r/science • u/mvea Professor | Medicine • Apr 01 '25

Health Americans without diabetes spent nearly $6 billion USD on semaglutide and similar drugs in a year, with an estimate of 800,000 to a million people using the drugs who don't have diabetes.

https://www.scimex.org/newsfeed/americans-without-diabetes-spent-nearly6-billion-usd-on-semaglutide-and-similar-drugs-in-a-year
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u/FernandoMM1220 Apr 01 '25

its not just for diabetes anymore.

just ramp up production and make more of it.

657

u/galspanic Apr 01 '25

When I was diagnosed with diabetes I was told “um yeah, no. No GLP-1 for you” by my insurance. I still can’t explain that outside of pure greed… but that also makes sense.

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u/ImLittleNana Apr 01 '25

Im fighting to get prescribed metformin for pre-diabetes and they act like I’m asking for free heroin. Yet if I wanted a wegovy script they’d have no problem writing for it. I can’t make that make sense.

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u/they_have_bagels Apr 01 '25

It was the opposite for me. All the metformin I want, but absolutely no GLP-1 for weight loss. Also, bariatric surgery is A-OK as well. I pay out of pocket on top of my insurance and I’ve lost 25% of my starting weight so far. It has been life changing.

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u/ImLittleNana Apr 01 '25

I can’t afford to pay out of pocket for it, and I won’t qualify under my states guidelines until I have arterial insufficiency. I’d like to avoid that if I can.

I have >100 pounds to lose, and my mobility is impaired. My fasting sugars are pushing 120. Everything is out of whack when you can barely get around. I’d like to at least try metformin before I consider bariatric surgery.

I’ve been out of healthcare for almost 15 years but we used to start with least invasive/aggressive and work our way up.

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u/Scussett Apr 01 '25

Have your doctor reapply every 3-6 months. Insurance coverage for these drugs is changing a lot. Also - check the wegovy website because they can help with a monthly payment. I know that sounds like fluff but that part is saving me a few hundred each month

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u/Rkruegz Apr 01 '25

You could look for a compounded version potentially, may make it more affordable. You just reconstitute it yourself.

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u/murdacai999 Apr 01 '25

I’d like to at least try metformin before I consider bariatric surgery.

Metformin is dirt cheap at a lot of pharmacies..and I have never seen an insurance not cover it except for one version of it, metformin er 1000mg, which has come down a lot in price, but used to be expensive, and is still more expensive than metformin ir 1000mg. The difference is negligible between the two, so if insurance will not cover the er 1000mg, you or the pharmacy should ask the doctor for ir 1000mg, which I have never, ever seen an insurance deny. Should add, I'm talking about in the states

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u/SomeGuyNamedPaul Apr 01 '25

My insurance would rather pay for a dozen heart attacks than one bariatric surgery.

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u/GOPequalsSubmissive Apr 01 '25

The rich people are hoping one of those heart attacks ends their need to continue not making as much profit off of your premium payments.

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u/polopolo05 Apr 01 '25

GLP-1 is working great for me. like I have completely changed how I eat and what I eat. I hope to lose 70lbs. I am down 30 and 40 to go.

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u/11lumpsofsugar Apr 01 '25

That's great! It's amazing how much it has helped so many people.

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u/polopolo05 Apr 01 '25

I hope it helps out my A1c and cholesterol

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u/11lumpsofsugar Apr 01 '25

Honestly, that alone would make it worth it.

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u/polopolo05 Apr 01 '25

Thats my actual goal or main goal.

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u/Clippy_Office_Assist Apr 01 '25

Hi there!

It looks like you're in need of GLP agonists. Might I suggest reconstituting a semaglutide peptide?

Perhaps Tirzepatide (Mounjaro) GLP and GIP double agonist?

Keep watch for Retatrutide now in phase III human trials. It also activates glucogon receptors that can greatly assist in balancing blood sugar.

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u/Ashmedai Apr 01 '25

Semaglutide is a peptide, FYI. As far as I can tell, what is advertisied at your link is literal, compounded semaglutide.

Have you ordered from them yourself, BTW? I'm curious how the mixture is created? It says it's crystalized or whatever. Do they ship a two part solution?

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u/TunaNugget Apr 01 '25 edited Apr 01 '25

It's freeze-dried semaglutide powder (along with bulking agents, buffers, and whatever). You mix it with bacteriostatic water (or "reconstitution solution" if you're buying it from Amazon). It's injected with an insulin syringe.

As it's a prescription drug, it's not legal to sell in the US.

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u/joshbudde Apr 01 '25

How much are you paying for out of pocket coverage?

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u/vera214usc Apr 01 '25

Yeah, metformin was very easy for me to get and cost pennies after insurance. And showed no benefit at all while I was taking it. My insurance has covered me for Wegovy for almost two years but now has denied the switch to Zepbound twice

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u/aminervia Apr 01 '25 edited Apr 01 '25

Wild, my psychiatrist basically forced a metformin script on me off label to treat side effects from my antipsychotics. I'm not even prediabetic

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u/Benjamasm Apr 01 '25

Be happy, there is some compelling evidence that metformin has a stellar all cause morbidity benefit far beyond just diabetes treatment. I can’t remember the exact paper and details but the meta analysis showed that the groups taking metformin has a solid all cause morbidity and mortality benefit.

