CHICAGO – If you’re on a serious weight loss journey, you know that skipping sweets isn’t always the hard part. It could be finding weight loss medications that your doctor has prescribed.
In a special FOX 32 report, Silvia Perez looks at what’s happening to Vegovi’s inventory.
“I feel like having to call 101 to a pharmacy just to get medicine is crazy to me,” said Vegovi patient Michelle Works.
Works has been taking Vegovi for about a year. She says that at first it was not difficult to find it at the local pharmacy, but now that has changed.
“I don’t drive to another state, but I drove 45 minutes in my local area to get my medication,” she said.
Dr. Neha Shah of Edward Elmhurst Medical Group is board certified in obesity and lifestyle medicine. She has patients who go to extremes to get Vego prescriptions.
“I’ve had patients drive to Wisconsin because they saw the pharmacy. They drive to different state lines to see if they can get access to this drug,” Shah said. “There are Facebook groups where patients go online to see if they can get access. ‘Oh, this pharmacy in downtown Naperville has two boxes, whoever can pick it up.'”
“I have a patient who told me last week, ‘I spend about an hour and a half every day trying to call different pharmacies because I don’t know when my next refill is going to arrive,'” Shah added. .
Finding Vegovi in stock is only half the battle.
“The most I paid was $200,” Works said.
That’s for a three-month supply. When Works picked up a refill at her regular pharmacy yesterday, she said she “got it for nothing”.
Shah said she sees most patients paying $400 to $500 for Vegovi.
“They’re emptying their HSA and FSA accounts to get coverage for these drugs. “I had a patient last year who paid out of pocket for his Vega for almost a year because of insurance issues and ended up taking out a second mortgage on his house because of it,” Shah said.
So what happens with filling a Vegovi prescription?
“You would think that something as popular as Vegovi would be a big hit for pharmacies.” It’s just not,” said Antonio Ciaccia, CEO of 3 Akis Advisors.
His firm consults with everyone from employers to health care groups to state attorneys general on drug pricing issues.
“We’re basically drug dealers.” If someone overprices medicines, they can hire us and we will help them get a better offer and re-harmonize their pharmacy experience,” said Ćaćia. “What’s really important here is to understand that the pharmacy experience, financially speaking, is a casino.”
“They’re going to make a lot of money on some drugs. They’re going to lose a lot of money on some drugs. Some pharmacies win in that model based on their overall drug mix. Other pharmacies lose.”
Ciaccia says the problem is that pharmacies can do little to control their own financial destiny.
“It’s really just a matter of which PBMs choose to favor which drugs and which patients walk in the door and get the drugs that the PBMs favor,” Ciaccia said.
PBM stands for “pharmacy benefit manager.” In some cases, it’s the department of your health insurance that manages your prescription drug coverage. In others, the PBM is an independent company.
According to the FTC, they are hired to negotiate discounts and fees with drug manufacturers and to reimburse pharmacies for patients’ prescriptions.
“Pharmacies are choosing not to stock these drugs anymore because PBMs are not necessarily paying commensurate with the actual value of the product, let alone the service the pharmacy provides,” Ciaccia said.
In his casino analogy, the PBM is also the “house.”
“No question. What do we know about the house? The house always wins,” said Čača.
He said this problem isn’t just happening with these new “hot” weight loss drugs.
“It’s something that’s been going on for many years, and in fact, our research shows that pharmacies are losing money relative to the cost of the drug on roughly 20% of what they actually dispense,” Ciccia said.
“The average loss reported in 30 days on these prescriptions was $40 per prescription.” They lose $40 on a 30-day prescription for these products. Ninety days they lose as much as $120,” said John Beckner, senior director of community initiatives for the National Community Pharmacists Association (NCPA).
These are some of the preliminary results of a recent NCPA survey. The group adds that Veg’s prescriptions have grown by 180% in the past year.
“So pharmacies make the difficult decision not to get them or, depending on how low that reimbursement is, they have to turn away patients,” Beckner said.
“We’ve seen problems with access to GLP-1 all over the world, from small pharmacies all the way up to the biggest pharmacies.” “In fact, some of the largest publicly traded pharmacies have found that they are experiencing what they call ‘headwinds’ as a result of increased demand for these products,” Ciaccia said.
In many states, Ciaccia says PBMs are essentially the answer to nobody from a regulatory perspective.
“PBMs will certainly have more favorable cost-sharing arrangements with preferred pharmacies than non-preferred ones.” But it’s not necessarily universally true that the patient gets better prices at those preferred pharmacies versus non-preferred pharmacies,” Ciaccia said.
In his line of work, Ciaccia said he has seen many cases where patients are overpaid even when their prescription is filled at their preferred PBM pharmacy.
