How weight-loss drugs work (and how to pay for them)

Here are answers to four questions about the new class of weight-loss drugs.

Lesson summary

Hi there everyone, it’s Jeff and this is Plain English, where JR and I help you upgrade your English with current events and trending topics.

A year ago, we talked about a new type of drug : diabetes drugs that produced significant weight-loss. And then on Monday, we talked about the difficulties of stopping treatment with these drugs.

Weight-loss drugs have exploded in popularity. Almost four million Americans now take them. And because they’re drugs for chronic disease, doctors expect that many people will be on them for the long run—possibly, for life. These drugs have the potential to play a big role in business and healthcare in the coming years.

So I had some questions about them. And today’s lesson is all about what I found. In the second half of the lesson, I’ll show you how to use the phrasal verb “press up against.”

This is lesson 661 of Plain English. That means JR, the producer, has uploaded the full content to PlainEnglish.com/661. That’s where you’ll find the transcripts to read along with each part of today’s audio lesson. Ready? Let’s dive in.

Four questions about weight-loss drugs

The question we’ll start with is this: how do patients take weight-loss drugs?

The drugs are injectable and they come in a pen-like device. The pen includes a pre-measured dose and is for one-time-use only. The drugs are injected subcutaneously: that means, under the skin. It’s not like a typical shot or vaccine, which is a jab in a muscle. The injection can be in the abdomen, thigh, or upper arm. Drugmakers recommend varying the location with each injection. The injections are once per week and should be done on the same day of every week.

The pen isn’t difficult to use. You swab the area of your skin with an alcohol wipe, press the pen up against your skin, and hold it until an indicator on the pen confirms the dose has been fully administered.

The pens come in a box, and the box stays in the refrigerator. Each pen is for a single dose, and after the pen is used, it should be disposed of in a needle-safe container.

Second question: what insurance plans cover weight-loss drugs?

This is complicated. In countries with private insurance for prescription drugs, like the U.S. and Canada, the decision is up to the insurance plans, which are often selected by employers as benefits for employees. In countries with national insurance plans, like the U.K., the decision is up to the government.

In the U.S., the drugs are not yet covered by Medicare, the national health insurance plan for retirees. And only about one in five private medical plans cover it. In Canada, most insurance plans cover these drugs for diabetes, but only about half cover drugs specifically for weight loss.

The U.K., Norway, Belgium and the Netherlands cover costs only for patients with the highest class of obesity. Italy and Poland cover the drugs for patients who suffer from obesity as a result of eating disorders. Germany’s health ministry said it has “no plans” to cover weight-loss drugs.

Insurance coverage, therefore, is different depending on where you live and what type of insurance you have. If insurance doesn’t cover the drug, then patients have to pay out-of-pocket .

So that leads to the third question: How much do the drugs cost?

Like most prescription drugs, the cost of weight-loss drugs varies by country. The drugs cost far more in the U.S. than they do in any other part of the world. And the cost for patients without insurance can be $1,000 per month or more.

To put this in perspective , the average household income in the United States is $75,000 per year, pre-tax. A single family member on a weight loss drug without insurance would spend 15 percent of the average household income—in other words , this is out of reach for the average household.

It’s not like that everywhere. A recent study found that Wegovy costs $1,300 per month in the U.S., but just the equivalent of $328 in Germany. Ozempic is a diabetes drug with the same active ingredient as Wegovy. It costs $936 per month in the U.S., but the equivalent of just $168 in Japan, $103 in Germany, and $83 in France.

Saxenda, another drug, costs about $100 per month in Mexico and Brazil. But incomes are much lower in Mexico and Brazil. So relative to household income, the drugs are just as expensive in those countries as they are in the U.S.

Next question: Why is it so hard to find doses of weight-loss drugs?

Eli Lily and Novo Nordisk are the makers of popular diabetes and weight-loss drugs. And they’ve struggled to keep up with demand. That’s because these drugs are harder to make than simple pills or capsules. The pens add to the complexity: each dose requires a needle and a specialized, plastic pen.

All this means that manufacturers can’t easily adapt existing factories and machinery to ramp up production. It takes time to get a production facility ready to produce the compounds and the pens. There are only a handful of sites around the world that are able to do it.

Dosage also complicates the supply. Drugmakers typically make pens with five different dosage levels. So they have to match supply with demand, not only for their drug overall, but for each of five color-coded dosages.

There’s another reason why drugs can be hard to find—and that is that it’s expensive for pharmacies carry. The drugs have to be refrigerated—and refrigeration space in a pharmacy is at a premium. Pharmacies don’t always know exactly how much to carry, and they don’t want to store too much because it’s expensive and refrigerated space is limited.

There can be some location-specific factors, too. Pharmacies in British Columbia, Canada’s westernmost province, have filled tens of thousands of prescriptions of Ozempic to Americans, making it hard for locals to find supply. The province restricted sales to U.S. addresses in the middle of last year and the problem subsided.

In Mexico, you can get weight-loss or diabetes drugs without a prescription at the pharmacy—or even get them delivered on Rappi, a food and grocery delivery service. But because there are no prescriptions required, many people are going on the drugs for just a few months at a time . That means it’s harder for pharmacies to plan ahead . Two of Mexico City’s large pharmacy chains recently said they’re either completely out or have only limited availability.

Jeff’s take

I read an article that quotes a doctor in Mexico City. She’s on social media and she sees people desperately trying to find weight-loss drugs at different pharmacies here, most without a prescription or without a doctor visit. She said she advises people to talk to a doctor before starting the drugs, especially since there are shortages and there’s no guarantee you’ll even be able to find the drug consistently. But, she says, as soon as she suggests a doctor’s visit, “people [on social media] stop responding.”