doctors and researchers discovered that drugs created to help control diabetes may also spark dramatic weight loss. The newest research has continued to show other benefits including improved cardiovascular outcomes and better kidney health.

The drugs are expensive, and many insurance companies do not cover the medications when patients use them to lose weight rather than to control diabetes. Also known as glucagon-like peptide 1 receptor agonists or GLP1RAs, the medications can cause gastrointestinal side effects, and patients may need to take the drugs forever in order to keep the weight off.

But high costs and other challenges haven’t stopped people from clamoring to get the drugs, which can help patients lose 20% or more of their body weight.

The most famous of these drugs is Ozempic. It has become a household name thanks to omnipresent advertising and the drug maker’s “O-O-O” jingle that may ring in the heads of many Americans. Ozempic is actually a diabetes medication, not a weight loss drug. But it has become an umbrella name of sorts for the new class of GLP1RAs. The generic name for the drug in Ozempic is semaglutide, which patients inject once a week. There is also a pill form of this drug that patients can take daily for diabetes; that’s called Rybelsus. When prescribed for weight loss, semaglutide is called Wegovy.

The newest weight loss drug is called Zepbound. That’s the brand name for a drug called tirzepatide. The version of tirzepatide for diabetes patients is called Mounjaro.

The popularity of all of these drugs has continued to explode this year as celebrities like Oprah, Whoopi Goldberg and Tracy Morgan have spoken publicly about their success in losing weight with the medications.

Millions of regular folks have followed suit, and now, due to widespread drug shortages, many people across the U.S. are struggling to get their prescriptions filled.

To help patients figure out what to do if they are dealing with shortages for medications like Zepbound, Wegovy, Ozempic and Mounjaro, we consulted with experts.

Their key message is to avoid using substitute weight loss medications from compounding pharmacies or medical spas. Patients should also be aware that some unscrupulous online sellers are marketing counterfeit weight loss drugs. Before taking any medication, always speak with your medical provider and obtain medications through trusted, licensed pharmacies.

“It’s an unnecessary risk to use compounded versions of these medications. We strongly recommend against it,” said Dr. Cecilia Low Wang, a UCHealth expert on endocrinology, diabetes and metabolism. “We can’t guarantee their sterility and safety. And if a compounding pharmacy tells you that there’s a certain amount of the active drug in an injection, that can’t be verified independently,” said Low Wang who is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus.

“Be really careful about the potential for fraud,” said Low Wang, who chairs the committee that advises the U.S. Food and Drug Administration (FDA) about drugs related to endocrinology and metabolism. (Low Wang does not receive funding from the drug companies. And her views do not represent those of the FDA or the FDA Endocrinologic and Metabolic Drugs Advisory Committee.)

FDA officials have issued warnings about compounded medications after having received reports of adverse reactions to weight loss medications.

Amy Gutierrez, vice president of pharmacy services for UCHealth, said if a deal for compounded versions of the newest weight loss drugs seems too good to be true, it probably is. She warned patients not to fall for unsafe alternatives to legitimate FDA-approved medications.

“Given the FDA warnings, I would be very concerned with the safety parameters of acquiring semaglutide from a compounding pharmacy,” said Gutierrez, who has a doctorate in pharmacy.

“Some compounders also may be using salt forms of the medication, such as semaglutide sodium and semaglutide acetate, which have different active ingredients from those in the FDA-approved drugs. Products containing these salts have not been shown to be safe and effective,” Gutierrez aid.

“The FDA-approved drugs are costly for patients who don’t have insurance coverage,” she said. “If the compounding pharmacy is selling medications for $350, these compounded agents may not contain the same active ingredients as the FDA-approved product, and may have potential safety concerns.”

The cash price that drug companies are charging for Ozempic, Wegovy, Mounjaro and Zepbound in the U.S. ranges from $1,200 to $1,400 per month, according to GoodRx. That’s far higher than patients pay in Europe, where monthly doses cost about $100. And recent research from experts at the Yale School of Medicine estimated that pharmaceutical companies could produce the drugs for as little as 75 cents per person for four monthly doses.

