March 31, 2025 • 29 mins
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The meteoric rise in demand for weight loss drugs has created widespread shortages, leading to the emergence of compounding pharmacies as an alternative source for these medications.
• Compounding pharmacies create custom medications by combining, mixing, or altering ingredients to meet specific needs
• Unlike FDA-approved medications, compounded drugs don't undergo the same rigorous safety and effectiveness reviews
• Dosing errors with compounded weight loss medications have led to serious adverse events requiring hospitalization
• Confusion between units, milliliters, and milligrams contributes to potentially dangerous dosing mistakes
• Some compounding pharmacies add unproven ingredients like vitamins, L-carnitine, and NAD to their formulations
• The long half-life of these medications (about one week) means overdose symptoms can persist for extended periods
• Pharmaceutical companies have responded with direct-to-consumer models offering FDA-approved versions at reduced prices
• Eli Lilly now offers Zepbound in vial form for approximately $499/month versus $1000+ for pen versions
• Novo Nordisk's NovaCare pharmacy provides direct-to-patient delivery of Wegovy single-dose pens at similar price points
Please talk to your healthcare provider about what option might be right for you, as these medications require careful consideration and proper dosing is essential for safety.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ed Delesky, MD (00:00):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine resident in the
Philadelphia area.
Nicole Aruffo, RN (00:14):
And I'm Nicole Aruffo.
I'm a nurse.
Ed Delesky, MD (00:16):
And we are so excited you were able to join us
here again today.
So if you want to hear moreabout what's going on in our
lives and a little ditty aboutfun, stick around for the next
five minutes or so.
But if you are interested ingetting right to the topic,
maybe you skip ahead.
Find a chapter marker, orsomewhere between five and ten
minutes is when we'll starttalking about the content of
(00:36):
interest.
But we do have to tell youabout our beverages that we had
yesterday and the experiencethat we had next to us.
What beverages did we hadyesterday?
Nicole Aruffo, RN (00:46):
and the experience that we had next to
us.
What beverages did we get?
We got extra dirty Grey Goosedirty martinis with blue cheese
olives and they were delicious.
I took like two sips of mine.
I'm doing this like I'm like aheadache girly and I'm finding
that there are a lot of thingsthat trigger a headache.
One of them is alcohol.
(01:08):
And then I have a headache thatlasts for like four to five
days, which, like some mightcall a migraine, and some might
call migraine yeah.
I've done everything except likego for my neurology followup.
So, however, things seem to bebetter anyway.
So I just needed to get alittle taste of the good nectar.
That was a really good dirtymartini, but then you finished
(01:31):
it and I eat the olives.
Ed Delesky, MD (01:34):
Yeah Well, and I use you as a reference because
my palate is not sosophisticated that sometimes I
can't tell what is good and whatis not good, and knowing that
that is right down the street,that is an excellent little
tidbit to add to ourneighborhood thing.
Speaking of neighborhood, whatabout the people that were
sitting next to us?
Nicole Aruffo, RN (01:51):
they had a wild dining experience yeah,
that was so annoying.
We were sitting next to thesetwo girls who were there before
we got there and they won likethe one girl, not the one that
was like next to you, the one,like next to that girl.
Yeah, was so rude to thewaitress, so like we were
(02:13):
sitting at the bar and then,like there are like certain
staff that are like serving thethe bar, the bar, so like it
wasn't like the.
we were at the bar but we wereon like the oyster section.
So like it wasn't like the wewere at the bar but we were on
like the oyster section.
Ed Delesky, MD (02:25):
so like it wasn't like a bartender was
right there so yeah, with likelarry the lobster staring at us
while he's like grooving in theice, yeah and the one girl was
like, so rude.
Nicole Aruffo, RN (02:34):
It was the girl that, like, came to take
our order was so rude to heryeah which, like I like right
off the bat, that was like 30seconds into us being there and
I just personally think, if youare rude, to like wait staff
you're just like the lowest formof a human and it's like yeah,
what are you doing?
yeah, like why are you beinglike this?
Um, like someone's, likebringing you your food and your
(02:56):
drink and like accommodating you, just like be polite to them,
like where's your mother, likewhere's the farm you were raised
on, whatever lowest bar you canhit yeah.
And then she, um, oh so sheordered like oysters rockefeller
.
And then she's telling herfriend she's like I think I'm
gonna get like however many rawoysters.
(03:17):
She's like okay.
So then the waitress comes back.
She's rude to her again because, like she just like wasn't
articulating, like she was justlike speaking things at her that
like didn't make sense.
So she's rude to her againbecause, like she just like
wasn't articulating, like shewas just like speaking things at
her that like didn't make sense.
So she was rude to her again.
Whatever comes back.
And then I think, like the other, like her other co-workers were
like okay, we'll like switchout, because I'm like another
(03:37):
girl came and like anotherrandom guy came and whatever,
and they were like switching out.
And then so she gets her rawoysters and then she eats half
of them and then she tells herfriend, you know, I don't really
want the rest of these.
Like I'm going to send theseback and get some more oysters
Rockefeller.
And I'm just sitting there I'mlike that's not like how it
works.
Like obviously, this isobviously your first time like
(03:58):
in a restaurant before, but OK.
So then she asked, and theywere also.
Another thing she was doing wasjust like flagging down, like
any staff member who, likeclearly wasn't their waitress,
or anyone who, like they hadseen before, she just like
someone could nonchalantly bepassing yeah, or it was like one
of like the like busboy peopleor like the barbacks, or like
(04:18):
someone who like didn't have onthe server uniform and like.
So she like flags down this likeguy and asks can I send these
back and get whatever?
And he's like I like.
He's like I don't know who youare like, also, this probably
isn't my job.
He's like uh, I guess I'll goask.
So then I guess it was like oneof the managers, because he had
like regular clothes on.
She asked to I want to sendthese back because I want
(04:41):
something else.
And he's like okay, like youcan't do that, like you ate half
of them like you, can't it'snot like it came out and like
something was wrong with it, orlike we brought you the wrong
thing and like that's differentto like send something back,
which I also feel is likewhatever sure, like it kind of
went over the threshold yeah,like you ate half of it yeah you
kept eating it, so like youdidn't not like it, whatever.
(05:03):
yeah, he's like I'm pretty sureshe was trying to just like get
away with like that part of thebill.
But then the manager guy waslike I mean, you can order more
of something, but and like I'lltake this from you, but this
isn't like a send back, you canorder something else in addition
to like.
Ed Delesky, MD (05:19):
You're entitled to not like something, but like
that doesn't't?
Nicole Aruffo, RN (05:22):
you don't like get to not pay for it, or
like send it?
