For now, Medicare does not cover drugs prescribed specifically for weight loss, but it will cover GLP-1 class drugs if they’re prescribed for other conditions, such as Type 2 diabetes. Wegovy, for example, is covered if it is prescribed to reduce the risk of heart attack and stroke in adults with either obesity or overweight. But, in November, the Biden administration proposed reinterpreting Medicare prescription-coverage rules to allow for coverage of “anti-obesity medications.”
Such a move is reportedly part of the argument Lilly’s CEO plans to bring to the Trump administration. Rather than using drug price negotiations to reduce health care costs, Ricks aims to play up the potential to reduce long-term health care costs by improving people’s overall health with coverage of GLP-1 drugs now. This argument would presumably be targeted at Mehmet Oz, the TV presenter and heart surgeon Trump has tapped to run the Centers for Medicare and Medicaid Services.
“My argument to Mehmet Oz is that if you want to protect Medicare costs in 10 years, have [the Affordable Care Act] and Medicare plans list these drugs now,” Ricks said to Bloomberg. “We know so much about how much cost savings there will be downstream in heart disease and other conditions.”
An October report from the Congressional Budget Office strongly disputed that claim, however. The CBO estimated that the direct cost of Medicare coverage for anti-obesity drugs between 2026 and 2034 would be nearly $39 billion, while the savings from improved health would total just a little over $3 billion, for a net cost to US taxpayers of about $35.5 billion.
Buying counterfeit weight loss drugs from illegal online pharmacies that don’t require prescriptions is, in fact, a very bad idea, according to a study published Friday in JAMA Network Open.
The counterfeit drugs are sold as equivalents to the blockbuster semaglutide drugs, Ozempic and Wegovy, which are prescription only. When researchers got their hands on three illegal versions, they found that the counterfeit drugs had low-purity semaglutide, had dosages that exceeded the labeled amount, and one had signs of bacterial contamination.
The three substandard drugs tested came from three different illegal online pharmacies, which sold them as generic semaglutide drugs for weight loss, appetite suppression, diabetes, and cardiovascular health. However, the researchers, led by scientists at the University of California, San Diego, and the University of Pécs in Hungary, had initially tried purchasing counterfeit drugs from six such sellers.
Three of the illegal pharmacies, which specifically sold Ozempic knockoffs, never delivered the drugs after researchers paid for them. Instead, the researchers were hit with “nondelivery” scams, in which the sellers requested additional, hefty payments, supposedly needed to get through customs. These extra fees ranged from $650 to $1,200—much more than what the researchers paid for small dosages of the counterfeit drugs, which ranged from $113 to $360 across the six sellers.
Rogue pharmacies
The Ozempic scams were run out of the rogue online pharmacies: weightcrunchshop.com, puremedsonline.com, and genius-pharmacy.com. The three pharmacies that delivered dubious drugs included semaspace.com, uschemlabs.com, and biotechpeptides.com.
Two of the sellers—semaspace.com and uschemlabs.com—have already received warning letters from the Food and Drug Administration for selling unapproved, misbranded drugs. At the time of publication, the Semaspace website was no longer reachable. The US Chem Labs site was still available, but their semaglutide vials were all listed as out of stock.
The study’s findings, while unsurprising, highlight the risk people may take in efforts to get hold of the popular drugs. Steep prices, lack of insurance coverage, and drug shortages have kept the drugs out of reach for many who could benefit from them. Compounding pharmacies have stepped in to make copycat versions. While these are legal and can come from legitimate pharmacies—ones that are properly registered and require prescriptions—they also carry risks. Compounded drugs are not approved by the FDA and may pose safety and efficacy risks. Last week, the FDA warned of increasing reports of people overdosing on semaglutide products made in compounding pharmacies, leading some patients to be hospitalized.
Enlarge/ Lars Fruergaard Jorgensen, chief executive officer Novo Nordisk A/S, during an interview at the company’s headquarters in Bagsvaerd, Denmark, on Monday, June 12, 2023.
After some persuasion from Sen. Bernie Sanders (I-Vt.), the CEO of Novo Nordisk will testify before lawmakers later this year on the “outrageously high cost” of the company’s diabetes and weight-loss drugs—Ozempic and Wegovy—in the US.