Dr. Annie Moore is an internal medicine doctor who is board certified in obesity medicine and has extensive experience prescribing the newest weight loss medications to her patients.

The real medications have been game changers for many patients, Moore said.

“They’re great for the right person,” said Moore, who cares for patients at CU Internal Medicine – Cherry Creek.

But due to high costs and medication shortages, she said some of her patients have turned to compounded medications, which she warns can be dangerous and ineffective.

“If you’re being told to buy a bottle with liquid in it and buy your own syringes and draw that up, you’re not getting the real product,” said Moore, who is also a professor of clinical practice, medicine and internal medicine at the University of Colorado School of Medicine and researches best practices in patient care through the Brown Moore Endowed Chair for Excellence in Patient Experience.

Which of the weight loss and diabetes drugs are hardest to get right now?

All of the newest weight loss drugs are in short supply and have been since last year. Currently, Zepbound, the weight loss version of tirzepatide, is the hardest medication to get, pharmacists and doctors said.

But the supply of all of these drugs varies dramatically from day to day. And Zepbound, Mounjaro, Wegovy and Ozempic all are currently in short supply, according to the FDA’s drug shortage list.

Why are these weight loss drugs so popular?

The drugs are extremely popular because they often work. Clinical trials showed that the medications were both safe and effective and helped people lose significant percentages of their body weight. (Learn more about the pros and cons of Ozempic and Wegovy and the basics about Zepbound.)

The drugs also have dramatically changed the way medical experts think about obesity. In the past, some doctors and researchers blamed the world’s obesity epidemic on individuals and their diets and lifestyle choices.

Now, while the prevalence of highly-processed foods, sugar-sweetened beverages and sedentary lifestyles certainly contribute greatly to weight gain, research is showing that people with higher body mass indexes, or BMIs, are more likely to be predisposed to gain weight easily and keep on extra pounds.

Medical experts now focus on brain chemistry in addition to stressing the importance of healthy behavior change. One of the reasons that the new weight loss drugs are effective is that food moves more slowly through the digestive system, making people feel satiated sooner. They also seem to help people who feel like they’re addicted to unhealthy foods and thus, make it easier to stick with healthy lifestyle resolutions.

Why are the weight loss drugs in short supply?

The answer is simple.

“The demand has really outweighed the available supply. That’s why this is happening,” Gutierrez said.

The drugs also are complex to manufacture. FDA experts have not yet approved a pill form for the weight loss drugs. Ozempic, Wegovy, Mounjaro and Zepbound are all liquid medications that come in injection pens that are harder to manufacture than pills.

The shortages of the drugs are affecting people around the world. In one ironic twist, public health leaders in Denmark — home of Novo Nordisk, the manufacturer of Ozempic and Wegovy — recently mandated that due to high costs and shortages, patients there will have to try other medications before going on semaglutide.

U.S.-based Eli Lilly, maker of Mounjaro and Zepbound, has announced plans to expand manufacturing of the popular drugs in Indiana and North Carolina. But so far, the company has not been able to keep pace with an onslaught of orders. 

What’s happening now? How are pharmacy workers handling shortages?

Every day, many pharmacists and pharmacy technicians say they start their days by trying to order more of the weight loss medications. That’s because large pharmacies will get dozens, if not hundreds, of inquiries for the weight loss drugs every single day.

The medications come in varied doses because patients start with lower doses and work up to higher doses. Sometimes, pharmacies will have the lowest and highest doses in stock since fewer patients use these doses. But some pharmacies don’t have any of the doses in stock.

When the FDA first approved Zepbound last fall, the name of the drug sounded odd to patients, providers and pharmacists alike. Zepbound is certainly not a household name yet, like Ozempic. But workers at pharmacies from hospitals to Costco, Sam’s Club, Walgreen’s, grocery stores and Amazon’s online pharmacy, are all now well acquainted with the drug because so many patients are asking for it every day.

What are the best tips for finding medications that are in short supply?