Ed Delesky, MD (05:24):
back like you made a mistake yeah, um, so that
was that.
And then these two girls werelike facetiming someone the
entire time which was kind ofdistracting for our experience,
which was like annoying also,like why didn't you just invite
this person fair, you could havetalked to invited them it was
so annoying yeah, and you know,they lingered longer than we
(05:44):
were there and as wetransitioned our evening to home
, came back, fed ollie, and thenwe started walking to there's a
place where you can go and getbeers bring them home a little
more like niche environment.
And we are walking down thestreet and all of of a sudden we
(06:05):
hear this guy yelling help,help.
And then we see this littlepuppy oh, he's so cute who is
just zigzagging in out of thestreet, in around cars and the
way that people came together tostop traffic.
One woman got out there and shewas like Moses and she just put
her arm up and she was like shewas like parting the Red Sea.
Nicole Aruffo, RN (06:25):
She was like stop and she like for some
reason, like cause we like sawthat, and he's like, oh my God,
the puppy.
And then I saw this little,like tiny little puppy, like
clearly not like trained or likedoesn't know, like any commands
or anything, Like it was like areally young puppy got out, I
guess, and this guy it was likeI don't know what kind of puppy
it was, I think it was like minigolden doodle or something like
(06:47):
that.
And I was telling Eddie, I waslike I'm pretty sure this had to
have been like his, likegirlfriend's dog or something,
Cause I'm like not to be thatperson but like no guy, like a
guy like him is not going tohave like this little tiny dog.
There wasn't like a femaleinfluence.
Um, oh yeah.
So then, like we saw it, Idon't know, I just like blindly
(07:08):
started walking in the middle ofthe street because for some
reason, like this woman in themiddle of like, I just felt safe
with her.
She meant business and I waslike no one's gonna drive.
I'm safe in the middle of thestreet yeah, so traffic was
stopped.
Ed Delesky, MD (07:22):
You know, a gaggle of people came around and
kind of cornered the puppy.
Nicole Aruffo, RN (07:25):
Everyone was circling the dog.
Ed Delesky, MD (07:26):
And then eventually the puppy darted back
into the guy's arms and he justsat there and his underwear was
not white anymore.
There was so much secondhandstress.
What a beautiful moment to knowthat that ended well.
But that was a really intensething to witness and it had a
(07:48):
happy ending, which I was reallyhappy about, because that would
have been devastating to see itotherwise oh my god.
Yeah, which we don't have tothink about because it didn't
happen.
All right.
So what are we going to talkabout today, nick?
Nicole Aruffo, RN (08:00):
Well, today we're talking about more about
weight loss drugs, butspecifically about the
compounding pharmacies and allthat.
Yeah Right, absolutely.
Ed Delesky, MD (08:12):
And a little bit about.
Nicole Aruffo, RN (08:13):
I didn't fully read the outline yet.
Ed Delesky, MD (08:15):
And a little bit about how, in response to
shortages and the rise ofcompounding pharmacies which we
will explain how the drugcompanies are responding in
their own way, in a kind ofinteresting way that actually
directly impacts patients.
Of course, we've talked in thisshow on prior episodes that
(08:36):
there is an extremely highdemand for these GLP-1 receptor
agonists, weekly injectablemedicines like FDA-approved
drugs like Wagovi, which come inpre-filled pens for weekly
dosing, or Ozempic, which hasmulti-dose pre-filled pens for
dosing, or the oral cousin,ribelsis, which is the same
(08:57):
medicine, semaglutide, in oralform.
There's also Zepbound, which isa terzepatide-based component
specifically put in the weightloss bucket that has two active
ingredients, a GIP and GLPreceptor agonist, and again,
it's indicated for adults whohave obesity or who are
overweight and have at least oneweight-related medical problem,
(09:20):
and it's also FDA-approved formoderate to severe obstructive
sleep apnea and people who haveobesity.
And so because they're soeffective at what they do
treating obesity there is anincredibly high demand.
And I think everyone saw thiscome about is that, like
everyone who was on thesemedicines was having a tough
time getting these medicines,and so the impetus for this
(09:45):
episode was to discuss theresponse to that demand, which
was the rise of compoundingpharmacies.
Nicole Aruffo, RN (09:53):
Tell us a little more about how we got
here with needing to compoundthese medications.
Ed Delesky, MD (10:00):
Yeah, so, like we were talking about, because
of this extremely high demand,there was a supply constraint
placed on many of the FDAapproved products, and so, to
circumvent that, people startedgoing to get the medicine other
ways, in compounded versions,and so I think it's important
(10:21):
that we define our terms.
So drug compounding is theprocess of combining, mixing or
altering ingredients to create amedication tailored to an
individual person's needs.
Now, this is not a new concept.
This has been around.
You have the most experiencebetween the two of us with these
meds yeah, compoundingpharmacies are not like a new
(10:44):
thing.
Nicole Aruffo, RN (10:45):
Since all of these weight loss meds I mean,
it's probably a new thing thatkind of like the general public
is now more familiar with.
But any med you know kind ofvariation can be compounded.
It's just the way that themedication is made in the
pharmacy more often, um, some oflike the more specialty meds
outside of like the weight lossmeds, the more specialty meds
(11:08):
that you can't get it just likea regular commercial retail
pharmacy, or if they have to bemade a certain way because like
a walgreens can't compound a medand they can't, you know, they
don't have the whatever you needsure the particulars to
compound it.
Or if you need like a medicationin a liquid form but maybe it
doesn't come in a liquid formalready, they can like do that
(11:30):
at a compounding pharmacy andyou know things like that gotcha
.
Ed Delesky, MD (11:34):
Are there any meds that like?
Are you are aware of that?
Nicole Aruffo, RN (11:39):
I mean all of like the weird meds.
I know, like a meprazole is abig one in peds.
Ed Delesky, MD (11:43):
Okay.
Nicole Aruffo, RN (11:44):
Um, that doesn't like.
Come in a liquid right off thebat.
Ed Delesky, MD (11:47):
Ah, yes.
Nicole Aruffo, RN (11:48):
Yeah, and it has to go to like a compounding
pharmacy and like, specifically,if it's, you know, like a, you
know, like a kid can't swallow apill, or maybe they're older
but they have like a feedingtube or something you know sure.
It needs to be liquid.
That's like the first one rightoff the top of my head.
Ed Delesky, MD (12:04):
And so we want to emphasize that, while really
useful, and they certainly servea purpose compounding
pharmacies and compounded drugs,moreover, specifically don't
undergo the FDA pre-marketreview for safety, quality or
effectiveness in comparison toFDA-approved drugs.
