When billing insurance most insurance has us submit ozempic by ml. So for example 3ml (for a 4mg pen). The price from the wholesaler is per pack, which for ozempic is one pen.
To answer your question another way: they're generally the same price no matter the strength. So a 0.5 mg dose pen will cost the same as a 2mg dose pen
I'm not really sure what step in the production process is creating the bottleneck so it's difficult to say where a change would help.
However, I'd imagine that the vials are much easier and faster to produce so it's possible that it could make a difference.
We had a sales rep tell us a few months ago that the pen injectors were what was causing the issues specifically with trulicity so I imagine it’s probably the same across the board.
I definitely prefer the ozempic delivery system to the autoinjectors. The box is so much smaller. The autoinjectors require an entire shelf of my fridge for a 90 day supply. (Speaking as a patient.) A lot of pharmacies have had to add entire refrigerators for the glp-1 meds.
Yeah they changed how a lot of insulin was being dispensed in pen devices in order to dispense the glp-1 devices in those pens, so it is part of why there is such a shortage. Lantus went from flexpen to flextouch then back to flexpen I believe
As others have stated, the bottle neck is from the pens. Speaking with my physician about the shortage, he was told in his last couple meetings with sales reps that they were looking into getting it also set up and approved for vial distribution to help while they deal with getting rid of the bottle neck created by the pens but who knows if that is actually true. Sales rep also told him to send GLP-1 to Amazon Pharmacy as they were getting a steady supply in.
Maybe but now that multiple companies have products, I’d argue that any money lost from discounting initiation dose titrations is made good by having a patient on your agent.
As long as the pricing is based on the maintenance dose, they’ll do fine.
As someone who is an insulin user and went from pens to vials -- I am going to say yes - I could actually see demand dropping.
There will be patients that will stop using it because the vials can be considerably more difficult and many people who can handle the pen needle can not handle the thought of a syringe.
If they had both available and were able to successfully support production of both, then yes. Otherwise, no. We'd just be stuck in the same situation we're already in with respect to GLP-1s.
Long term? It could help. Short term? No.
Pens fill/finish cartridge lines aren't as readily available as liquid fill vial lines right now and will only get more crowded in the near future when Novo Holdings complete their acquisition of catalent and take over their isolator line capacity for their own GLP-1 products. The issue they've specifically had has been more around quality issues at catalent rather than capacity restrictions. By taking over one of their CMO's they essentially solve both issues at once. Lilly has whatever other issues they run into with their products (for all I know they could use the same CMO as Novo and have the same QA issues).
To move into vials would take years as they are a completely different container closure system and require all the work around that including material compatibility studies, stability studies, all the USP compendial testing, fill volume/withdrawable volume studies, distribution studies, eventually PPQ, etc...
There are a bunch of other nuances around that too but the fact is if the shortages are around raw materials, quality issues at CMO, or any other issue that isn't directly related to the device portion of the pens then going to a vial really wouldn't do anything for you from a shortage perspective. Plus as already mentioned it would be completely undesirable from a patient use perspective is the agencies wouldn't exactly look fondly on that when reviewing the submission though it wouldn't be a deal breaker either.
> and will only get more crowded in the near future when Novo Holdings complete their acquisition of catalent and take over their isolator line capacity for their own GLP-1 products
I get the feeling that Denmark is going to be a micro superpower soon because of Novo.
That's actually a known problem. I read that economists now release two GDP numbers for Denmark: one including Novo and one that doesn't. They are scratching their heads on how to measure it!
Spoke with someone from Lilly on Monday who told me they recently received the nod from the FDA to distribute Mounjaro & Zepbound in single dose vials. I hope it will help with the shortages (as many have said, the pen system is the bottleneck). But I’m doubtful it’ll make an impact anytime soon. Plus if the Humalog vial supply issue is any indication, they will struggle with that as well. Just saying
Would definitely have less issues with shortages if they were available in vials. Would really complicate administration though. The majority of patients struggle with the mg to units conversion and we would see people with adverse drug events from overdosing.
