New Year, New Me?
New Year’s Dieting. Again…
Here we go again, another new year is upon us, and I’m fat as usual. Slightly less fat (326 lbs) than when I started a private Facebook diet group during the pandemic, but feeling increasingly debilitated as I continue to age. I know what to do, I know how to lose weight, but I can’t seem to stick with it long enough to hit my goals and just gain it back. To add to the situation, I just crossed the line into pre-diabetes on my A1C level.
Lack of willpower? Lack of motivation? Just too busy for self care? All of the above and more. So what will I do differently this time? Well something more drastic and controversial, and if that doesn’t agree with you, I’m happy to hear your feedback and engage in thoughtful dialogue.
What are my options?
No, I’m not getting surgery. Probably would have to consider it at some point, but my gastric system is pretty bulletproof, and everyone I’ve talked to has had some ill effect from getting a gastric bypass. I’d rather not permanently alter my body.
I was intrigued by gastric balloons, they drop them in your stomach on a thin tube and inflate them with saline solution. It’s like a reversible bypass. The problem is that insurance doesn’t cover it, they are unreasonably expensive, and they only last six months. The medical community isn’t excited about these because once removed, you are likely to regain the weight.
My doctor offered a gastric sleeve, which is covered under insurance, but it’s just another form of permanent surgery which I rejected. So aside from restrictive dieting, diet apps like Noom, and gym memberships, there weren’t really any good options. At the same time, the medical community was beginning to acknowledge that obesity is not due to poor decisions and lack of willpower, it may in fact be a disease.
I am not a medical professional, nor do I play one on TV, and this is not intended to provide any medical or diet advice. I am simply sharing my research, conclusions, and opinions in hopes that it is helpful for others who wish to learn more. I have linked to articles I have read, and you should do your own research and consult with your doctor before considering any similar course of action.
As of this writing I am not receiving any compensation from anyone to write about this subject, but hey, I’m not going to turn down free stuff in the future. Also I started an Amazon Affiliate program, so if you click product links I might get a commission at no cost to you. Why should I make any money? Well I’ve put in at least 20 hours researching and writing about this subject, so that’s got to be worth something, right?
Drugs to the rescue?
In 2012 Novo Nordisk developed an antidiabetic medication used for the treatment of type 2 diabetes called Semaglutide. The drug is in a class known as “GLP-1 receptor agonists”, which mimics the action of the human incretin glucagon-like peptide-1 (GLP-1). What does this mean in plain English? Semaglutide increases insulin secretion which increases blood sugar disposal, and improves glycemic control.
Semaglutide was approved by the FDA in December 2017 under the name Ozempic. It’s delivered at home by an injectable pen, kinda like when Mr Spock stabs a Kligon in the neck, except you don’t pass out. OK, so great, this helps people with type 2 diabetes, which I don’t have, yet.
Well, Semaglutide was found to cause increased weight loss, and was more effective at a slightly higher dosage. During the clinical trial, individuals who received the drug lost 6.2% of their initial body weight compared to those who received placebo. So Novo Nordisk set out to offer the higher dosage, which of course requires FDA approval.
In 2021, Semaglutide was FDA approved under the name Wegovy, specifically for weight management, again in a (slightly different) injectable pen. You may have heard of Ozempic or Wegovy in 2022, as Novo Nordisk ran an aggressive marketing campaign over the summer, and several celebrities jumped on the bandwagon. Presumably this is how Kim Kardasian slimmed down to fit into Marilyn Monroe’s dress.
How does Semaglutide work?
Let me start by saying that all drugs come with potential side effects and risks. Someone close to me took Phen/Fen in the late 1990s, and later found out they might have had heart valve damage when the drug was pulled from the market. This has definitely made me hesitant to take a diet drug, and the long term effects of Semaglutide are not yet known.
According to Novo Nordisk, Semaglutide:
- Helps your pancreas produce more insulin when your blood sugar is high
- Helps prevent your liver from making and releasing too much sugar
- Slows down food leaving your stomach
Fun fact: Semaglutide was inspired by Lizard Venom.
Which drug is right for me?