(12:27):
Truly, a compounded drug shouldideally only be used when a
patient's specific medical needscannot be met by available FDA
approved drugs.
So, pretty reasonably, here youlisted off a great example
right there of an infant whocan't swallow a pill and it's
not readily available at aWalgreens.
Boom, great reason to have acompounded version of that
(12:50):
that's liquid.
So when there was this shortageof semaglutide and terzepatide
based medications for weightloss, then people started to go
to compounding pharmacies, whichis more often what you're
seeing on tv when you're beingadvertised by like direct to
consumer marketing for thesespecific weight loss medicines.
(13:11):
So something to note is thatthe fda is aware of compounded
semaglutide because I'm notseeing anything active about
compounded terzepatide at thispoint but they are aware of
compounded semaglutide productsthat are being marketed for
weight loss and for a period oftime it was reasonable because
(13:32):
they're like a reasonable avenueto go, because it wasn't FDA
approved, because it wasn'tavailable in the market.
So we found that thesemedications have a certain place
in peds adult care, specialtycare but now for something so
common such as obesity, a lotmore people are looking for this
(13:53):
medicine and have reached outto compounding pharmacies to
satisfy that need.
But this isn't perfect.
There's actually some negativedownside to this.
So what are we seeing out there?
That's a little troublesome.
Nicole Aruffo, RN (14:07):
We're seeing a lot of errors in dosing.
It seems that people are givingthemselves too much of the
medication.
Ed Delesky, MD (14:14):
And so when someone gives themselves too
much of the medication, thereare adverse events that can
happen, some requiringhospitalization, and so, like
you said, some of these arecoming from dosing errors.
But I mean, this isn't theclearest thing in the world.
It seems there's a lot ofdifferent experiences that a
patient may have.
There's confusion that can comeup.
(14:35):
A lot of these people aregetting from online doctors as
well.
I'm not seeing a lot of peoplewho are seeing patients
face-to-face saying like, yes,go to this compounding pharmacy
and get your medication, becausesomething we're seeing is that
people are getting advice togive themselves X amount of
(14:56):
maybe a milliliter, or maybe amilligram or maybe a unit, and I
would say that that's prettyconfusing, especially for
someone who hasn't done aninjection before.
Nicole Aruffo, RN (15:08):
Yeah, but you should also be receiving the
correct syringes, which canpotentially also be another
issue.
Ed Delesky, MD (15:14):
Totally Right.
Nicole Aruffo, RN (15:15):
Like one unit and one ml is a lot, would be
another issue.
Ed Delesky, MD (15:18):
Totally Right, like one unit and one ml is a
lot.
But is a unit, an ml?
No, right, and not.
Everything is like onemilliliter is one milligram
either, so that opens up like awhole world of confusion, and so
when people are overdosing inthis way, they are getting the
nausea, vomiting, increased riskfor pancreatitis, and something
(15:40):
that's really disturbing isthat the half-life of this
medicine is one week, and that'swhy you dose the medicine every
week.
A half-life is how long ittakes for a drug to leave the
body, and so if you have toomuch, this will stick around,
and so you may not be able toeat and not be able to drink and
(16:00):
lingers as an issue.
Nicole Aruffo, RN (16:03):
I think it's important also to note that you
should always, always, always,check what the label on whatever
medication it is and forwhatever the concentration is,
because that might be somethingdifferent than what your doctor
is telling you, because, like,the pharmacy might just carry a
(16:24):
different prescription ofsomething, or it might be com,
or a different prescription, adifferent concentration of
something.
Ed Delesky, MD (16:30):
Right.
Nicole Aruffo, RN (16:31):
So your pharmacy might carry something
that's like higher or lowerconcentration per you know, one
pill or one ml or one unit ofwhatever you're getting yeah
it's like your doctor might tellyou take two milligrams of
something, and then it mighteven say like I don't know if
(16:52):
it's like a liquid or aninjection, like two milligrams
or one unit.
But then if you get it from acompounding pharmacy, where that
might be a little bit different, and then your bottle says you
know, maybe it's two units orwhatever, yeah.
It might just be different butlike, always go by what the
bottle says, not necessarilywhat the you know, your
discharge paperwork or likewhatever your doctor kind of
(17:15):
mentioned to you.
Ed Delesky, MD (17:16):
Absolutely, and like this is something to slow
down and pay attention tobecause, especially when it
comes to liquids andconcentrations, it's so easy to
make a mistake.
Yeah, especially when, like youmentioned syringes earlier like
syringes come in all differentshapes and sizes.
(17:38):
Maybe not all shapes, but theycome in different sizes, maybe
different diameters, andrequiring different amounts to
be drawn up, like one milliliterin a really tiny syringe may
look very different to like onemilliliter, the whole thing,
whereas in a five ml syringe itfills up 20 of it, which is
(17:58):
totally different.
And then, like you were saying,like where your doctor may tell
you take 10 milligrams, but theconcentration of the liquid is
five milligrams per milliliteryeah like you have to sit down
and do that math and say likehow much?
Nicole Aruffo, RN (18:13):
yeah, I mean you shouldn't have to do the
math because it should be on thelabel, on the bottle, but I
don't know it should, I don'tknow.
Ed Delesky, MD (18:20):
Well, I was even seeing a guy this last week.
He was doing every two weekinjections of testosterone and
he was having a tough timeactually drawing up the very
specific amount of liquid to getthe exact dose that he needed.
So that's a whole othercommunity of people out there
who this affects.
So it's just something verymuch to be aware of that, like,
(18:41):
milliliters are not necessarilymilligrams and are certainly not
necessarily units, and you haveto take special attention to
the size of the syringe and theconcentration of the medicine
that you're getting.
So one other thing that I thinkwe should bring up is that
these pens that people aregetting, like the once
(19:04):
injectable, make it very, verysimple pens from the Wagovi and
the Terzepatide, the ZepboundUsually the compounding
pharmacies aren't giving you apen.
Nicole Aruffo, RN (19:15):
Yeah, no, because well, it's like the pen,
that's the expensive part tomake, not the actual drug.
Ed Delesky, MD (19:21):
Exactly.
Nicole Aruffo, RN (19:22):
Really annoying, actually it is.
Ed Delesky, MD (19:23):
No, really annoying, actually, it is no, it
yeah, and then we're going toit's such a coincidence that all
those drugs that come in a penare expensive.
And we're going to dive intothat in the back half of the
episode where, like, how thesedrug companies are making it
more affordable quote unquote,more affordable but you kind of
have to learn how to do theinjection yourself in a syringe
(19:45):
and a needle, not with the pen.
So that's a whole other skillthat perhaps you weren't used to
before.
