The Metabolic MD - CGM Doctor

How to get the same Ozempic benefits but at a lower cost.

• DR. Paul Kolodzik • Season 2 • Episode 19

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This episode we Dr. Paul Zolodzik talks in great detail about the Ozempic medication ( best practice) . How to use Ozempic OR a generic to achieve the best results at a lower cost.  We also talk about ways to step down / off  the medicine with out having weight gain.  This episode is the one to listen too if you are considering using a semaglutide medication.    

Speaker 1:

<silence> Welcome to the Metabolic MD. Health means everything. We all seek optimal health, but most of us do not know how to achieve it. Dr . Paul Kloza has spent a career in the emergency department now, he helps his patients avoid ever ending up there. During these podcasts, you'll learn how you can lose weight and prevent and reverse disease through new technology, a modified diet, and the use of some new recently approved F D A medications. This information is not meant to be medical advice. Please seek consultation from your own medical provider. Let's listen in.

Speaker 2:

Alright , everybody, welcome back to the Metabolic MD with Dr. Paul Kozik . I'm Terry O'Brien here at Tri-Level Studios, and we are gathered here today to talk about a lot of fun topics. That topic today is gonna be ozempic. We're gonna talk about that, right?

Speaker 3:

Right. And supply issues and cost issues and how people really can gain access to that medicine. So

Speaker 2:

Everything you wanted to know about Ozempic, we're gonna try to cover here in this short podcast. But before we do that, let's, let's go through a few things that are going on in the metabolic world, at least your metabolic world, right? Right. You have another , uh, seminar coming up on September 14th, right at 7:00 PM

Speaker 3:

September 14th , uh, 7:00 PM Eastern Standard Time. We're gonna do another metabolic seminar where I'm gonna go ahead and go through topics such as insulin resistance, low carb diets, intermittent fasting. I'll do that quickly in 20, 25 minutes. And then we're gonna have plenty of time for questions for this hour long seminar. I

Speaker 2:

Will tell you after that last seminar, we had a great turnout. We had about 50 people. Um, and every single one of those people just hung in there the whole time. No drop offs. It was amazing. Yeah. Um, and I think they all got a lot out of it. So, so I think if you're interested in learning more, asking questions to Dr. Paul about what he can do or you can do to help lose weight or become more healthier , uh, please join us September 14th at 7:00 PM and you can find information about that at metabolic MDs s metabolic mdss.com. And we will also be sending out some emails and things like that. Yeah.

Speaker 3:

Registration required. So go to the website and please register. No cost.

Speaker 2:

And another thing, I just , I was just out there looking at the Facebook No , the Google ads, right. And we, you just kind of hit a milestone, didn't you? You have 55 star reviews. Every single one of 'em is a five star review. Yeah.

Speaker 3:

I'm very proud of this. Five star reviews. 100%, five star reviews . So I don't know how you get, you know, 50 people to agree on every, on anything. You can't, but, yeah. But , um, we did. And that's that , uh, you know, our patients have been very supportive of our practice, feel that we're providing a good service. So again , uh, I take care of patients in Ohio, Indiana, Florida, and Arizona. Right. Lots of information on the Metabolic MDs website. But it's satisfying to me as a clinician that people think we're doing a good job and having success with their weight loss and metabolic health improvement.

Speaker 2:

I think it's fantastic. So, again, not everybody knows if you're online, the odds are you actually filling out a review form is low. So to get 50 Right. And you haven't been doing this that long. This is a tremendous milestone. Yeah. Yeah.

Speaker 3:

Well , I'm very happy with that result. And it's just, it's encouragement and positive feedback that we're doing the right thing.