Pharmacists, pharmacy techs and medical providers don’t have easy answers.

“We’re advising our patients to shop around and to check with different pharmacies,” Low Wang said.

The following strategies may help:

• Start early. Patients who are taking medications like Zepbound, Wegovy, Ozempic and Mounjaro typically receive a one-month supply, or four injection pens at a time. For the best luck in finding the next month’s doses, pharmacists advise patients to start calling around at least a week or two before they need their next box of injections.
• Be flexible. Patients may need to call multiple pharmacies. Doctors’ offices are getting used to frequent emails and calls from patients asking for new prescriptions to be sent to different locations, depending on which pharmacy might have the dose the patient needs.
• Try getting on a waiting list. Some pharmacies allow patients to be on a waiting list. With an active prescription, pharmacy workers will try every day to get the medication and will contact patients if they happen to get a dose that patient needs.
• Consider switching to a different medication. If patients have gotten used to a particular medication and aren’t experiencing too many side effects, most will want to stick with the same drug that’s working for them. But if a popular weight loss drug is not available, doctors may encourage patients to switch to a different medication to avoid a gap in treatment with that class of medication.

“I’ll have patients who are on one medication and tell me that they’re calling around and that a different medication is available. And they’ll ask if I can put in a prescription for that other medication so they can rush over and pick it up while it is still available,” Low Wang said.

Doctors and medical assistants are having to spend a great deal of extra time as patients navigate the shortages. And there isn’t research yet to guide best practices.

“We really don’t know how well switching will work, so we’re doing our best,” Low Wang said.

In general, the newest medications are the most potent in terms of average weight loss effect.

Low Wang said patients who can’t find their medications can revert to daily injections instead of using a weekly medication, but understandably, some people don’t want to do that. The daily medications are easier to find. People who are using weight loss drugs might also be able to use older medications but they don’t tend to be as potent for weight loss.

If patients have to switch to older, less effective medications, doctors might consider the following drugs:

• Liraglutide, which is called Saxenda when used for weight loss
• A combination of phentermine and topiramate which is known as Qsymia
• A combination of buproprion and naltrexone called Contrave

If you have diabetes, your doctor might consider these medications:

• Liraglutide or Victoza, which is a daily injectable medication
• Dulaglutide or Trulicity
• Weekly exenatide, also known as Bydureon

All of these older drugs are less effective on average than the newest weight loss medications.

“And of course, they come with their own host of precautions and side effects,” Low Wang said. “Phentermine, for instance, can cause heart palpitations, elevated heart rate and blood pressure. So we’re dealing with challenges like that with the older medications, which are also less effective for weight loss.”

What’s more, insurance plans may not cover these medications, while others want people to try these older medications first before going to the newer, expensive, medications affected by shortages. So, once again, there are no easy answers.

Moore said most of her patients are eventually finding the medications they need, but it takes a lot of work. She prefers to keep patients on the newest medications.

“Unless a patient has contraindications, like they’ve had medullary thyroid cancer, most of us want to prescribe the most effective weight loss drug,” she said.

What should patients do if they can’t get their next dose? Is it dangerous to stop taking weight loss drugs suddenly?

No. It’s not dangerous to stop the medications suddenly because they are long-acting, meaning that the medication will stop working gradually over time.

Evidence has shown, however, that most people who stop taking the drugs gain at least some of the weight back.

Patients likely will find that their appetite increases.

“Unfortunately, these medications don’t change your brain permanently. They change your brain while you’re on the medication,” Moore said.

“There are people who sustain significant weight loss through huge amounts of effort and personal discipline. But that’s the exception,” Moore said.

Should patients consider spacing out doses of weight loss medications by more than a week to ration the drugs so they can save money and use fewer doses?

The FDA approves medications to be used according to manufacturers’ exact instructions. But Moore said that some of her patients who are worried about high costs or drug shortages have been trying to stretch to 10 to 12 days between doses rather than a week. She said it’s not dangerous to stretch the doses, but it’s unclear whether the drugs will be as effective.