But, like, there's tons ofvideos out there about how to do
the pen self-injection, butit's not as easy to do the
needle injection with thesyringe.
So just a couple, um, a coupleof stories that the FDA did put
(20:05):
out, uh, about errors in dosemanagement.
Just to put this intoperspective, um, most of the
errors came up in people likemistakenly drawing up more than
the prescribed dose of multipledose vials.
So like you get something andyou have to actually pull up the
medicine no-transcript, a quickinteraction and the prescriber
(20:45):
was like, oh yeah, do this realquick.
And then like there was anerror there.
So like it's not all on thepatient, it might be from the
provider as well, or maybe adecimal point isn't in the right
spot.
So instead of taking, you know,0.25 milligrams, you're taking
25 units or something like that.
So it can get very confusing.
(21:05):
So, aside from any of thechanges or difficulty in dosing,
compounding pharmaciessometimes have different
ingredients and different formsof the medication that are also
not FDA approved are also notFDA approved.
So some compounders actuallyhave ingredients like vitamin
B12, b6, l-carnitine and NAD totheir semaglutide products.
Nicole Aruffo, RN (21:30):
People love NAD nowadays.
Ed Delesky, MD (21:33):
That's such a niche biochem thing of the
electron transport chain, Iguess.
Sure A real nerd in me, that'swhat they say Wow, that was a
deep cut right there.
Are you hearing about this likepeople are like, searching,
like nad.
Oh yeah, people go places tolike get these like infusions I
(21:54):
was like, look, I was gettingthis and learning this from like
making this episode.
Nicole Aruffo, RN (21:57):
But I did, yeah, but you're seeing that
people are like oh yeah, it'slike a thing I want my, my
semaglutide with my b12 I know alot of people get b12 with that
.
They'll like get both.
Um, I haven't heard like thenad being mixed in with it.
I just know that's like aseparate thing.
People like go for their nadinfusions and like b12 shot.
(22:22):
Right, right, right Apparentlyit's the fountain of youth.
Ed Delesky, MD (22:25):
So, while this, these aren't looked at for
safety and effectiveness.
Nicole Aruffo, RN (22:30):
Yeah, so don't take my word for it, but
that's just what the people aredoing.
Ed Delesky, MD (22:33):
Right and so like this is something that's
out there that people are doingand it's unestablished, and so
that's one of the importantthings.
We are kind of bound byevidence-based medicine and so
this isn't looked at and so wedon't know, and one usually
operates in the realm of like ifwe don't know, it's probably
not safe.
Or semaglutide acetate, andthese are actually different
(23:04):
than the active ingredients inthe base form in the approved
drugs and these don'tnecessarily fall under any sort
of FDA conditions forcompounding, and so it just adds
to a lot of confusion in thismarket altogether.
So really you just have to becareful, because if you inject
the wrong amount of medicine,this can lead to some really bad
side effects like nausea,vomiting, abdominal pain,
(23:26):
headache, migraine, and somepeople have required
hospitalization, and thesesymptoms or side effects don't
go away immediately because themedication lasts for a long time
and the FDA is looking out forstuff like this.
So, because of all of the hooplawith compounding pharmacies and
how expensive these medicinesare and you kind of teased at
(23:48):
this earlier.
Pharmaceutical companies haveresponded, specifically Eli
Lilly and Novo Nordisk haveresponded and offered direct to
consumer models for people to beable to access the FDA-approved
versions of these medications.
Nicole Aruffo, RN (24:05):
All right, eddie, tell us about this
direct-to-consumer model that'sout there.
Ed Delesky, MD (24:11):
So if someone didn't know Eli Lilly, we'll
talk about Zepbound first.
Eli Lilly has a self-payjourney program, is what it's
called.
It's from the Lilly DirectSelf-Pay Pharmacy Solutions, and
for a while they were offeringreduced prices of ZepBound for
the 2.5 milligram and 5milligram vials, so that's
(24:36):
specifically different than theinjector pen.
And so they were able to bringdown the cost of this of
production, because now they'reonly producing the drug, not the
drug and the auto self-injectorpen which, like you said
earlier, it turns out to be thereally expensive thing.
And so this model that theyhave aims to provide transparent
(24:56):
pricing by removing third-partysupply chain entities, and so
now altogether third-partysupply chain entities, and so
now altogether, through theirdirect-to-consumer system that
they have, they have vialoptions where you draw up the
medicine and you give it toyourself.
But it's an FDA-approved drugof 2.5, 5, 7.5, and 10
(25:19):
milligrams.
The 7.5 and 10 milligram doseswere just recently added, and
while the two and a half andfive milligram ones were there
all the while since theinitiation of the program.
So understanding that you'reonly missing the 12 and a half
and 15 milligram doses whichpeople use, but they may not be
(25:40):
as common.
And so, for pricing wise.
You can find this on theirwebsite and we're recording this
episode, sunday, march 30th butas it's currently written, the
Zepbound self-pay journeyprogram offers seven and a half
and 10 milligram vials for $4.99a month for the first refills
(26:02):
within 45 days or so, and so$4.99 a month is admittedly
still a very high number, but tocompare, that is against the
over $1,000 per month that thesemedicines cost in the pen.
The 2.5 and 5 milligrams aremore affordable.
The 2.5 and 5 milligrams aremore affordable.
(26:23):
The data from at least February25th 2025 suggests that the 2.5
milligram dose is $3.49 permonth and 5 milligrams is $4.99
per month, like the other ones.
I thought this was a pretty coolthing when I found this
(26:43):
initially, because a lot ofpeople may want this medication
but their insurance companiesmay not pay for it, and that's
been one of the most frustratingthings.
You got nothing, and so wetalked about how Zepbound has
this new program.
Novo Nordisk just came out withtheir program for Wagovi
through their NovaCare pharmacy,and they offer a
direct-to-patient deliveryoption for actually all of the
(27:06):
FDA-approved doses, from 0.25all the way up to 2.4 milligrams
.
Their price is quote-unquote,reduced at $4.99 per month for
cash-paying patients, and thekey piece to this is that Novo
Nordisk is offering this in thesingle dose pens, compared to
(27:26):
Zepbound which is being offeredin syringes, and so that might
be their little niche ofoffering like a hey, we're doing
this, but we're still doingthis with the pens.
We just wanted to relay all ofthat information to you, knowing
that some of these are updatesand a changing environment, that
information to you, knowingthat some of these are updates
and a changing environment, fdaapproval is really important in
(27:47):
this whole thing, and thatknowing that Zepbound and Wagovi
now may be available throughthese direct programs, albeit
still very expensive, at leastthey've undergone rigorous
review for safety, quality andeffectiveness and really reflect
about where you're getting yourmedicines, as we kind of think
back to our conversation aboutcompounding pharmacies and, at
the end of the day, make sureyou always talk to your
(28:08):
healthcare provider for anyfurther advice that's specific
to you.