CEO Lars Jørgensen will appear before the Senate Committee on Health, Education, Labor, and Pensions (HELP), which is chaired by Sanders, in early September. The agreement came after a conversation with Sanders in which the CEO reportedly “reconsidered his position” and agreed to testify voluntarily. As such, Sanders has canceled a vote scheduled for June 18 on whether to subpoena Novo Nordisk to discuss its US prices, which are considerably higher than those of other countries.
The independent lawmaker has been working for months to pressure Novo Nordisk into lowering its prices and appearing before the committee. In April, Sanders sent Jørgensen a letter announcing an investigation into the prices and included a lengthy set of information requests. In May, the committee’s investigation released a report suggesting that Novo Nordisk’s current pricing threatens to “bankrupt our entire health care system.”
Sanders has repeatedly hammered not only the high prices of Novo Nordisk’s two blockbuster drugs but also the huge disparity between US prices and those in other countries.
Up to 15x more in the US
“Novo Nordisk currently charges Americans with type 2 diabetes $969 a month for Ozempic, while this same exact drug can be purchased for just $155 in Canada and just $59 in Germany,” Sanders wrote in April. “Novo Nordisk also charges Americans with obesity $1,349 a month for Wegovy, while this same exact product can be purchased for just $140 in Germany and $92 in the United Kingdom.”
Yale researchers, meanwhile, published a study in JAMA in March estimating that both drugs could be manufactured for less than $5.
In May, Novo Nordisk responded with a letter to Sanders, arguing that blame for high prices in the US lies with the country’s complex health system and with middle managers who take cuts, according to Bloomberg. Novo Nordisk said in the letter that it is prepared to address “systemic issues so that everyone who can benefit from its medicines is able to get them,” the outlet reported. The company also said it has spent over $10 billion on research and development to bring Wegovy and Ozempic to the market.
Still, that number is small in comparison to the projected revenue from the drugs. Bloomberg noted that analysts estimate that Novo Nordisk will make $27 billion from the two drugs this year alone. The May analysis by the HELP committee found that if just half of the adults in the US with obesity start taking a new weight-loss drug, such as Wegovy, the collective cost would be around $411 billion per year. Another report by the Congressional Budget Office found that the drugs’ costs are so high that they will not be offset by any financial gains from improved health outcomes.
“The Committee looks forward to Mr. Jørgensen explaining why Americans are paying up to 10 or 15 times more for these medications than people in other countries,” Sanders said last week.
Enlarge/ Panty liners, hygienic tampons, and sanitary pads.
People in the US are starting their menstrual cycles earlier and experiencing more irregularities, both of which raise the risk of a host of health problems later in life, according to an Apple women’s health study looking at data from over 70,000 menstruating iPhone users born between 1950 and 2005.
The mean age of people’s first period fell from 12.5 years in participants born between 1950 and 1969 to 11.9 years in participants born between 2000 and 2005, with a steady decline in between, the study found. There were also notable changes in the extremes—between 1950 and 2005, the percentage of people who started their periods before age 11 rose from 8.6 percent to 15.5 percent. And the percentage of people who started their periods late (at age 16 or above) dropped from 5.5 percent to 1.7 percent.
In addition to periods shifting to earlier starting ages, menstrual cycles also appeared to become more irregular. For this, researchers looked at how quickly people settled into a regular cycle after the start of their period. Between 1950 and 2005, the percentage of people obtaining regularity within two years fell from 76.3 percent to 56 percent.
The study, published by researchers at Apple and Harvard in the journal JAMA Network Open, notes that both of these findings bode poorly for long-term health. Early starting age of menstrual cycles is linked to adverse health outcomes, including cardiovascular diseases, cancers, spontaneous abortion, and premature death, the researchers write. And a longer time to regularity is linked to fertility problems, longer menstrual cycles, and an increased risk of metabolic conditions and all-cause mortality.
Looking across race and ethnicity categories, researchers found that the trends affected all groups. However, Black and Hispanic participants had consistently earlier menstrual starting ages than white and Asian participants. Black participants also saw a larger magnitude shift toward earlier starting ages compared with white participants.
It’s unclear what’s driving the menstrual changes, but the authors speculate that there could be a multitude of factors. The most prominent potential factor is childhood obesity, which has increased in the US over the course of the study period and is known to be linked to earlier puberty. However, the authors note that obesity doesn’t explain the totality of the shifts—an exploratory analysis indicated that obesity only accounted for 46 percent of the trends seen in the study. And other studies have indicated that the shift toward earlier menstrual cycles began before the upward trend of obesity in the US.