There’s no research yet on how effective it is to take doses less frequently. Diabetic patients or those who are taking medications to improve cardiovascular or kidney health should take medications as prescribed.

“If people with diabetes are missing doses, that could cause concerning effects on blood sugar levels, and the benefits to reduce heart disease risk or kidney disease are likely to be less,” Low Wang said.

When are the shortages likely to ease?

Experts don’t know when the shortages will ease. Drug manufacturers are trying to boost supplies. But they’ve been pledging to do so for more than a year — in the case of Ozempic — and for the most part, haven’t succeeded yet.

I’m thinking of starting on one of these medications. Since it’s so hard to get weight loss drugs, should I reconsider?

Patients who are considering starting on one of the newest weight loss drugs will want to think carefully before starting on the medications, doctors said.

In addition to the shortages, patients are likely to encounter problems paying for the medications.

“The first question I ask patients is, ‘Does your insurance cover it?’” Moore said.

For most people, the answer to that question is “no.”

But a surprising number of people are willing to pay hundreds of dollars out of pocket each month, Moore said.

For highly motivated patients who have money to pay for prescriptions and the time to search for doses, Moore said patients are finding doses, and most love the results.

“It just takes so much work on the patient’s part,” she said. “The second question I ask is, ‘Do you have the time to look for a needle in a haystack every month?’

“People who can put at least an hour-and-a-half a month into researching where they can find it usually succeed, but finding doses really involves a lot of heavy lifting on the patient’s side,” Moore said.

She’s spending considerable time setting expectations with patients so they can make informed decisions about whether to go on the weight loss drugs now or to wait until shortages ease and prices someday decline.

For people who are not at high risk of getting diabetes and have their blood pressure under control, it may be wise to wait.

“The right answer may be to say, ‘Hey, I’m going to watch and wait until insurance coverage for these medications gets better.’ We’ll see when we get the first generic version of these drugs,” Moore said.

She’s finding that Ozempic and Mounjaro are more available now because insurance companies have become much more strict about providing those medications only to people who have diabetes rather than to patients who are using the drugs to lose weight.

“The weight loss brands, Wegovy and Zepbound, are more difficult, with Zepbound being the most difficult to find,” Moore said.

There are deep inequities related to the drugs, doctors say.

People who can easily pay the high prices for the medications are getting them. Some even pay double the cost per month for two orders of a lower dose since those are easier to find. People with lower incomes, people of color and those who are not tech-savvy have a harder time finding the weight loss drugs.

Moore conducts research on how patients access care, and those who are uncomfortable with digital tools like using apps and emailing their doctors are not receiving the same level of care and the same access to popular new weight loss drugs as those who are tech savvy and comfortable advocating for themselves.

Are there ways to save money on these expensive drugs? Is insurance coverage improving?

Many employers and insurance providers are not covering the weight loss drugs, and coverage doesn’t seem to be improving, doctors say.

The drug companies offer some coupons to help reduce the cost of the drugs for people without insurance coverage. Learn about coupons for Wegovy and Zepbound.

Medicare coverage for weight loss drugs is not allowed in general, but in March, Medicare managers announced that they will now cover Wegovy for people with heart disease.

A bill this year in the Colorado legislature known as the Diabetes Prevention & Obesity Treatment Act that would have mandated broad coverage for the weight loss drugs for people of all income levels passed the state Senate, but failed to get hearings in the House.

Are there other new medications on the horizon that might help with the shortages for Wegovy and Zepbound?

Yes. There are many new medications in development. And shortages should ease eventually.

“There are a lot of medications on the horizon,” Low Wang said.

“Each study seems to show that the next medication is at least as good as or better than the previous ones are. There’s really, really amazing work that’s being done.

“There are triple peptides and new combinations being studied intensively,” she said.

It’s unclear, however, exactly when medications now being studied will win FDA approval.

“We’re expecting to see new medications over the next several years,” Low Wang said.

Moore is very optimistic about the future of weight loss drugs.

“There are probably 100 medications in the pipeline. I can’t tell you exactly when the next one is going to be released,” Moore said.