So thank you for coming back toanother episode of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
Please check out our website,send us some fan mail, please
rate and review the show.
If you don't mind, perhapsleave a comment where you're
listening.
Any of that support would begreatly appreciated and until
(28:31):
next time, stay healthy, myfriends.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you and goodbye Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
(28:56):
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
Thanks for listening.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine resident in the
Philadelphia area.
Nicole Aruffo, RN (00:14):
And I'm Nicole Aruffo.
I'm a nurse.
Ed Delesky, MD (00:16):
And we are so excited you were able to join us
here again today.
So if you want to hear moreabout what's going on in our
lives and a little ditty aboutfun, stick around for the next
five minutes or so.
But if you are interested ingetting right to the topic,
maybe you skip ahead.
Find a chapter marker, orsomewhere between five and ten
minutes is when we'll starttalking about the content of
(00:36):
interest.
But we do have to tell youabout our beverages that we had
yesterday and the experiencethat we had next to us.
What beverages did we hadyesterday?
Nicole Aruffo, RN (00:46):
and the experience that we had next to
us.
What beverages did we get?
We got extra dirty Grey Goosedirty martinis with blue cheese
olives and they were delicious.
I took like two sips of mine.
I'm doing this like I'm like aheadache girly and I'm finding
that there are a lot of thingsthat trigger a headache.
One of them is alcohol.
(01:08):
And then I have a headache thatlasts for like four to five
days, which, like some mightcall a migraine, and some might
call migraine yeah.
I've done everything except likego for my neurology followup.
So, however, things seem to bebetter anyway.
So I just needed to get alittle taste of the good nectar.
That was a really good dirtymartini, but then you finished
(01:31):
it and I eat the olives.
Ed Delesky, MD (01:34):
Yeah Well, and I use you as a reference because
my palate is not sosophisticated that sometimes I
can't tell what is good and whatis not good, and knowing that
that is right down the street,that is an excellent little
tidbit to add to ourneighborhood thing.
Speaking of neighborhood, whatabout the people that were
sitting next to us?
Nicole Aruffo, RN (01:51):
they had a wild dining experience yeah,
that was so annoying.
We were sitting next to thesetwo girls who were there before
we got there and they won likethe one girl, not the one that
was like next to you, the one,like next to that girl.
Yeah, was so rude to thewaitress, so like we were
(02:13):
sitting at the bar and then,like there are like certain
staff that are like serving thethe bar, the bar, so like it
wasn't like the.
we were at the bar but we wereon like the oyster section.
So like it wasn't like the wewere at the bar but we were on
like the oyster section.
Ed Delesky, MD (02:25):
so like it wasn't like a bartender was
right there so yeah, with likelarry the lobster staring at us
while he's like grooving in theice, yeah and the one girl was
like, so rude.
Nicole Aruffo, RN (02:34):
It was the girl that, like, came to take
our order was so rude to heryeah which, like I like right
off the bat, that was like 30seconds into us being there and
I just personally think, if youare rude, to like wait staff
you're just like the lowest formof a human and it's like yeah,
what are you doing?
yeah, like why are you beinglike this?
Um, like someone's, likebringing you your food and your
(02:56):
drink and like accommodating you, just like be polite to them,
like where's your mother, likewhere's the farm you were raised
on, whatever lowest bar you canhit yeah.
And then she, um, oh so sheordered like oysters rockefeller
.
And then she's telling herfriend she's like I think I'm
gonna get like however many rawoysters.
(03:17):
She's like okay.
So then the waitress comes back.
She's rude to her again because, like she just like wasn't
articulating, like she was justlike speaking things at her that
like didn't make sense.
So she's rude to her againbecause, like she just like
wasn't articulating, like shewas just like speaking things at
her that like didn't make sense.
So she was rude to her again.
Whatever comes back.
And then I think, like the other, like her other co-workers were
like okay, we'll like switchout, because I'm like another
(03:37):
girl came and like anotherrandom guy came and whatever,
and they were like switching out.
And then so she gets her rawoysters and then she eats half
of them and then she tells herfriend, you know, I don't really
want the rest of these.
Like I'm going to send theseback and get some more oysters
Rockefeller.
And I'm just sitting there I'mlike that's not like how it
works.
Like obviously, this isobviously your first time like
(03:58):
in a restaurant before, but OK.
So then she asked, and theywere also.
Another thing she was doing wasjust like flagging down, like
any staff member who, likeclearly wasn't their waitress,
or anyone who, like they hadseen before, she just like
someone could nonchalantly bepassing yeah, or it was like one
of like the like busboy peopleor like the barbacks, or like
(04:18):
someone who like didn't have onthe server uniform and like.
So she like flags down this likeguy and asks can I send these
back and get whatever?
And he's like I like.
He's like I don't know who youare like, also, this probably
isn't my job.
He's like uh, I guess I'll goask.
So then I guess it was like oneof the managers, because he had
like regular clothes on.
She asked to I want to sendthese back because I want
(04:41):
something else.
And he's like okay, like youcan't do that, like you ate half
of them like you, can't it'snot like it came out and like
something was wrong with it, orlike we brought you the wrong
thing and like that's differentto like send something back,
which I also feel is likewhatever sure, like it kind of
went over the threshold yeah,like you ate half of it yeah you
kept eating it, so like youdidn't not like it, whatever.
(05:03):
yeah, he's like I'm pretty sureshe was trying to just like get
away with like that part of thebill.
But then the manager guy waslike I mean, you can order more
of something, but and like I'lltake this from you, but this
isn't like a send back, you canorder something else in addition
to like.
Ed Delesky, MD (05:19):
You're entitled to not like something, but like
that doesn't't?
Nicole Aruffo, RN (05:22):
you don't like get to not pay for it, or
like send it?
Ed Delesky, MD (05:24):
back like you made a mistake yeah, um, so that
was that.
And then these two girls werelike facetiming someone the
entire time which was kind ofdistracting for our experience,
which was like annoying also,like why didn't you just invite
this person fair, you could havetalked to invited them it was
so annoying yeah, and you know,they lingered longer than we
(05:44):
were there and as wetransitioned our evening to home
, came back, fed ollie, and thenwe started walking to there's a
place where you can go and getbeers bring them home a little
more like niche environment.
And we are walking down thestreet and all of of a sudden we
(06:05):
hear this guy yelling help,help.
And then we see this littlepuppy oh, he's so cute who is
just zigzagging in out of thestreet, in around cars and the
way that people came together tostop traffic.
