Pharmacists dish about GLP-1 challenges

A reporter asked us recently for some anecdotal stories from compounders about what’s really going on with GLP-1s as we reach the May 22 deadline for the end of compounded copies of semaglutide injection. We knew some of these issues already, of course, but we were surprised at how much broader the real-world issues are than simply price and availability. 

For example, contrary to the idea that compounders are adding B12 and glycine to GLP-1s as ‘a way around FDA limitations,’ we found that patients and providers are reporting significant quality-of-life improvements and fewer side effects thanks to those additives. 

On the prescriber side, they’re requesting compounded versions so patients can have dosing flexibility — the microdoses or alternate strengths that commercial pens don’t provide — as well as alternative dosage forms (e.g., sublingual, intranasal).

From patients’ perspectives, even with insurance approval the medications often aren't in stock; unreliable fulfillment (backorders are common) means regaining weight and potentially returning to drugs like antihypertensives they thought they could leave behind.

And looming over it all, of course, is the cost. Insurance coverage is inconsistent or nonexistent for GLP-1s, especially for weight loss indications. Patients without insurance are looking at $2,000 or more out of pocket, and those with coverage can see absurdly high copays. And many pharmacies are still reporting that they are reimbursed hundreds of dollars below cost for GLP-1 prescriptions, making them reluctant to stock or fill them — especially when they know many of those prescriptions are going to be abandoned because people can’t afford them. 

The result of this mess — one of the drugmakers’ making, we’re confident saying — is dissatisfied patients, frustrated prescribers, and aggravated compounding pharmacists who have a solution but are unable to provide it. 

Scott Brunner shared pharmacists’ unedited anecdotes in his May 20 Compounding Interests.