What most people get wrong about GLP-1 drugs like Ozempic, Wegovy and Zepbound

About 40 million Americans are on GLP-1 medications like Ozempic, Wegovy, Zepbound and Mounjaro. There are plenty of opinions about the new class of drugs, some of which are backed up by facts or misconceptions.

Here's what most people get wrong about GLP-1s.

What are GLP-1s?

GLP-1 stands for Glucagon-like peptide-1, "which is a hormone that is made in our own body, particularly when we eat. The medications are engineered little molecules which are mimic a natural hormone," said Dr. Mihal Zilbermint, an endocrinologist at Johns Hopkins University.

One thing people get wrong about GLP-1s is that the drug's history goes back a lot further than the current decade when they entered the mainstream.

In the 1980s, Joel Habener and Svetlana Mojsov were credited with discovering the specific hormone which would lead to the creation of GLP-1s. In 1992, John Eng, who had been studying the venom of Gila monsters for years, discovered a new peptide called exendin-4 that acted like GLP-1 in the body. All of that research and more led to the FDA approving exenatide, the first GLP-1 medication, in 2005.

Most people have probably never heard of exenatide, but have heard of Ozempic, Wegovy, Zepbound and Mounjaro. But what most people don't know is that there are some differences between the drugs: What they are and what they do.

Ozempic and Wegovy are semaglutides, which means they are solely a GLP-1. Ozempic is for diabetes and Wegovy is for weight loss. Mounjaro and Zepbound are tirzepatide, which combine GLP-1 and GIPs, another gut hormone which also helps people lose weight. Mounjaro is for diabetes and Zepbound is for weight loss.

Who can get GLP-1s, and how? 

The simplest answer is to talk to a doctor and see if it's the right choice. For people with type 2 diabetes, the answer is probably going to be yes. There is a lot of research showing GLP-1s help regulate blood sugar levels and reduce bad outcomes for diabetics.

For people who are just overweight, it depends on how overweight and their health insurance plan. The FDA has approved semaglutide for weight loss for obese patients, meaning they have a body mass index of 30 or higher. But most major health insurance carriers require patients to have at least one other comorbidity, like high cholesterol or hypertension, to be covered. Each prescription is reviewed on a case-by-case basis by adjusters, so claims are often denied.

That leads a lot of people to compounding, which involves specialized pharmacies making the medication themselves, not the drug companies. Patients still need a doctor's prescription to get the drug from a compounding pharmacy, but won't have to jump through as many hoops since insurance is not footing the bill.

Another thing most people get wrong about GLP-1s is how much they cost and who is paying for them.

"They're expensive and they're in high demand. And so that's a bad combination," said Paul Pruitt, the co-founder of SharkX, a company that helps people get their hands on expensive medicines.

Why are GLP-1s so expensive?

"When it comes to the economics of medications, it's really hard to point your finger at a rational cause," Pruitt said. "The manufacturing processes aren't necessarily disclosed, so you can't look at that as a contributing factor in a meaningful way. I think oftentimes what we see in the United States, it's really what the market can bear."

Due to the popularity of these drugs, the market can bear quite a bit.

Currently, 1 in 8 adults say they are taking a GLP-1 drug, according to a poll by the Kaiser Family Foundation. That's roughly 40 million Americans.

From 2018 to 2023, spending on GLP-1s went from $13.7 billion to $71.7 billion in the U.S., a 500% increase.

So who's paying for it all? The answer is, kind of, everyone.

Obviously, people on the medication are likely paying something. The price range is all over the place, from as low as $50 a month to well over $1,000.

If the medicine is covered by insurance, the money they use to pay for their portion comes from premiums. Not just the patient's premiums, but those of coworkers or anyone else on the health plan.

That's where things get complicated.

"Once the money goes into the insurance company, it's their responsibility to manage those dollars to a certain loss ratio from premium to actual claims going out, leaving. And they're really good at hitting those exact marks," Pruitt said.

If an employer's expenses exceed their premium contributions, then premiums will go up the next year. Premiums are already up a lot. Some employers, especially local governments, are starting to consider removing GLP-1s from the list of medications they cover.

But that's just one side of the equation, since so much of the health care costs in the U.S. are tied to diabetes and obesity.

It's a major cause of disease and death in this country. It's said 40% of Americans are obese, and they tend to have higher rates of high blood pressure, more diabetes, more problems with their intestines," said Dr. David Winter, an internal medicine physician in Dallas.

The CDC says obesity costs $173 billion every year. Diabetes is even more expensive, costing $640 billion every year. If GLP-1s are effective in fighting those two, they might be worth every penny.

How do GLP-1s actually work?

"Originally, those medications have been developed primarily for people who live with type 2 diabetes, because those medications have been known to improve blood sugar. And then later on, we learned that they also have an extremely powerful effect on the appetite and the body weight," Zilbermint said.

They work in several ways at once:

• They turn off a hormone in the brain that kicks on appetite.
• They help the body release insulin from the pancreas when glucose goes high.
• They help to reduce a hormone called glucagon, which regulates blood sugar.
• They slow the movement of food through the stomach and intestines.

All of those effects lead patients to eat less and consume fewer calories, and better-regulated blood sugar for those that need it.

Just taking GLP-1s will cause some weight loss, but it might not be as much as needed or the right kind of weight. Without exercise, they can cause a loss of muscle and gain of fat.

"GLP-1s have to be part of a comprehensive approach where you have to get a nutrition, physical activity, in order to preserve the muscle," Zilbermint said. "Once you start losing some of the fat tissue, you also lose the muscle tissue as well. So in order to keep up the muscle mass, you need to start lifting at least some weight. You don't have to go to the gym, but maybe you can get some weight and start lifting at home or join some online exercise classes."

Doctors advise using GLP-1s as part of a diet and exercise plan to get healthier. That's just what the drugs were designed to do. 

What else can they do?

Researchers are just starting to scratch the surface of what GLP-1s are capable of.

Originally, GLP-1s were designed to help people with diabetes. Then they were found to help people lose weight. Now that millions of people are on them, researchers are finding out additional benefits with:

• Heart attacks
• Strokes
• Kidney failure
• Liver failure
• Some cancers
• Sleep apnea
• Dementia

"Trust me, there will be many more benefits coming out in the coming years," Zilbermint said.

The drugs do have side effects, including:

• Nausea
• Cramping
• Bloating
• Diarrhea
• Constipation

Longer term, there is not much known about the negative impacts of GLP-1s. Regardless, doctors around the country are singing their praises.

"These remind me of the statin drugs for cholesterol. When they came out, it was amazing. Heart attacks and strokes went down in this country. A huge benefit. I think these drugs are going to be similar. A huge benefit. We'll see people living longer and living healthier because of GLP-1 drugs," Winter said.