One woman got out there and shewas like Moses and she just put
her arm up and she was like shewas like parting the Red Sea.
Nicole Aruffo, RN (06:25):
She was like stop and she like for some
reason, like cause we like sawthat, and he's like, oh my God,
the puppy.
And then I saw this little,like tiny little puppy, like
clearly not like trained or likedoesn't know, like any commands
or anything, Like it was like areally young puppy got out, I
guess, and this guy it was likeI don't know what kind of puppy
it was, I think it was like minigolden doodle or something like
(06:47):
that.
And I was telling Eddie, I waslike I'm pretty sure this had to
have been like his, likegirlfriend's dog or something,
Cause I'm like not to be thatperson but like no guy, like a
guy like him is not going tohave like this little tiny dog.
There wasn't like a femaleinfluence.
Um, oh yeah.
So then, like we saw it, Idon't know, I just like blindly
(07:08):
started walking in the middle ofthe street because for some
reason, like this woman in themiddle of like, I just felt safe
with her.
She meant business and I waslike no one's gonna drive.
I'm safe in the middle of thestreet yeah, so traffic was
stopped.
Ed Delesky, MD (07:22):
You know, a gaggle of people came around and
kind of cornered the puppy.
Nicole Aruffo, RN (07:25):
Everyone was circling the dog.
Ed Delesky, MD (07:26):
And then eventually the puppy darted back
into the guy's arms and he justsat there and his underwear was
not white anymore.
There was so much secondhandstress.
What a beautiful moment to knowthat that ended well.
But that was a really intensething to witness and it had a
(07:48):
happy ending, which I was reallyhappy about, because that would
have been devastating to see itotherwise oh my god.
Yeah, which we don't have tothink about because it didn't
happen.
All right.
So what are we going to talkabout today, nick?
Nicole Aruffo, RN (08:00):
Well, today we're talking about more about
weight loss drugs, butspecifically about the
compounding pharmacies and allthat.
Yeah Right, absolutely.
Ed Delesky, MD (08:12):
And a little bit about.
Nicole Aruffo, RN (08:13):
I didn't fully read the outline yet.
Ed Delesky, MD (08:15):
And a little bit about how, in response to
shortages and the rise ofcompounding pharmacies which we
will explain how the drugcompanies are responding in
their own way, in a kind ofinteresting way that actually
directly impacts patients.
Of course, we've talked in thisshow on prior episodes that
(08:36):
there is an extremely highdemand for these GLP-1 receptor
agonists, weekly injectablemedicines like FDA-approved
drugs like Wagovi, which come inpre-filled pens for weekly
dosing, or Ozempic, which hasmulti-dose pre-filled pens for
dosing, or the oral cousin,ribelsis, which is the same
(08:57):
medicine, semaglutide, in oralform.
There's also Zepbound, which isa terzepatide-based component
specifically put in the weightloss bucket that has two active
ingredients, a GIP and GLPreceptor agonist, and again,
it's indicated for adults whohave obesity or who are
overweight and have at least oneweight-related medical problem,
(09:20):
and it's also FDA-approved formoderate to severe obstructive
sleep apnea and people who haveobesity.
And so because they're soeffective at what they do
treating obesity there is anincredibly high demand.
And I think everyone saw thiscome about is that, like
everyone who was on thesemedicines was having a tough
time getting these medicines,and so the impetus for this
(09:45):
episode was to discuss theresponse to that demand, which
was the rise of compoundingpharmacies.
Nicole Aruffo, RN (09:53):
Tell us a little more about how we got
here with needing to compoundthese medications.
Ed Delesky, MD (10:00):
Yeah, so, like we were talking about, because
of this extremely high demand,there was a supply constraint
placed on many of the FDAapproved products, and so, to
circumvent that, people startedgoing to get the medicine other
ways, in compounded versions,and so I think it's important
(10:21):
that we define our terms.
So drug compounding is theprocess of combining, mixing or
altering ingredients to create amedication tailored to an
individual person's needs.
Now, this is not a new concept.
This has been around.
You have the most experiencebetween the two of us with these
meds yeah, compoundingpharmacies are not like a new
(10:44):
thing.
Nicole Aruffo, RN (10:45):
Since all of these weight loss meds I mean,
it's probably a new thing thatkind of like the general public
is now more familiar with.
But any med you know kind ofvariation can be compounded.
It's just the way that themedication is made in the
pharmacy more often, um, some oflike the more specialty meds
outside of like the weight lossmeds, the more specialty meds
(11:08):
that you can't get it just likea regular commercial retail
pharmacy, or if they have to bemade a certain way because like
a walgreens can't compound a medand they can't, you know, they
don't have the whatever you needsure the particulars to
compound it.
Or if you need like a medicationin a liquid form but maybe it
doesn't come in a liquid formalready, they can like do that
(11:30):
at a compounding pharmacy andyou know things like that gotcha
.
Ed Delesky, MD (11:34):
Are there any meds that like?
Are you are aware of that?
Nicole Aruffo, RN (11:39):
I mean all of like the weird meds.
I know, like a meprazole is abig one in peds.
Ed Delesky, MD (11:43):
Okay.
Nicole Aruffo, RN (11:44):
Um, that doesn't like.
Come in a liquid right off thebat.
Ed Delesky, MD (11:47):
Ah, yes.
Nicole Aruffo, RN (11:48):
Yeah, and it has to go to like a compounding
pharmacy and like, specifically,if it's, you know, like a, you
know, like a kid can't swallow apill, or maybe they're older
but they have like a feedingtube or something you know sure.
It needs to be liquid.
That's like the first one rightoff the top of my head.
Ed Delesky, MD (12:04):
And so we want to emphasize that, while really
useful, and they certainly servea purpose compounding
pharmacies and compounded drugs,moreover, specifically don't
undergo the FDA pre-marketreview for safety, quality or
effectiveness in comparison toFDA-approved drugs.
(12:27):
Truly, a compounded drug shouldideally only be used when a
patient's specific medical needscannot be met by available FDA
approved drugs.
So, pretty reasonably, here youlisted off a great example
right there of an infant whocan't swallow a pill and it's
not readily available at aWalgreens.
Boom, great reason to have acompounded version of that
(12:50):
that's liquid.
So when there was this shortageof semaglutide and terzepatide
based medications for weightloss, then people started to go
to compounding pharmacies, whichis more often what you're
seeing on tv when you're beingadvertised by like direct to
consumer marketing for thesespecific weight loss medicines.