But she’s expecting a pill form of semaglutide — the drug in Ozempic and Wegovy — to be approved for weight loss fairly soon.

Drug makers are highly motivated to find the next blockbuster weight loss drug since they are profiting greatly from these medications.

Moore also said we’ve experienced other eras in medicine in the U.S. when drug shortages and high prices have prevented patients from getting highly effective medications that would greatly benefit their health. Over time, markets, drug manufacturers and insurance coverage caught up, and the costs of beneficial drugs declined.

She cites statins, for example. These cholesterol-reducing drugs came on the scene in the late 1980s. At first, they were extremely hard to get, and patients were having to pay at least $400 a month for prescriptions, a very high price at the time.

“It was pretty prohibitive. Now, we have many statins, and they are inexpensive and widely available for patients,” Moore said.

Do people who take these drugs to lose weight need to keep taking them forever?

From all that doctors and researchers know so far, it’s likely that patients will need to keep taking the medications in order to avoid gaining weight again.

The newest medical term for obesity is “excess adiposity,” meaning that people who are affected are more resistant to efforts to lose excess fat. Another term is “adiposity-based chronic disease,” which focuses on adverse health outcomes that a person might be at risk for or develop from having excess weight.

“This is a chronic condition, just like high blood pressure. And when you stop taking a blood pressure medication, you expect your blood pressure to go up again. The same is true for excess adiposity. If you stop taking a medication, then we expect the weight to be regained,” Low Wang said.

Some emerging studies are showing that it may be possible for patients to taper off of weight loss drugs or take lower doses and maintain a lower BMI.

“An important part of that involves making effective, sustainable lifestyle changes,” Low Wang said.

What if people can’t find the drugs and have to go off of them for a while? Since people gradually work up to higher doses, will they have to start over again with the lowest doses?

Yes. That’s possible, Low Wang said.

“If you’re off of the drugs for several weeks, then you may have lost the ability to tolerate the side effects and you might need to start at a lower dose,” Low Wang said.

Patients and their doctors will want to make decisions about medications and specific doses together, she said. 

Speaking of conversations with doctors, how are doctors and pharmacists dealing with the shortages and so many questions?

Most health professionals go into the field because they love helping people. But the rush to get weight loss medications and constant questions about where to find them are causing challenges.

Medical providers and their assistants are having to deal with many, many emails, phone calls and visits from patients who either want to start weight loss drugs or have questions once they are using them.

“We have an entire team helping, but it’s been pretty difficult,” said Low Wang, who, like other health care professionals, doesn’t like to complain.

“We make every effort to go above and beyond for every patient. These drug shortages add to the burden,” she said.

The greatest frustrations stem from lack of insurance coverage for medications that clearly are working for many patients.

“Many times, we have to jump through a lot of hoops, and now there’s this additional layer of trying to locate the drugs. These shortages just highlight the difficulties with frequent changes in insurance company medication formularies and restrictions on certain classes of medications,” Low Wang said.

Moore said primary care doctors are trained these days to discuss obesity and potential treatments with patients who bring up the topic. That’s a big change from an era when many people with higher BMIs felt stigmatized in doctors’ offices and, as a result, some avoided medical care.

The best practice now is to deliver “patient-driven care,” Moore said.

“That means that if a patient is relatively healthy — even with a high BMI — and they are not interested in weight loss medications, we support that decision,” Moore said. “If patients want to start on these medications, we want to help them. It’s up to the patient. The history of shaming makes this shared decision making especially important.”

As the only board-certified obesity specialist in her primary care clinic, Moore is doing all she can to educate her colleagues about the newest medications and the profound effects they can have for patients.

“This is a chronic health condition, just like other things we treat, like hypertension,” Moore said.

She’s finding that a very high percentage of patients would qualify for the medications and want to talk about getting prescriptions. With new coverage for Medicare patients, Moore is receiving more requests for Wegovy than ever before.

“I do at least one new prescription every day,” she said.

She’s doing her best to keep up with constant queries about new prescriptions and shortages.