I was obviously intrigued by this new weight loss drug, so I did an extensive amount of research, and dug in to understand the drug pricing, dosage, and packaging. It’s all over the place, and I’ll share all the details below. Please read this, because there is a gray market for Semaglutide, and with that are a number of risks I’m not willing to take.
Someone I knew had recently begun taking Ozempic, not for type 2 diabetes, but for weight loss. Predictably both Wegovy and Ozempic are very expensive, and as it turns out, only Ozempic is available in Canada, and as usual at a more “affordable” price. I’ll get into pricing in a bit.
Because I was considering a drug assisted diet program which impacts my blood sugar, I wanted my doctor involved. Also predictably, neither drug was covered by my insurance when I first inquired. Although I could get access to “Semaglutide” through online companies (so I thought), the worst my doctor could say was “no”.
So I approached my doctor to get her to buy in. I explained that because I was considered pre-diabetes and needed to get my A1C level under control, and because weightloss was required to do so, and because Semaglutide could accomplish both, I wanted her to prescribe me Ozempic even if insurance didn’t cover it.
My doctor agreed to do some research as she had heard interest from other patients, and she referred me to an article in the New England Journal of Medicine. Because Wegovy was more effective than Ozempic, she suggested I take Wegovy instead. I checked into pricing with my insurance company, and as expected there wasn’t much of a price discount.
I pushed back and requested I be prescribed Ozempic (“off label” since I’m not diabetic) and she agreed to provide me with a prescription so long as I kept her in the loop by monitoring and reporting my vitals. I’m slightly in shock because I’m on an HMO plan, and they are historically pretty rigid about how they deliver care.
The Semaglutide Business Explained
If you live in the US, you already know our healthcare system is deeply flawed. US based drug companies innovate and market drugs at high prices, yet magically sell them in other countries for a fraction of the cost. In reality, these drugs cost a lot to create from research and development, testing, regulation, etc. While it’s fair for them to recover these costs, it really seems unfair when we as Americans can’t get access to these drugs for an affordable price, and are rarely covered by our insurance.
On the surface, Ozempic and Wegovy appear to be the same drug, just at slightly different dosages. When researching pricing, I found that Wegovy was disproportionately more expensive than Ozempic. This suggests that Novo Nordisk is discounting Ozempic as a medically necessary anti-diabetes drug, while charging a premium for Wegovy which could be argued as a “nice to have”.
Novo Nordisk has stated that the two drugs are “not interchangeable”, however I was unable to find any evidence of any difference, Semaglutide is the only pharmaceutical ingredient in both. I think this is a thinly veiled attempt to increase margins, and to encourage doctors to prescribe the drug specific to the use case instead of “off label”.
There’s also been a shortage of both drugs as they’ve become very popular due to the promise of weight loss. This has opened up a gray market for bootleg Semaglutide which has been created by “compounding pharmacies” which are creating the drug on their own. Several online companies are offering inexpensive ($150/mo) guided weight loss programs with Semaglutide included.
As this article and this article discuss, these compounding pharmacies aren’t getting the drug from Novo Nordisk, and there’s no way to judge the effectiveness or risk of this bootleg drug because it’s not undergoing proper testing. Although the pricing is compelling, I’m not willing to take this risk. For this reason I am not linking to any of these providers or programs.
Dosing and Pricing
Before you can understand the drug pricing, you have to understand the drug dosing. Hint: it’s complicated. Both drugs involve a once-per-week injection.
For both Type 2 Diabetes and weight loss, both drugs require a “ramp up” to mitigate the gastric side effects. These include Nausea, Diarrhea, Stomach (abdominal) pain, Vomiting, Constipation, and Erectile Dysfunction. Just kidding, you’ll be able to perform in the bedroom just fine.
|Drug Name||Month 1||Month 2||Month 3||Month 4||Ongoing|
The starting dose of 0.25 mg is a non therapeutic dose, and as you can see the ramp up and ongoing dosage for Wegovy is different from Ozempic. To make things unnecessarily more complicated, the injection pens between the two drugs are completely different.