(13:11):
So something to note is thatthe fda is aware of compounded
semaglutide because I'm notseeing anything active about
compounded terzepatide at thispoint but they are aware of
compounded semaglutide productsthat are being marketed for
weight loss and for a period oftime it was reasonable because
(13:32):
they're like a reasonable avenueto go, because it wasn't FDA
approved, because it wasn'tavailable in the market.
So we found that thesemedications have a certain place
in peds adult care, specialtycare but now for something so
common such as obesity, a lotmore people are looking for this
(13:53):
medicine and have reached outto compounding pharmacies to
satisfy that need.
But this isn't perfect.
There's actually some negativedownside to this.
So what are we seeing out there?
That's a little troublesome.
Nicole Aruffo, RN (14:07):
We're seeing a lot of errors in dosing.
It seems that people are givingthemselves too much of the
medication.
Ed Delesky, MD (14:14):
And so when someone gives themselves too
much of the medication, thereare adverse events that can
happen, some requiringhospitalization, and so, like
you said, some of these arecoming from dosing errors.
But I mean, this isn't theclearest thing in the world.
It seems there's a lot ofdifferent experiences that a
patient may have.
There's confusion that can comeup.
(14:35):
A lot of these people aregetting from online doctors as
well.
I'm not seeing a lot of peoplewho are seeing patients
face-to-face saying like, yes,go to this compounding pharmacy
and get your medication, becausesomething we're seeing is that
people are getting advice togive themselves X amount of
(14:56):
maybe a milliliter, or maybe amilligram or maybe a unit, and I
would say that that's prettyconfusing, especially for
someone who hasn't done aninjection before.
Nicole Aruffo, RN (15:08):
Yeah, but you should also be receiving the
correct syringes, which canpotentially also be another
issue.
Ed Delesky, MD (15:14):
Totally Right.
Nicole Aruffo, RN (15:15):
Like one unit and one ml is a lot, would be
another issue.
Ed Delesky, MD (15:18):
Totally Right, like one unit and one ml is a
lot.
But is a unit, an ml?
No, right, and not.
Everything is like onemilliliter is one milligram
either, so that opens up like awhole world of confusion, and so
when people are overdosing inthis way, they are getting the
nausea, vomiting, increased riskfor pancreatitis, and something
(15:40):
that's really disturbing isthat the half-life of this
medicine is one week, and that'swhy you dose the medicine every
week.
A half-life is how long ittakes for a drug to leave the
body, and so if you have toomuch, this will stick around,
and so you may not be able toeat and not be able to drink and
(16:00):
lingers as an issue.
Nicole Aruffo, RN (16:03):
I think it's important also to note that you
should always, always, always,check what the label on whatever
medication it is and forwhatever the concentration is,
because that might be somethingdifferent than what your doctor
is telling you, because, like,the pharmacy might just carry a
(16:24):
different prescription ofsomething, or it might be com,
or a different prescription, adifferent concentration of
something.
Ed Delesky, MD (16:30):
Right.
Nicole Aruffo, RN (16:31):
So your pharmacy might carry something
that's like higher or lowerconcentration per you know, one
pill or one ml or one unit ofwhatever you're getting yeah
it's like your doctor might tellyou take two milligrams of
something, and then it mighteven say like I don't know if
(16:52):
it's like a liquid or aninjection, like two milligrams
or one unit.
But then if you get it from acompounding pharmacy, where that
might be a little bit different, and then your bottle says you
know, maybe it's two units orwhatever, yeah.
It might just be different butlike, always go by what the
bottle says, not necessarilywhat the you know, your
discharge paperwork or likewhatever your doctor kind of
(17:15):
mentioned to you.
Ed Delesky, MD (17:16):
Absolutely, and like this is something to slow
down and pay attention tobecause, especially when it
comes to liquids andconcentrations, it's so easy to
make a mistake.
Yeah, especially when, like youmentioned syringes earlier like
syringes come in all differentshapes and sizes.
(17:38):
Maybe not all shapes, but theycome in different sizes, maybe
different diameters, andrequiring different amounts to
be drawn up, like one milliliterin a really tiny syringe may
look very different to like onemilliliter, the whole thing,
whereas in a five ml syringe itfills up 20 of it, which is
(17:58):
totally different.
And then, like you were saying,like where your doctor may tell
you take 10 milligrams, but theconcentration of the liquid is
five milligrams per milliliteryeah like you have to sit down
and do that math and say likehow much?
Nicole Aruffo, RN (18:13):
yeah, I mean you shouldn't have to do the
math because it should be on thelabel, on the bottle, but I
don't know it should, I don'tknow.
Ed Delesky, MD (18:20):
Well, I was even seeing a guy this last week.
He was doing every two weekinjections of testosterone and
he was having a tough timeactually drawing up the very
specific amount of liquid to getthe exact dose that he needed.
So that's a whole othercommunity of people out there
who this affects.
So it's just something verymuch to be aware of that, like,
(18:41):
milliliters are not necessarilymilligrams and are certainly not
necessarily units, and you haveto take special attention to
the size of the syringe and theconcentration of the medicine
that you're getting.
So one other thing that I thinkwe should bring up is that
these pens that people aregetting, like the once
(19:04):
injectable, make it very, verysimple pens from the Wagovi and
the Terzepatide, the ZepboundUsually the compounding
pharmacies aren't giving you apen.
Nicole Aruffo, RN (19:15):
Yeah, no, because well, it's like the pen,
that's the expensive part tomake, not the actual drug.
Ed Delesky, MD (19:21):
Exactly.
Nicole Aruffo, RN (19:22):
Really annoying, actually it is.
Ed Delesky, MD (19:23):
No, really annoying, actually, it is no, it
yeah, and then we're going toit's such a coincidence that all
those drugs that come in a penare expensive.
And we're going to dive intothat in the back half of the
episode where, like, how thesedrug companies are making it
more affordable quote unquote,more affordable but you kind of
have to learn how to do theinjection yourself in a syringe
(19:45):
and a needle, not with the pen.
So that's a whole other skillthat perhaps you weren't used to
before.
But, like, there's tons ofvideos out there about how to do
the pen self-injection, butit's not as easy to do the
needle injection with thesyringe.
So just a couple, um, a coupleof stories that the FDA did put
(20:05):
out, uh, about errors in dosemanagement.
Just to put this intoperspective, um, most of the
errors came up in people likemistakenly drawing up more than
the prescribed dose of multipledose vials.
So like you get something andyou have to actually pull up the
medicine no-transcript, a quickinteraction and the prescriber
(20:45):
was like, oh yeah, do this realquick.
And then like there was anerror there.
So like it's not all on thepatient, it might be from the
provider as well, or maybe adecimal point isn't in the right
spot.