“PBMs are not here to work for the consumer. PBMs work for the plan sponsors they work for and often the interests of the plan sponsors will not be the same as those of the patients. In fact, we see many cases where patients are overpaying for their drugs, while rebates are generated to the PBM and plan sponsor and not shared with the patient,” Ćacia said.
If that’s the case, what are the chances that a patient will ever hit the drugstore price jackpot?
“All you can do is do your research. You go to the pharmacy, you bring your benefit card and they tell you what the cost will be under that benefit plan,” Ciacia said.
Ciaccia said checking prices at several pharmacies could save you thousands of dollars a year. Because when costs are too high, many patients often stop taking their medications simply because they can’t afford them or aren’t covered by insurance.
“The three largest pharmacy benefit managers are part of companies that are in the top 20 corporations on the Fortune 500 list. These are companies with revenues in the hundreds of billions of dollars,” said Dr. Tim Klassen, a health economist at Loyola University in Chicago.
“There were many attempts at regulation. They were in Congress. They were in Florida. Certain states have attempted to develop regulations or legislation to try to limit the market power of pharmacy benefit managers. But it’s usually a challenge. These are huge companies,” he added.
In 2020, the Illinois Department of Insurance was given the authority to license and regulate all pharmacy benefit managers operating in the state.
In June 2022, the Federal Trade Commission announced an investigation into the “prescription drug intermediary industry” – requiring the six largest pharmacy benefit managers to “provide information and records regarding their business practices.” The FTC’s investigation will analyze the impact that PBMs have on “access and affordability of prescription drugs.”
So far, it has received at least 24,000 complaints or public comments about pharmacy benefit managers.
“What we know about these drugs is that if you stop taking them, it’s very common to go back to where you were from a weight perspective,” Ciaccia said.
That was a concern for Works. She lost only half of the 50 pounds her doctor told her she needed to lose because she was pre-diabetic.
“You have success and then all of a sudden, bam, you see the numbers go up on the scale. I tried this, I tried that. Then my anxiety starts to kick in,” Works said.
“This is also a drug that requires titration, which means that every month they take drugs that they should increase in dosage,” Shah said.
“So if they go more than two weeks without medication, they’re likely to have some pretty serious side effects.” I’ve had patients end up in the hospital who haven’t taken their meds for three weeks and started dosing in the hospital. higher leverage and now they are vomiting, they have nausea,” she added.
And the list of patient concerns does not end there.
“I have patients taking Vegs who are on the liver transplant list and can’t get a liver transplant until they lose a hundred pounds.” I have patients who need a knee or hip replacement who can’t get access to that medical care because their doctors need 50 or 70 pounds of weight loss,” Shah said.
Meanwhile, Works has come up with her own solution to determine when her Veggie recipe will be next.
“I started changing my medication. Normally you’re supposed to take them every week, but I’ve started taking it every other week just in case, I’m not going to run out,” Works said.
What did her doctor say?
“I didn’t tell my doctor,” Works said.
There are other weight-loss drugs that doctors can prescribe besides Vegovi, but some experts say patients may not see the same results.
FOX 32 reached out to Novo Nordisk, the maker of Vegovi, and several pharmacy benefit managers for our story. Novo Nordisk sent us a statement saying:
“Today, about 110 million American adults are living with obesity and about 50 million of them have obesity drug coverage. It is important to note that approximately 80% of Vegovi patients in the US with commercial Vegovi coverage pay $25 per month or less for Vegovi. For commercially insured patients who do not have Vegovi insurance, or those who pay cash for their prescriptions, they can take advantage of the savings offer to receive $500 off the full retail price. Offer good for (12) 28-day fills.”
“Novo Nordisk believes that the most effective way for the millions of Americans who need anti-obesity drugs to be able to access and afford them is to ensure that these drugs are covered by government and commercial insurance plans.” We need to work with our elected officials to advance legislation that recognizes obesity as a chronic progressive disease and supports fair reimbursement for treatment costs. We advocate for patients and policies that support access to all obesity treatments, including Medicare Part D coverage of obesity medications. We are also actively working with private insurers and employers to encourage broader coverage of anti-obesity drugs.”
Regarding the pharmacy benefits manager, FOX 32 reached out to the three largest companies: CVS Caremark, Express Scripts and Optum. All three referred us to their trade association, the Pharmaceutical Care Management Association.
The PCMA sent FOX 32 the following statement about whether pharmacies are paid at cost for Vegovi:
“It is important that only pharmaceutical companies determine and raise the prices of medicines. The companies that provide the pharmacies are the only check against the pricing power of the pharmaceutical companies,” the statement said. “Additionally, pharmacy benefit companies reimburse pharmacies based on the terms of the contract they agree to.” Whether Vegov or Zepbound is covered, and the cost-sharing associated with access, is a decision made by the patient’s health plan sponsor, not the PBM.”
#Vegovi #shortage #slimming #drugs #reveals #price #pitfalls #pharmacies
Image Source : www.fox32chicago.com