HealthChangers Podcast: Pharmacy deserts and the rise of Ozempic and GLP-1 drugs
Main image (L-R): Podcast host Ashley Bach (left) and Katie Lai (right)
While prescription medications don’t always get as much attention as other aspects of health care, recent events have proven how critical pharmacy is to each person’s health care experience. Thousands of pharmacies across the U.S. have closed, creating what are known as “pharmacy deserts,” where communities no longer have access to the pharmacies they need.
And it’s been difficult to miss the headlines about the surge in popularity of the GLP-1 class of drugs, like Ozempic and Mounjaro, that many people are using in an effort to lose weight.
To launch our new season of the HealthChangers podcast, we spoke with Katie Lai, a clinical pharmacist client manager at Regence – and a pharmacist for three decades. Lai is part of the Regence pharmacy team, which helps our members achieve the best health possible from their medication treatment at an affordable cost. Podcast host Ashley Bach spoke to Lai about the impact of pharmacy closures, and the pros and cons of the GLP-1 drugs.
For coverage of any drug, Regence regularly reviews our policies based on evidence-based medical data.
Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity.
AB: You mentioned GLP-1s have been used to treat diabetes since 2005. Why are so many people now clamoring to get these medications?
KL: There are two main reasons. The first one is a Wegovy shortage, which started in late 2022. What happened is that the manufacturers of Ozempic got FDA approval to promote it as a weight loss drug. They did that under a new drug called Wegovy. And once Wegovy hit the market, the demand surpassed the supply, causing a shortage. So to get more Wegovy, social media started to promote Ozempic because it has the same active ingredient as Wegovy. So now you get the attention of the news media, Hollywood, the comedians, all of them talking about Ozempic and weight loss capability.
The second thing that really is driving the need of these drugs is that there's an increase in utilization in the diabetic sector. The American Diabetes Association updated their guidelines in 2023. And typically, they always endorse metformin, a very effective drug for diabetes that's inexpensive, weight-neutral, but very effective. This year, the ADA endorsed the GLP-1 drug class as first-line therapy for obese diabetics, therefore encouraging providers to prescribe more expensive diabetic drugs. So the reason you're seeing the clamoring is that you have these groups fighting for the limited supply of these expensive drugs. There is a high prevalence of overweight Americans without diabetes wanting to lose weight, and then you have the obese diabetic members with more prescriptions for GLP-1 drugs from their doctors.
AB: What are the downsides to these medications that people may not be thinking of?
KL: The biggest downside is going to be your wallet because these drugs are expensive--easily $1,000 to $2,000 a month. The second downside is if you're taking them, these drugs work in the stomach. So a lot of the side effects are stomach related. Severe cramping, severe stomach pain, chills, constipation, nausea, vomiting, lightheadedness. And that's why the manufacturer really encourages low titration at a lower dose to avoid these side effects.
AB: What do you think the future holds in coming years for GLP-1s?
The jury is still out on many things. One of the things is, we don't know what other modalities are needed for sustained weight loss. And we know medication alone, without lifestyle modification, is not successful. We see this in smoking cessation when it first got marketed. People thought they could just continue smoking and slap on a patch--the nicotine replacement patch--and then not do counseling, or anything else and then they may stop smoking for a brief moment and then the rebound. We found that the nicotine replacement therapy patch plus counselling is vital for success in the long run. So we don't know what other modalities are needed with these GLP-1 drugs to have sustained weight loss.
Being a pharmacist, I’m really geeked out about all these drugs. I do know there are a lot of these GLP-1 drugs in the pipeline. And that's good, because you know, more GLP-1s in that class would drive competition and lower the cost of the drugs.
AB: Shifting to our second topic, what are pharmacy deserts and why are they so important to recognize?
KL: Pharmacy deserts are communities in which residents do not have adequate access to pharmacies. If you live in an urban area, it would mean most of the population doesn’t have a pharmacy within one mile of where they live; it'd be two miles for the suburbs; and it'd be 10 miles for rural areas.
In Washington state, for example, there are about 450,000 adults who live in pharmacy deserts, both in urban and rural areas, according to a study from the University of Washington.
Pharmacy deserts are important because the World Health Organization said that geographic access to pharmacies is a key determinant of access to essential medicine and affects health outcomes. These communities with pharmacy deserts are often low income, have many people of color and are usually underserved.
Pharmacy deserts are also very important to us at Regence because it's our mission to improve the access of medications and to provide better outcomes.
AB: Are pharmacy deserts a new problem?
KL: Recent pharmacy consolidations really worsen the issue – big chains buying up independent pharmacies and then closing them to reduce competition. And then you have big chain pharmacies merging with other big chains. They close up a few so that they don’t have a surplus of stores under the same ownership. And then you get the national opioid lawsuits, which many people heard about couple of years ago, but didn't realize how they impact pharmacies. With the recent opioid lawsuits, CVS, Walgreens and Walmart were all forced to pay large settlements for their role in the opioid epidemic, leading to store closures, particularly in low-income areas.
Pharmacy deserts deeply affect underserved communities. And they directly impact medication access for these underserved communities, especially the communities that really need access to medicines and access to pharmacists. But more importantly, pharmacists are connected to the larger community, the health care community. So we're almost like representatives and ambassadors in all different locations of health care. And when you take that away, you really leave people clamoring and working harder to take care of themselves.
AB: What can be done to combat pharmacy deserts?
KL: First of all, I'm happy to say our pharmacy network at Regence is broad, because we understand that access to medicine is crucial.
Our pharmacy benefit manager (PBM) also gives us analytics to show us where our members live in pharmacy deserts, which is so vital, because with that information, we're able to have our PBM do outreach to Medicare members and talk about home delivery and filling your medications 90 to 100 days to avoid multiple trips. And really, I think the most important thing is synchronizing the refills, because every 30 days, you can get your medications. So if you have to come in six times a month to get different kinds of medication, it's really hard, especially if the drive is farther. So we try to work it so that members synchronize and get all their medications filled one time a month.
We're also planning to use the same analytics that our PBM provides, and do the same outreach for our commercial members. But in the meantime, for the commercial members, we really encourage the 90-day supply. In fact, we have lower co-pays if you do so that really incentivizes the members to fill more medications [at the same time], and fewer have to go in to get multiple refills for chronic conditions.
For some commercial groups we also have what we call, “Ask a Pharmacist”—it’s on the digital platform. So they can be home with an Internet connection and log in for their questions for pharmacists, and in 24 or 48 hours, get an answer to any of their concerns.