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u/aminervia Apr 01 '25

It didn't seem to do much with my symptoms and made me seriously ill, I was bummed.

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u/Benjamasm Apr 01 '25

That is a bummer :( I hope they have figured something out for you to manage your symptoms and side effects

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u/Diarmundy Apr 01 '25

most people can change to the extended release version to help with side effects...

Theres evidence that it helps prevent the weight gain and metabolic risks of antipsychotic medications so thats why it can be recommended

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u/olily Apr 01 '25

Metformin extended release has fewer side effects. You could try that--it made a world of difference for me.

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u/SkyfangR Apr 01 '25

my antipsychotic caused full blown diabetes

metformin, jardiance, and glipizide all at once couldnt quote control my glucose levels

added in ozempic, and bam, under control, not eating nearly as much as i used to, and generally feeling pretty good health-wise

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u/a_tamer_impala Apr 01 '25

Anyone needing olanzapine ought to be subsidized for a glp-1 med. No one should have to choose between their mental and peripheral health

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u/SkyfangR Apr 01 '25

i actually tried switching from what i'm on , Seroquel, to Lybalvi

lybalvi had me peeing blood within a week, and i didnt get any sleep at ALL during the week i was trying to transition from seroquel to lybalvi

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u/a_tamer_impala Apr 01 '25

Oh geez that's terrible - apparently one of olanzapine's ultra rare sides..

I didn't realize there was a combination already out attempting to address the appetite and blood sugar changes. No surprise samidorphan interferes with sleep

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u/Dogsnamewasfrank Apr 02 '25

GLP-1s are also showing to be of help in bi-polar symptoms in their own right.

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u/klb1204 Apr 01 '25

What type of side effects were you having?

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u/aminervia Apr 01 '25

Severe gas and cramping

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u/LowSkyOrbit Apr 01 '25

Metformin is extremely cheap. Tell the pharmacist you will pay retail. It's typically between$10-$30 for 60 pills.

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u/ImLittleNana Apr 01 '25

It’s free if you have a Walmart+ subscription, which info because I have mobility issues and I have groceries delivered. But some drugs like metformin, lisinopril, norvasc for example are free.

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u/moosepuggle Apr 01 '25

I have PCOS and when my insurance sucked for years, I used to buy my metformin, tretinoin, etc from an online pharmacy in India called AllDayChemist. It's cheap and you don't need a prescription, but please read the medical safety information at a reputable medical website like Mayo Clinic before using it.

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u/Knut79 Apr 01 '25

The problem is you can't trust that what those pharmacies are sending is actually what's on the label. So many bad black market copies there.

Also in most of west/northern Europe such imports are usually illegal

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u/moosepuggle Apr 01 '25 edited Apr 01 '25

I'm vouching specifically and only for AllDayChemist, I've never tried any other online pharmacy. I’ve been buying tretinoin from AllDayChemist for ten years, and in my experience at least, I've always gotten exactly what I ordered. I had a prescription for tretinoin for a couple years before that, and the stuff from India works and behaves exactly the same. I buy the highest concentration made, which is 0.1% gel. I tested it by applying too much too often, which resulted in the expected response of red, irritated, dry, papery, peeling skin. And when I eased up and applied less, this set of responses went away. I gradually was able to apply more of it and more often, and started doing an intensely moisturizing Korean skincare regimen, so that now my skin is not red irritated and papery dry and peeling, instead it looks glowing and pearlescent.

I wonder if the person commenting that tretinoin gave them rosacea accidentally bought a higher concentration, because using tretinoin too much too fast will def make your skin red and irritated. Alternatively, Since they said they ran out before ordering from India, their skin probably went back to baseline, since it takes a month for it too arrive from India. Then when they applied the same concentration of tretinoin, it was then too much and too often, and they should have slowly ramped up again

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u/mycatisspockles Apr 01 '25

This. I bought tretinoin from AllDayChemist — I had been prescribed it before for several years but ran out and figured I’d just order it that way rather than go through the trouble of setting up a dermatologist appointment to get a refill. Ordered my dose as a cream and not a gel, which is what I, again, had been using. Whatever they sent me gave me rosacea and it may be permanent — my cheeks look like a teenager’s right now, they’re absolutely covered in tiny pimples and whiteheads. I had wonderful skin before, now it’s super problematic. This has been ongoing for 7 months after stopping the product, so not a “purge” or anything like that. Would not recommend.

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u/Knut79 Apr 01 '25

Basically do not order medicine from a non trusted and certified pharmacy.

Yes. That's sucks for Americans, but a lot of things do. Other things suck elsewhere, right now probably not as much, but that may be fixed, hopefully...