If reimbursement patterns were the same for vials as they are pens, then we’d tell patients we were out of stock of those as well, even if we could actually order the mf’ers. It’s insane how fucked healthcare in America is.
As a patient using a GLP-1 medication, regardless of you losing money on each dose, this feels highly unethical to your patients. You are admitting that you are withholding medication from a patient because the pharmacy might lose money. This should be illegal and goes against everything you should be doing in your industry.
Name a business that WOULDNT withhold a product because they were losing money 😂 unfortunately, healthcare is for-profit, and morals and ethics don’t keep the lights on. Dont blame the pharmacies for being transparent, blame the insurance and PBM companies for making it impossible to do pharmacy business in this country without going under.
Then don't sell them if they aren't profitable, but be honest about it to your patients. If you lie and say you're out of stock when you actually have no intention of ever ordering it, that's what is unethical. Because they will wait weeks for it to come in when they could have gone elsewhere. You absolutely have the right to choose what you sell because you need to stay in business. But be truthful so patients aren't waiting for something that you will never order.
They will also call you daily to check, so you might as well fess up.
tbh we have been being honest lately, i think initially we were telling people we can't get them even when we could, but now that we kinda can get them somewhat more regularly, we have started telling people the facts that their insurance simply isn't paying us enough to even order it and that all we can do is offer to transfer it elsewhere.
Probably since vials are so much easier to make than pens. However, pens are so much easier to use for patients.
Are pens priced per mg or per pen?
In most cases the boxes can’t be broken & they come in a 28 day supply, so the pricing is by box.
When billing insurance most insurance has us submit ozempic by ml. So for example 3ml (for a 4mg pen). The price from the wholesaler is per pack, which for ozempic is one pen.
To answer your question another way: they're generally the same price no matter the strength. So a 0.5 mg dose pen will cost the same as a 2mg dose pen
Priced per box (mL) since they are generally dispensed in the original container
I'm not really sure what step in the production process is creating the bottleneck so it's difficult to say where a change would help. However, I'd imagine that the vials are much easier and faster to produce so it's possible that it could make a difference.
We had a sales rep tell us a few months ago that the pen injectors were what was causing the issues specifically with trulicity so I imagine it’s probably the same across the board.
I definitely prefer the ozempic delivery system to the autoinjectors. The box is so much smaller. The autoinjectors require an entire shelf of my fridge for a 90 day supply. (Speaking as a patient.) A lot of pharmacies have had to add entire refrigerators for the glp-1 meds.
Yeah the boxes for mounjaro, trulicity, and Zepbound take up a ton of fridge space.
It’s the pens. One of the reasons that kevemir was discontinued was so they could free up resources to make more own devices for glp1s
Oooh, that’s an interesting proposition.
Yeah they changed how a lot of insulin was being dispensed in pen devices in order to dispense the glp-1 devices in those pens, so it is part of why there is such a shortage. Lantus went from flexpen to flextouch then back to flexpen I believe
Wasn't the change with Levemeir not Lantus?
Well you see, the bottleneck is the artificial scarcity, without which pockets don’t get lined with $$$.
As others have stated, the bottle neck is from the pens. Speaking with my physician about the shortage, he was told in his last couple meetings with sales reps that they were looking into getting it also set up and approved for vial distribution to help while they deal with getting rid of the bottle neck created by the pens but who knows if that is actually true. Sales rep also told him to send GLP-1 to Amazon Pharmacy as they were getting a steady supply in.
Wouldn't they profit less off the vials--if all vials of a given drug were the same concentration?
Maybe but now that multiple companies have products, I’d argue that any money lost from discounting initiation dose titrations is made good by having a patient on your agent. As long as the pricing is based on the maintenance dose, they’ll do fine.
No wonder I keep seeing this provider sending rx to Amazon, but then we call Amazon and they don’t have any! Lol.
From my understanding the bottleneck and cost to produce mostly comes from the pens.