So instead of taking, you know,0.25 milligrams, you're taking
25 units or something like that.
So it can get very confusing.
(21:05):
So, aside from any of thechanges or difficulty in dosing,
compounding pharmaciessometimes have different
ingredients and different formsof the medication that are also
not FDA approved are also notFDA approved.
So some compounders actuallyhave ingredients like vitamin
B12, b6, l-carnitine and NAD totheir semaglutide products.
Nicole Aruffo, RN (21:30):
People love NAD nowadays.
Ed Delesky, MD (21:33):
That's such a niche biochem thing of the
electron transport chain, Iguess.
Sure A real nerd in me, that'swhat they say Wow, that was a
deep cut right there.
Are you hearing about this likepeople are like, searching,
like nad.
Oh yeah, people go places tolike get these like infusions I
(21:54):
was like, look, I was gettingthis and learning this from like
making this episode.
Nicole Aruffo, RN (21:57):
But I did, yeah, but you're seeing that
people are like oh yeah, it'slike a thing I want my, my
semaglutide with my b12 I know alot of people get b12 with that
.
They'll like get both.
Um, I haven't heard like thenad being mixed in with it.
I just know that's like aseparate thing.
People like go for their nadinfusions and like b12 shot.
(22:22):
Right, right, right Apparentlyit's the fountain of youth.
Ed Delesky, MD (22:25):
So, while this, these aren't looked at for
safety and effectiveness.
Nicole Aruffo, RN (22:30):
Yeah, so don't take my word for it, but
that's just what the people aredoing.
Ed Delesky, MD (22:33):
Right and so like this is something that's
out there that people are doingand it's unestablished, and so
that's one of the importantthings.
We are kind of bound byevidence-based medicine and so
this isn't looked at and so wedon't know, and one usually
operates in the realm of like ifwe don't know, it's probably
not safe.
Or semaglutide acetate, andthese are actually different
(23:04):
than the active ingredients inthe base form in the approved
drugs and these don'tnecessarily fall under any sort
of FDA conditions forcompounding, and so it just adds
to a lot of confusion in thismarket altogether.
So really you just have to becareful, because if you inject
the wrong amount of medicine,this can lead to some really bad
side effects like nausea,vomiting, abdominal pain,
(23:26):
headache, migraine, and somepeople have required
hospitalization, and thesesymptoms or side effects don't
go away immediately because themedication lasts for a long time
and the FDA is looking out forstuff like this.
So, because of all of the hooplawith compounding pharmacies and
how expensive these medicinesare and you kind of teased at
(23:48):
this earlier.
Pharmaceutical companies haveresponded, specifically Eli
Lilly and Novo Nordisk haveresponded and offered direct to
consumer models for people to beable to access the FDA-approved
versions of these medications.
Nicole Aruffo, RN (24:05):
All right, eddie, tell us about this
direct-to-consumer model that'sout there.
Ed Delesky, MD (24:11):
So if someone didn't know Eli Lilly, we'll
talk about Zepbound first.
Eli Lilly has a self-payjourney program, is what it's
called.
It's from the Lilly DirectSelf-Pay Pharmacy Solutions, and
for a while they were offeringreduced prices of ZepBound for
the 2.5 milligram and 5milligram vials, so that's
(24:36):
specifically different than theinjector pen.
And so they were able to bringdown the cost of this of
production, because now they'reonly producing the drug, not the
drug and the auto self-injectorpen which, like you said
earlier, it turns out to be thereally expensive thing.
And so this model that theyhave aims to provide transparent
(24:56):
pricing by removing third-partysupply chain entities, and so
now altogether third-partysupply chain entities, and so
now altogether, through theirdirect-to-consumer system that
they have, they have vialoptions where you draw up the
medicine and you give it toyourself.
But it's an FDA-approved drugof 2.5, 5, 7.5, and 10
(25:19):
milligrams.
The 7.5 and 10 milligram doseswere just recently added, and
while the two and a half andfive milligram ones were there
all the while since theinitiation of the program.
So understanding that you'reonly missing the 12 and a half
and 15 milligram doses whichpeople use, but they may not be
(25:40):
as common.
And so, for pricing wise.
You can find this on theirwebsite and we're recording this
episode, sunday, march 30th butas it's currently written, the
Zepbound self-pay journeyprogram offers seven and a half
and 10 milligram vials for $4.99a month for the first refills
(26:02):
within 45 days or so, and so$4.99 a month is admittedly
still a very high number, but tocompare, that is against the
over $1,000 per month that thesemedicines cost in the pen.
The 2.5 and 5 milligrams aremore affordable.
The 2.5 and 5 milligrams aremore affordable.
(26:23):
The data from at least February25th 2025 suggests that the 2.5
milligram dose is $3.49 permonth and 5 milligrams is $4.99
per month, like the other ones.
I thought this was a pretty coolthing when I found this
(26:43):
initially, because a lot ofpeople may want this medication
but their insurance companiesmay not pay for it, and that's
been one of the most frustratingthings.
You got nothing, and so wetalked about how Zepbound has
this new program.
Novo Nordisk just came out withtheir program for Wagovi
through their NovaCare pharmacy,and they offer a
direct-to-patient deliveryoption for actually all of the
(27:06):
FDA-approved doses, from 0.25all the way up to 2.4 milligrams
.
Their price is quote-unquote,reduced at $4.99 per month for
cash-paying patients, and thekey piece to this is that Novo
Nordisk is offering this in thesingle dose pens, compared to
(27:26):
Zepbound which is being offeredin syringes, and so that might
be their little niche ofoffering like a hey, we're doing
this, but we're still doingthis with the pens.
We just wanted to relay all ofthat information to you, knowing
that some of these are updatesand a changing environment, that
information to you, knowingthat some of these are updates
and a changing environment, fdaapproval is really important in
(27:47):
this whole thing, and thatknowing that Zepbound and Wagovi
now may be available throughthese direct programs, albeit
still very expensive, at leastthey've undergone rigorous
review for safety, quality andeffectiveness and really reflect
about where you're getting yourmedicines, as we kind of think
back to our conversation aboutcompounding pharmacies and, at
the end of the day, make sureyou always talk to your
(28:08):
healthcare provider for anyfurther advice that's specific
to you.
So thank you for coming back toanother episode of your Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
Please check out our website,send us some fan mail, please
rate and review the show.
If you don't mind, perhapsleave a comment where you're
listening.
Any of that support would begreatly appreciated and until
(28:31):
next time, stay healthy, myfriends.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you and goodbye Bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
This is not medical advice oran attempt to substitute medical
(28:56):
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
We explicitly disclaim anyliability relating to the
information given or its use.
Thanks for listening.
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