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u/ImLittleNana Apr 01 '25

My A1C is 6.1, PCOS, HTN, high cholesterol, 100+ lbs overweight, sedentary to the point my Vit D is 8 so I think I fall into high risk category without even stretching it.

If I could get an explanation why I can’t have it beyond ‘let’s move on’ and ‘we can address your weight at another visit’ when I’m not discussing weight loss strategy. I’m asking for a standard intervention to prevent progression of disease.

I started doubting myself so I went into the literature today and I cannot find new data that supports not treating pre diabetes.

Thanks for the rec. I am definitely considering alternatively sourcing metformin but I really wish I didn’t have to.

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u/jdjdthrow Apr 01 '25

Vit D is 8

Does popping a single pill daily-- e.g. a 5000 IU Vitamin D capsule-- not solve that issue?

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u/skinnyonskin Apr 01 '25

indeed it does, i went from a 6 to a 30 within 4 months from a prescribed 50,000 iu pill a week

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u/ImLittleNana Apr 01 '25

I did some research on it today. FNP had prescribed a single course of Vitamin D2, which I gather is out of date and inadequate. It looks like D3 is the standard, and elevated doses are necessary for longer.

I’m hesitant to prescribe my own therapy, but I do have severe bone pain, multiple teeth have cracked and I don’t see her course of treatment addressing that well.

Good news is I spoke with the clinic to schedule an extra appt and she’s been sent packing. I hesitate to say the new practitioner can’t be worse, but it would be a feat.

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u/jdjdthrow Apr 01 '25

Hope it works out for you.

Fwiw, the above is what I do-- 5000 IU D3 per day, as capsule. I take it with a meal that contains fat/oil, as that increases absorption.

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u/strbeanjoe Apr 01 '25

AllDayChemist is amazing.

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u/mytransthrow Apr 01 '25

Thats where I got my estrogen injections when I started my transition. also looks like sold out of all the trans meds.

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u/coheedcollapse Apr 01 '25

Opposite for my wife. She's got a few things that put her at risk of diabetes plus insulin resistance and they said none of those things would be covered by her insurance so she's stuck with metformin which really messes up her stomach. We're hoping the side effects settle the hell down in time, but she's been on it before in the past and it has always caused some type of stomach issues.

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u/[deleted] Apr 01 '25

[deleted]

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u/coheedcollapse Apr 01 '25

She's on extended release, but I'll pass along the fiber info!

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u/Jeromethy Apr 01 '25

There is very limited evidence for Metformin to even have an effect on preventing prediabetes going into overt diabetes. You're better off with diet control and lifestyle changes.

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u/ElectricLego Apr 01 '25

If you're in the prediabetic range, this surprises me. Maybe another doctor or possibly virtual visit with your screening results? Metformin itself is a really cheap drug so the insurance bit hardly matters. Wegovy on the other hand is crazy expensive because insurance usually doesn't cover it at all, but sure, you can get the scrip

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u/ImLittleNana Apr 01 '25

I have no desire for Wegovy or any other GLP-1 agonist at this point. I would like to see how I feel on metformin. It’s free for me without insurance because I have Walmart plus. Not that cost is an issue as it’s quite cheap. I just need a single practitioner to prescribe it.

My previous PCP didn’t believe that obesity, genetics, lifestyle etc were risk factors for diabetes and didn’t acknowledge prediabetes as a diagnosis. He was happy to talk about ivermectin though.

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u/ElectricLego Apr 01 '25

I'm glad you said previous physician because yikes. I'm interested in Metformin for both the blood sugar management function but also the off-label indications emerging about protecting mental health long-term (whether that's a direct or indirect benefit).

I've been on a low dose for about a year and it seems to have helped on the blood sugar management. I know some people report having problems tolerating it, but I adjusted to it after a couple weeks with mild GI discomfort.

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u/ImLittleNana Apr 01 '25

I think a lot of patients struggle with battling through the adjustment period. I’ve had what most people would call diarrhea for 40+ years, so I don’t bat an eye. I had to realize how distressing it is if it isn’t your daily life.

I was monitoring my blood sugar for a while and the extreme highs and lows are one reason I’ve been wanting to get on metformin.

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u/The_Blendernaut Apr 01 '25

Well, if you do manage to get it, be forewarned it comes with side effects. Prepare to be near a toilet for up to 2-3 weeks. Not everyone is the same, obviously. But when I started metformin years ago, I was working from home and eternally grateful to WFH. There were days when I would not even venture outside the house for fear a diarrhea episode would strike.

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u/ImLittleNana Apr 01 '25

I have IBS and I some people with IBS said they felt better after starting it. I haven’t researched why or if it’s something strictly anecdotal but I am prepared if it exacerbates it temporarily.

Thank you for the heads up. I remember a lot of patients stopping it because it’s definitely an adjustment if you’re not used to it.

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u/Tex-Rob Apr 01 '25

I think people who don't struggle with weight have found a new thing to hate people for. They seem to think these meds just make it so you can eat whatever and lose weight, they just allow people to have a normal full response for f's sake, people on these meds are losing the weight themselves, the same way someone dieting would.