How the Ozempic boom affects hospital pharmacies

The viral popularity of Ozempic, Wegovy, and other diabetes and weight loss drugs is affecting hospital operations in a roundabout way. 

High demand has pushed some of these medications into monthslong shortages. Inpatient pharmacies aren't much affected by the surge of prescriptions, but hospital pharmacists and pharmacy technicians are dealing with these drugs daily. This work ranges from managing patients' regimens and collaborating with endocrinology teams to handling insurance complications and monitoring perioperative risks. 

At Louisville, Ky.-based Baptist Health System, Chief Pharmacy Officer Nilesh Desai and System Director of Ambulatory and Specialty Care Leslie Hurst, PharmD, make the formulary decisions for Baptist's employer-sponsored plan — and they're focused on the long-term use of these drugs and how that can increase expenses.

"It's become a huge concern for these insurance plans because they're paying out a very large cost for these medications," Eric Tichy, PharmD, outgoing chair of the End Drug Shortages Alliance, told Becker's. "There are so many people who could be eligible for it that it's straining health plan budgets."

Besides weight loss and diabetes, this drug class is on track for new indications in cardiovascular care. Payers and health systems' employer-sponsored plans are already shrinking coverage for these drugs with weight loss uses, but if the FDA approves the new indication, insurance plans will be facing higher costs. 

Plus, Ozempic and Mounjaro just became more expensive, costing about $1,000 for a month's supply. 

"I think the biggest side effect of these drugs is sticker shock," Dr. Tichy said, adding that he thinks semaglutide — Ozempic and Wegovy's active pharmaceutical ingredient — might overtake Humira's yearslong status as the nation's top selling drug. "For a lot of insurance plans, it's become the No. 1 expense they have, especially if they cover weight loss — and everyone wants to use it."

Dr. Hurst at Baptist said her team is also constantly evaluating utilization management criteria as insurance plans become stingier with coverage.

"Often we'll see patients who [could previously] get the medication, and suddenly more guardrails are in place or more requirements for the patient to enroll in a weight management program or fail their therapies before they start," she said. "It's definitely challenging to navigate with all the different payers taking different actions and all the different employer-sponsored plans having their own criteria, which rapidly changes."

For the system's formulary decisions, Mr. Desai and Dr. Hurst said they're developing a "max out strategy" amid the lack of long-term return-on-investment data. 

Hospital systems and their pharmacy departments are also focused on patient safety concerns, specifically surrounding perioperative care, according to Brandon McLain, PharmD, system director of pharmacy operations at Baptist Health. 

In June, the American Society of Anesthesiologists recommended patients skip their last dose of these drugs before surgeries because of a risk of regurgitation and aspiration during the operation. Most hospitals are closely following the guidance, which requires new workflows. At Baptist, this means reminding clinicians through its EHR system to instruct their patients to skip a dose before a surgery. 

With this web of considerations for hospital pharmacy operations, "We'll have to keep a good finger on the pulse on this class of medications," Mr. Desai said.

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