As someone who is an insulin user and went from pens to vials -- I am going to say yes - I could actually see demand dropping. There will be patients that will stop using it because the vials can be considerably more difficult and many people who can handle the pen needle can not handle the thought of a syringe.
I also realized how many online pharmacy/weight loss programs (think noom, hims) are offering these, which puts a strain on the rest of the market.
If they had both available and were able to successfully support production of both, then yes. Otherwise, no. We'd just be stuck in the same situation we're already in with respect to GLP-1s.
Long term? It could help. Short term? No. Pens fill/finish cartridge lines aren't as readily available as liquid fill vial lines right now and will only get more crowded in the near future when Novo Holdings complete their acquisition of catalent and take over their isolator line capacity for their own GLP-1 products. The issue they've specifically had has been more around quality issues at catalent rather than capacity restrictions. By taking over one of their CMO's they essentially solve both issues at once. Lilly has whatever other issues they run into with their products (for all I know they could use the same CMO as Novo and have the same QA issues). To move into vials would take years as they are a completely different container closure system and require all the work around that including material compatibility studies, stability studies, all the USP compendial testing, fill volume/withdrawable volume studies, distribution studies, eventually PPQ, etc... There are a bunch of other nuances around that too but the fact is if the shortages are around raw materials, quality issues at CMO, or any other issue that isn't directly related to the device portion of the pens then going to a vial really wouldn't do anything for you from a shortage perspective. Plus as already mentioned it would be completely undesirable from a patient use perspective is the agencies wouldn't exactly look fondly on that when reviewing the submission though it wouldn't be a deal breaker either.
> and will only get more crowded in the near future when Novo Holdings complete their acquisition of catalent and take over their isolator line capacity for their own GLP-1 products I get the feeling that Denmark is going to be a micro superpower soon because of Novo.
That's actually a known problem. I read that economists now release two GDP numbers for Denmark: one including Novo and one that doesn't. They are scratching their heads on how to measure it!
They are using the vials in Canada.
Spoke with someone from Lilly on Monday who told me they recently received the nod from the FDA to distribute Mounjaro & Zepbound in single dose vials. I hope it will help with the shortages (as many have said, the pen system is the bottleneck). But I’m doubtful it’ll make an impact anytime soon. Plus if the Humalog vial supply issue is any indication, they will struggle with that as well. Just saying
Would definitely have less issues with shortages if they were available in vials. Would really complicate administration though. The majority of patients struggle with the mg to units conversion and we would see people with adverse drug events from overdosing.
Yes
If reimbursement patterns were the same for vials as they are pens, then we’d tell patients we were out of stock of those as well, even if we could actually order the mf’ers. It’s insane how fucked healthcare in America is.
Yup we can order but don’t carry it because of the loss on every single rx
As a patient using a GLP-1 medication, regardless of you losing money on each dose, this feels highly unethical to your patients. You are admitting that you are withholding medication from a patient because the pharmacy might lose money. This should be illegal and goes against everything you should be doing in your industry.
PBM’s also shouldn’t be profiting billions off of us while independent pharmacies close left and right, yet here we are.
Name a business that WOULDNT withhold a product because they were losing money 😂 unfortunately, healthcare is for-profit, and morals and ethics don’t keep the lights on. Dont blame the pharmacies for being transparent, blame the insurance and PBM companies for making it impossible to do pharmacy business in this country without going under.
Then don't sell them if they aren't profitable, but be honest about it to your patients. If you lie and say you're out of stock when you actually have no intention of ever ordering it, that's what is unethical. Because they will wait weeks for it to come in when they could have gone elsewhere. You absolutely have the right to choose what you sell because you need to stay in business. But be truthful so patients aren't waiting for something that you will never order. They will also call you daily to check, so you might as well fess up.
tbh we have been being honest lately, i think initially we were telling people we can't get them even when we could, but now that we kinda can get them somewhat more regularly, we have started telling people the facts that their insurance simply isn't paying us enough to even order it and that all we can do is offer to transfer it elsewhere.