Ozempic comes in multi-use injection pens with replaceable needles. They are available in 2mg (Red), 4mg (Blue), and 8mg (Yellow) pens. As you can see from the table above, your starter (Red 2mg) pen will deliver your four “Month 1” doses of 0.25mg, and two of your “Month 2” doses of 0.5mg.
0.25 + 0.25 + 0.25 + 0.25 + 0.5 + 0.5 = 2 mg
Even more confusing, all the pen sizes cost the same amount regardless of the amount of drug in the pen. This means your per dose cost depends on the volume of the pen, and would suggest you just buy the biggest pen because it has more.
Pro tip: You can order extra needles to go with your pen.
Wegovy comes in a single use injection pen, and like Ozempic, all pens cost the same regardless of dosage. Wegovy pens come in the specific dosage for each month, and you have to buy them in a carton of 4 pens.
Now that we understand the dosing, and the pens (don’t feel bad if you are still confused, it gets worse), we can look at the drug pricing. I used GoodRx as a source of pricing information, your pricing may vary when purchased through your medical provider. As I said, all pens regardless of size all cost the same amount.
Ozempic retails anywhere from $986 – $1178 per multi-dose pen, and with a GoodRx discount ranges from $892.01 to $944.01.
Wegovy retails anywhere from $1490 – $1781 per 4 pen carton, and with a GoodRx discount ranges from $1345.77 to $1426.56.
On the surface it appears that Wegovy is on average 50% more expensive than Ozempic which is substantial considering they are the same drug (except “not interchangeable” per Novo Nordisk).
I’ll take this opportunity to remind you that Ozempic is available from Canada online with a prescription, and the cost per pen at Marks Marine Pharmacy is $299/each. Wegovy is not approved in Canada, so currently you can’t obtain it with a discount.
Pricing Per Dose (Week)
Remember the per dose pricing is much more complex because the two drugs come in different pens. So where Wegovy injections are “as little as” $337/week in the US, Ozempic Injections range from “as low as” $112/week to $223/week depending on dosage. Ozempic doses range from $37/week to $75/week when purchased in Canada.
Below are tables which show the pricing breakdowns for US and Canada.
Please note: Ozempic pricing assumes you ramp up the pen size, as directed, based on what month you are on. The “Per Dose Cost” for the 0.25 and 0.5mg doses in months 1 and 2 is not accurate because you are using the starter pen for 1.5 months, and then switch to a different pen depending on how long you stay at the 0.5mg dose.
Ozempic’s website says you stay on the 0.5mg dose for “at least 4 weeks” which implies you may stay at 0.5mg for a longer period of time in order to acclimate and mitigate the side effects.
In other words, the suggested dosing does not fit uniformly into the suggested pen sizes, and thus it makes the math really confusing. I did the best I could, but I blame big pharma on this one.
Theoretically your per dose cost would be lower if you just bought the Blue 4mg or Yellow 8mg pen earlier, but I’m not sure if this is advisable (i.e. is there a contamination risk?) or if your doctor would prescribe you the larger pen in the beginning.
US Drug Pricing (Assumes GoodRX lowest cost)
|Ozempic||1 prefilled 2 mg pen of 2 mg/1.5ml||.25mg||8||$892||$112||$446|
|Ozempic||1 prefilled 2 mg pen of 2 mg/1.5ml||.5mg||4||$892||$223||$892|
|Ozempic||1 prefilled 4 mg pen of 4 mg/3ml||1mg||4||$892||$223||$892|
|Ozempic||1 prefilled 8 mg pen of 8 mg/3ml||2mg||4||$892||$223||$892|
|Wegovy||4 prefilled 0.25 mg pens of 0.25mg/0.5ml||.25mg||1||$1,346||$337||$1,346|
|Wegovy||4 prefilled 0.5 mg pens of 0.5mg/0.5ml||.5mg||1||$1,346||$337||$1,346|
|Wegovy||4 prefilled 1 mg pens of 1mg/0.5ml||1mg||1||$1,346||$337||$1,346|
|Wegovy||4 prefilled 1.7 mg pens of 1.7mg/0.75ml||1.7mg||1||$1,346||$337||$1,346|
|Wegovy||4 prefilled 2.4 mg pens of 2.4mg/0.75ml||2.4mg||1||$1,346||$337||$1,346|
Canada Drug Pricing (Assumes Marks Marine Pharmacy pricing)
|Ozempic||1 prefilled 2 mg pen of 2 mg/1.5ml||.25mg||8||$299||$37||$150|
|Ozempic||1 prefilled 2 mg pen of 2 mg/1.5ml||.5mg||4||$299||$75||$299|
|Ozempic||1 prefilled 4 mg pen of 4 mg/3ml||1mg||4||$299||$75||$299|
|Ozempic||1 prefilled 8 mg pen of 8 mg/3ml||2mg||4||$299||$75||$299|
As of this writing I have not started taking Ozempic, but it’s ready waiting for me in the refrigerator. That’s right folks, the medication ships on ice and must remain refrigerated and not frozen. During the time I was negotiating with my doctor, my insurance began covering Ozempic and my first pen was $80 with shipping. I was so excited, I never thought to use the discount card.
