There’s No Easy Way to Stop Taking Ozempic

Without insurance, weight-loss drugs including Wegovy can cost roughly $1,000 a month.
Without insurance, weight-loss drugs including Wegovy can cost roughly $1,000 a month.

Summary

Those who go off weight-loss drugs risk regaining weight, but staying on them forever isn’t always a realistic option.

What happens if you have to go off weight-loss drugs?

It’s a growing concern for the millions of Americans taking medications including Wegovy, Zepbound or Ozempic. Employer-health plans are tightening requirements or dropping coverage. And manufacturers’ discount coupons for initial supplies of medication expire, leaving people having to cough up roughly $1,000 a month without insurance.

For patients, this presents a conundrum. They have to stay indefinitely on the drugs, known as GLP-1s, or risk gaining back the weight, according to many doctors. But for lots of people, taking the medication forever isn’t a realistic option.

Faced with this predicament, some are trying to switch to a different GLP-1 to see if their insurance will cover it. Others are looking into older anti-obesity treatments or finding cheaper versions at compounding pharmacies.

No option is perfect. Older drugs don’t work as well, and doctors worry about safety and quality with cheaper compound versions.

Christine Hayworth, a 41-year-old in Long Beach, Calif., lost about 60 pounds in a year on GLP-1 medication. But in the fall, she stopped taking it when her manufacturer savings card expired.

In the month and a half when she was off the drugs, she regained 8 to 10 pounds. Ultimately she got insurance approval for Wegovy, and relost the weight, she says.

“I went into a panic, and during that time it was like my body was spiraling," she says. “I had all this success. Now what if I just go backwards?"

Getting approval

A commonly cited 2022 study funded by Novo Nordisk, the manufacturer of Wegovy and Ozempic, found that patients regained two-thirds of their lost weight a year after they stopped taking semaglutide, the main component in the medications. Wegovy is approved for obesity treatment. Ozempic is approved for Type 2 diabetes, but many people take it off-label for weight loss.

People typically reach peak weight loss and plateau six to nine months after starting to take GLP-1 medications, says Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.

Doctors say it has become harder for patients to be covered for these drugs as health plans grow more concerned about costs. The coverage issues mainly affect people taking the drugs for weight loss, not for managing Type 2 diabetes, doctors say.

Back in 2022, about 60% of prior authorizations got approved by insurers, says Dr. Myra Ahmad, chief executive of Mochi, a telehealth obesity clinic. Now the rate is down to 25% to 30%, she says.

Weight regain is gradual at first, then comes back more forcefully, she says.

If you lose access to one drug, you can have your doctor try to get your insurance to approve a different one. So if you’ve been on Wegovy, for instance, you could try getting coverage for Zepbound.

There are also older anti-obesity medications, but they aren’t as effective and might have more side effects, such as phentermine, Contrave and Qsymia, as well as drugs that are taken off-label for weight loss, such as the diabetes medication metformin.

Often, patients have to go on multiple medications as well as trying to change their diet and exercise habits, says Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health in Los Angeles.

Eating a high-protein diet, staying away from ultra-processed foods and adding resistance training to your workouts also helps, says Apovian.

Another possibility is bariatric surgery, which can result in patients’ losing up to 35% of their body weight in the long term, says Apovian. This is a good option for people who need to lose more than 20% of their body weight, she says.

Strategies for stopping

Doctors say more research is needed to determine the best way to go off the drugs for patients who need to. If possible, the best way to go off GLP-1s is to reduce your dosage very gradually over time, says Dr. Dan Azagury, medical director of Stanford Lifestyle and Weight Management Clinic.

“If you do it abruptly, it’s practically guaranteed you’re going to regain weight," he says. “Sometimes the hunger comes back really significantly, and it’s really hard to fight that if you stop it overnight."

He also recommends significantly increasing your exercise routine and to aim for intense exercise six days a week.

If your body has been at a healthy weight for some period—likely at least a year or more—it might be possible to go off the drugs at some point, says Dr. Lydia Alexander, chief medical officer of Enara Health, a San Francisco-area obesity telehealth startup. Even then, going off the drugs will probably be much harder for someone who has had obesity for years compared with someone who gained weight more recently, she adds.

Ken Chinavare, a 53-year-old airplane mechanic in the Detroit area, stopped taking Wegovy last year after he had shed more than 30 pounds on the medication and was comfortable with his weight. Over the past year, he has regained most of the weight. Now he is thinking about whether to go back on a GLP-1.

“The regain has taken a psychological toll," he says. “It’s disheartening. While on Wegovy, I felt normal. I didn’t have constant food noise in my head."

Write to Sumathi Reddy at Sumathi.Reddy@wsj.com

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