Speaker 2:

All right . So let's get into the topic of the day . Ozempic, the expense, the supply, the dosing, all that kind of stuff. So where do you wanna start this conversation? Well,

Speaker 3:

Let's, let's go ahead and just do a little review about what these medicines are. Okay . What formulations they come in. And then we'll talk about the big issues right now, which is the supply chain issues associated with this medication and the cost for patients and the lack of insurance coverage in most situations. All right . Um, but the history again is these medicines were developed , um, for diabetics di they were found to be effective in lowering blood sugar for diabetics. But then it was noticed that these diabetics also lost 12 to 15% of their body weight. And how

Speaker 2:

Long ago was this?

Speaker 3:

This was three to four years ago.

Speaker 2:

Okay. So it's relatively a newer drug. Yeah. Okay.

Speaker 3:

Yeah. And then the , uh, drug company that manufactures this medicine, Novo Nordisk , went back and did additional studies on non-diabetics finding that they also lost weight. And you know, the rest is kind of history in terms of the craze with these medications. Um, they work three ways. One is they slow gastric empty , which means your stomach stays full or longer. They lower blood sugar, just like we talked about. Right. And that helps people lose weight. 'cause when your blood sugar is lower, you're burning fat for energy as opposed to blood sugar. And then third one is they have a direct effect on the brain, a hypothalamic effect on the hypothalamus of the brain. And we'll get to this a little later on. And what I have found is that sometimes you can get these effects even at lower doses, which is important in terms of providing access to people for medication because the lower doses can cost less . So we'll get into that detail a little bit later on.

Speaker 2:

All right . So let's, let's go into , um, a little bit about this thing. It's , it's a weight loss medicine for the stars, right? Yeah. How did it get that name? Is it people in Hollywood found out about this? And next thing you know, it's a rage across the country,

Speaker 3:

Right? And I mean, you know, the celebrities take the medicine and they have weight loss and that gets publicized a lot. Um, the medicine comes in three formulations, ozempic, which is only for diabetics. You really can't get it approved unless you're diabetic. Wego V , which is the weight loss medicine, which is the medicine that is expensive out of pocket with limited insurance coverage, with significant supply chain issues. Now, so

Speaker 2:

Wait, let's pause on that. 'cause there's ozempic, which is for diabetics. Yes. And then they took that yellow pin , that injectable pin painted it blue, put a label in there called wavy . Right. And then they're selling it as a weight loss medicine.

Speaker 3:

Correct. And you , and you can't prescribe ozempic to non-diabetics, at least in terms of insurance coverage because it , the insurance company won't accept that the doctor has to do a prior authorization and vouch that this is a diabetic patient that needs this medication. So that really can't be done. And then with wego , ovy , there's limited insurance coverage. And of course the out-of-pocket cost is, you know, 12 to $1,400 a month. So

Speaker 2:

Let , let me poke at this real quick , uh, because again, is if the insurance companies see you lose weight, losing weight means you're probably less likely to end up in your emergency room. Right? Right. Yeah. Isn't it better for them to stop this before they end up in your emergency room?

Speaker 3:

It's very good long-term thinking, Terry .

Speaker 2:

I'm a long-term

Speaker 3:

Thinker. Okay . But y you know, insurance companies are public companies and they're worried about what next quarters earnings look like. Got it. Um, and I think that, you know, these medicines will eventually have widespread use, but the , the cost really is kind of overwhelming to start. And let me give you an example. Some , uh, self-insured large organizations, and the one I saw a recent article on was the University of Texas Health System. Um, they had coverage for wago v uh , last year, actually, I should say this year in 2022. Right. They are changing their formulary and taking Wago off their formulary, which means it will no longer have coverage. And the reason they did that is because they were spending tens of millions of dollars on this medicine during 22 and it was breaking the bank. And of course, that eventually is gonna roll down to premium costs for individuals. Sure. So, and , and I've seen this with a number of patients in my practice. They come to us for the compounded semaglutide, the generic , uh, version of Semaglutide because , um, they were previously prescribed. Wavy had some coverage for it. Um, but their plan has now changed and it's been taken off the formulary. Hmm . So this is a fairly common practice. Again, I think over a period of years , uh, the coverage will increase with these medicines. