The United States is one of only two countries that allows direct-to-consumer advertising for prescription drugs, the other being New Zealand. There are good reasons that other developed countries forbid this practice. This type of advertising is quite controversial and often criticized for promoting expensive brand-name drugs over more affordable, generic options. Drug ads are propaganda that has one purpose—increasing sales for the benefit of stockholders. These ads promote the product. They are never balanced. They never help you understand where their drug fits into a best practice strategy for diabetes management. They never emphasize the critical role of diet in type 2 diabetes management. They never help patients understand that they should start metformin first—before you start their drug. These ads are very effective, and I see them every day on the television. They steer patients away from a best practice approach, they dramatically increase costs, and they don’t produce the greatest reduction in diabetic complications. There is no better example than in the case of the most expensive drugs for type 2 diabetes.
Both Wegovy and Ozempic contain semaglutide and both are made by a Danish company, Novo-Nordisk. Wegovy is approved to treat obesity and comes in a higher dose of 2.4 mg. Ozempic is approved to treat type 2 diabetes. Ozempic is given in lower doses of 0.5 mg, 1 mg., and 2 mg. The cash price for Wegovy at Walmart is $1620 for a one month supply. With a Good Rx coupon, it is $1406. The corresponding price for Ozempic is $1163 and $1014. The current price of gold is 9 cents per milligram. This stuff is much more expensive than gold and you are all being ripped off. “Wegovy costs patients up to $365 a month in Denmark, which typically doesn’t cover the drug — and about $140 in Germany and $92 in the U.K.” The reasons you are being used in this way are clear. Our law allows drug companies to aim their ads directly at consumers. Our law, uniquely among all developed nations, does not allow drug price negotiation. That is how you are being ripped off.
Individuals with type 2 diabetes don’t die of high sugar. They die of heart attacks, strokes, kidney failure, and heart failure. Patients with type 2 diabetes who have chronic kidney disease are a very high-risk group. Most of them die of heart attacks and strokes before they lose enough kidney function to need dialysis. These new, frightfully expensive drugs are not the most effective at protecting you from life-threatening diabetes complications.
A new study in the New England Journal of Medicine compares the effects of an injection of Ozempic 1 mg. with an injection of placebo over three and a half years in patients with type 2 diabetes and chronic kidney disease. It lowered the risk of cardiovascular death by 29% and all-cause death by 20%. The risk of cardiovascular events was 18% lower. 87 patients on semaglutide progressed to dialysis vs 100 on placebo. A non-fatal heart attack occurred in 52 patients on Ozempic vs 64 on placebo. That is a 20% risk reduction. A non-fatal stroke occurred in 63 patients on Ozempic vs 51 on placebo. That is a 22% increased risk.
A very similar study compared optimal medical therapy (OMT) with usual care for patients with type 2 diabetes and chronic kidney disease over twenty years ago. OMT is a comprehensive approach that combines aggressive goals for blood pressure, sugar, and cholesterol with counseling to stop smoking and aspirin to prevent clots if you are high risk. This analysis occurred at 7.8 years into the study
In the OMT group, there were 5 non-fatal heart attacks vs. 17 in the usual care group. There were 3 nonfatal strokes vs 20 in usual care. There were 5 bypass grafts vs 10 in usual care. These are not fractional reductions. They are multiple. It is an order of magnitude better than Ozempic. There were three times as many heart attacks in the usual care patients and seven times as many strokes. Because the difference between the two groups were so dramatic, the researchers believed it was unethical to keep patients on usual care. At 7.8 years, everyone went on OMT, but even though everyone was on the same treatment, the early OMT people continued to do much better.
The differences between the two groups continued to increase. Thirteen years into the OMT study, the benefits are even greater. There were 4 times as many heart attacks, 5 times as many strokes, and six times as many patients moving to dialysis in patients on usual care compared with patients on OMT.
Denmark’ socialized health system had for years covered Ozempic as a diabetes treatment, but “in 2022 doctors began prescribing it for weight loss, too, and soon they “emptied all the money boxes in the entire public health system,” said University of Copenhagen professor Jens Juul Holst, a co-inventor of the drug.” And remember, in Denmark the drug costs one third of what it does here. “In Denmark, with prescriptions for the drugs gobbling up 18% of regional drug budgets in 2023, officials were considering the unthinkable in a system that prides itself on free cradle-to-grave coverage: forcing patients to pay out-of-pocket for Ozempic — a drug made in the country.”
“The potential Medicare market alone is enormous. In 2020 about 13.7 million Medicare beneficiaries, around a quarter of the total, were diagnosed as overweight or obese, according to Juliette Cubanski and Tricia Neuman, researchers at KFF, a health information nonprofit that includes KFF Health News. Assuming a 50% discount on a $1,300 monthly list price for Wegovy, that’s a $107 billion price tag. The entire federal share of Medicare Part D spending in 2024 was projected to be $120 billion. Novo Nordisk spent $7.6 million lobbying Congress over the past 12 months, and lobbying disclosures show that most of that was to promote bills in the House and Senate to expand use of the GLP-1 drugs.” That is the kind of lobbying that distorts American health policy. That is why we pay twice as much money for worse clinical outcomes compared with other developed nations.
Optimal medical therapy does not just include lowering the sugar and weight in diabetes. OMT pays equal attention to lowering blood pressure, reducing LDL or bad cholesterol levels, and helping patients stop smoking. That is why OMT is an order of magnitude better than Ozempic in preventing diabetic complications. Not only that, but OMT addresses all of those issues for about $60 a month even if you need six drugs to address them-Losartan/hydrochlorothiazide ($4), amlodipine ($9), and eplerenone ($27) for high blood pressure; atorvastatin ($16), for cholesterol, and metformin ($4) for type 2 diabetes. It is crazy to cover Ozempic for diabetes when much better results are available for a dramatically lower price.
Drug company advertising leads to more complications with much greater costs. Drug company lobbying stands in the way of price negotiation for medicine. These laws need to be changed.
Dr. W is an excellent and heartfelt writer. He brings up on a point that I have wondered about: Why don't the ihealthcare nsurance companies negotiate prices for medications? I do not like the government interceding in anything because things like the bridge to nowhere, a grossly expensive and unfinished because of cost for a bullet train in California, only 8 EV charging stations after billions were spent--all by governments. The easily visible and underlying socialisT tendency of Dr. W is apparent. But his concept is correct that there should be negotiation over prices such that Americans pay the same as those in foreign countries such as Denmark, Germany, and the UK
Dr. Bestermann, I have been reading about the longevity effects of metformin. A study in Cell showed really positive results in monkeys. Are there any negative side effects of taking this drug?