Additionally I have not decided what I will do when I reach month 5 when theoretically I should be taking a dosage of 2.4mg/week which is not available with Ozempic unless I start doing multiple injections of different amounts (i.e. one injection of 2mg, a second injection of 0.25 or 0.5mg). I’ll consult my doctor at that time, and pray Wegovy is covered by my insurance, otherwise I’ll probably just stay at 2mg/week.
I have intentionally not disclosed my medical insurer or provider, because I’m not clear how this diagnosis was coded, if it was done off label, and I sure as hell don’t want to find out next month that I need to pay more elsewhere. If your provider denies you access to this drug on the grounds that it is “non-formulary” (a complicated way of saying “we won’t pay for this name brand drug”), you can appeal your provider’s decision.
Diet Planning and Data Collection
My basic plan is to go back to what worked for me before, and to introduce exercise proportionally to avoid injury based on my weight and strength. In 2021 I lost 45 lbs doing a combination of intermittent fasting, eating prepackaged meals, and diligently measuring and logging everything I put in my body. Oh, and I quit drinking beer. Sweet delicious nourishing beer, how I will miss you for now.
I use and recommend a number of apps and devices to track your progress on your smartphone. These are often more feature rich and expensive than base models, but it was important to me that all of my medical data was logged on my iPhone as I plan to do analysis on this data in 2023 and I will share that data publicly as a citizen science project.
Follow My Progress
Devices and Apps
- Renpho Body Weight and Composition Scale Uses Wifi and Bluetooth, multi-person weight tracking, and an app to track your progress.
- Omron Blood Pressure Monitor Uses Bluetooth and allows two profiles.
- Renpho Digital Food Scale Uses Bluetooth and has an app.
- Apple Watch Allows me to track everything from activity (steps, walks, workouts) to vitals like heart metrics and blood oxygen to recording my sleep patterns and levels. Also works with my Bosch E-Bike and Strava Apps for more accurate calorie burn and workout data.
- Continuous Glucose Monitor (CGM) This is a new one for me, and I haven’t decided which one I will use yet, but it looks like either the Dexcom G6 or the Abbott Freestyle Libre 3. Both provide frequent updates (5 minutes and 1 minute respectively), and it will be interesting to see how my glucose levels change based on when/what I eat and from exercise. Insurance doesn’t cover these, and I’m hoping maybe one of these companies will sponsor my citizen science project.
- Apple Health
- Cobi-e-Bike (Bosch Powered E-Bikes)
- MyNetDiary I use the paid version ($69/yr) because it allows me to track my food intake by time of day instead of day. This is important to me because I want to correlate my food intake to other data such as blood glucose. This app had the single biggest impact on my weight loss because I tracked everything and it gave me a real-time calorie budget based on any exercise I had that day. MyFitnessPal is a competitor, but their crowd sourced food database is inaccurate, whereas MyNetDiary validates all crowdsourced info to curate unique and accurate data. What’s more, they have a barcode scanner which makes it painless to log (or submit) any food items.
- Muscle Booster Started a 3 month paid trial 2 months ago as a way to do some short exercises at home. No idea if the app is any good 🙂