rewrite this title Patients turn to ‘gray market’ for cheaper obesity drugs, but it’s risky

Patients who want a deeper discount on obesity meds than compounding pharmacies can offer are turning to the gray market, where they buy the raw active ingredient from China and prepare it themselves.

JUANA SUMMERS, HOST:

Patients are clamoring to get their hands on obesity medications like Wegovy and Zepbound, but even with manufacturer discounts, their high prices can put them out of reach. So some patients are doing something they call going gray. NPR’s Sydney Lupkin looked into this phenomenon for an episode of Planet Money, and she has this report.

SYDNEY LUPKIN, BYLINE: When Phil started taking Ozempic in 2022, he was amazed at how well it worked. His blood work looked better. He was no longer prediabetic. He was losing weight. Ozempic is approved to treat Type 2 diabetes, but is sometimes prescribed for weight loss. But he says maybe the best part was that it also quieted his addictive tendencies.

PHIL: Literally, the bourbon in my freezer sat in my freezer for probably, I would say maybe till Christmas or something like that. And I – like, I took one drink and I was like, what are you doing?

LUPKIN: In the past, he’d had problems with prescription painkillers and alcohol. We’re not using his last name or location because he could lose his job. When Phil’s health insurance changed, however, it wouldn’t cover Ozempic for him anymore. So instead of a $25 copay, Phil would have to pay more than a thousand dollars a month.

PHIL: As thankful as I am for them to develop this – you know, I’m very thankful for that – but I think it’s disgusting that they make this drug, and – that’s life-changing, and then so many people can’t afford it.

LUPKIN: So he started looking online for other options. He found compounded versions of the drugs. They aren’t approved by the FDA, but were allowed while obesity drugs were in short supply over the last couple of years. And he found something else – the gray market. He showed me this summer.

PHIL: This is the thing it came in.

LUPKIN: Oh, just, like…

PHIL: Oh.

LUPKIN: …A box. It looks like the size of a contact…

PHIL: Yeah.

LUPKIN: …Lens box.

PHIL: Yeah.

LUPKIN: In his hands, Phil is holding 10 months’ worth of tirzepatide, the active ingredient in Zepbound, an obesity medicine made by Eli Lilly. The little carton is covered in a mix of Chinese and English words.

PHIL: Multi-effect, young skin set.

LUPKIN: What?

PHIL: Yeah.

LUPKIN: So it’s disguised?

PHIL: Yeah. It’s disguised.

LUPKIN: Inside the box, there are 10 little vials with big red caps. Each of them holds 30 milligrams of white powder. He makes his own medicine by mixing it with sterile water and then injects himself. In two years, Phil says he hasn’t had any problems, but there are huge risks, including of getting contaminated or counterfeit products. That’s according to Dr. Scott Isaacs, president of the American Association of Clinical Endocrinology.

SCOTT ISAACS: They could get an infection. They could have a reaction. They could have severe side effects from dosing errors. They could also have a lack of effect. And that’s probably the biggest thing that I’ve seen, is when patients take these, is that it does nothing.

LUPKIN: Still, he says he can empathize with patients who feel like they don’t have any other choice.

ISAACS: The bottom line is that they’re really just trying to get a medication that they need.

LUPKIN: He says it’s key to communicate with your doctor, who may be able to convince insurance to cover the drug anyway. Dr. Tony Cirillo is the president of the American College of Emergency Physicians. He says ER doctors have seen patients with complications from taking either gray market or compounded obesity medicines, but they don’t always say which.

TONY CIRILLO: Look, we – particularly in emergency department, we take care of a lot of people who have done a lot of things that maybe not was their proudest moment. Doesn’t matter to us.

LUPKIN: He says they’re there to take care of patients, and getting the full story is a big help.

CIRILLO: So these are not benign medications without proper monitoring and supervision.

LUPKIN: Cirillo says do not hesitate to go to the ER if you think you’re having an emergency.

Sydney Lupkin, NPR News.

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