The authors of the current study point to various potential environmental factors, including endocrine-disrupting chemicals, metals, air pollutants, dietary patterns, psychosocial stress, and adverse childhood experiences.
The study has limitations, of course, including that it relied on self-reported data and was limited to people who own iPhones, who generally skew toward higher socioeconomic status. Thus, the findings may not be generalizable to the population overall. Still, the data fits with other studies, and the researchers called for more awareness among health care practitioners and more studies to look at trends and health outcomes.
Enlarge/ Night view of company logos in Nestlé Avanca Dairy Products Plant on January 21, 2019, in Avanca, Portugal. This plant produces Cerelac, Nestum, Mokambo, Pensal, Chocapic and Estrelitas, among others.
In high-income countries, Nestlé brand baby foods have no added sugars them, in line with recommendations from major health organizations around the world and consumer pressure. But in low- and middle-income countries, Nestlé adds sugar to those same baby products, sometimes at high levels, which could lead children to prefer sugary diets and unhealthy eating habits, according to an investigation released recently by nonprofit groups.
The investigation, conducted by Public Eye and the International Baby Food Action Network (IBFAN), says the addition of added sugars to baby foods in poorer countries, against expert recommendations, creates an “unjustifiable double standard.” The groups quote Rodrigo Vianna, an epidemiologist and professor at the Department of Nutrition of the Federal University of Paraíba in Brazil, who calls added sugars in baby foods “unnecessary and highly addictive.”
“Children get used to the sweet taste and start looking for more sugary foods, starting a negative cycle that increases the risk of nutrition-based disorders in adult life,” Vianna told the organizations for their investigation. “These include obesity and other chronic non-communicable diseases, such as diabetes or high blood-pressure.”
The two groups compared the nutritional content of Nestlé’s Cerelac and Nido products, the company’s best-selling baby food brands in low- and middle-income countries that generate sales of over $2.5 billion. In a Cerelac wheat cereal product, for instance, the product contained up to 6 grams of added sugar in countries including Thailand, Ethiopia, South Africa, Pakistan, India, and Bangladesh. In the United Kingdom and Germany, the same product contained zero added sugars.
In the Philippines, where the sugar content was the highest, and in other countries—including Nigeria, Senegal, Vietnam and Pakistan—the added sugar content was not listed on Nestlé’s labeling, the investigation found.
Double standard
“There is a double standard here that can’t be justified,” Nigel Rollins, a WHO scientist, told the nonprofit groups. Rollins pointed out that the company does not add sugars to its baby products in Switzerland, where the company is headquartered. Thus, continuing to add it in low-resource settings is “problematic both from a public health and ethical perspective,” he said.
In a report last month, the WHO found that as of 2022, 37 million children under the age of 5 worldwide had overweight. Additionally, over 390 million children ages 5 to 19 had overweight and 160 million had obesity. The prevalence of overweight in children 5 to 19 rose from 8 percent in 1990 to 20 percent in 2022, the United Nations agency noted. Obesity rates in this age group, meanwhile, rose from 2 percent to 8 percent in the same timespan.
Nestlé responded to the investigation with a statement suggesting that the differences in sugar content “depend on several factors, including regulations and availability of local ingredients, which can result in offerings with lower or no-added sugars.” But it argued that these differences do not “compromise the nutritional value of our products for infants and young children.”
Nestlé is a multinational food and drink behemoth with a controversial history of selling baby products in poorer countries. In the 1970s and ’80s, the company came under heavy international fire for aggressively marketing its baby formula to impoverished mothers. Health advocates accused Nestlé of misleading mothers into thinking formula is better than breast milk for their babies, even though leading health organizations recommend exclusive breastfeeding for the first six months of life when possible.
Critics accused Nestlé of providing free formula to hospital maternity wards, causing new, low-income mothers to turn to it shortly after birth in the critical window in which breast milk production would otherwise ramp up in response to nursing a newborn. Without nursing in that time, mothers can struggle to lactate and become dependent on formula. Out of the hospital, the powdered formula is no longer free and must be mixed in proper amounts and in sanitary conditions to ensure it is safe and meeting the nutritional needs of the infant, which can be a struggle for poor families.
Nestlé now states that it follows international standards for marketing breast-milk substitutes, despite ongoing boycotts in some countries.
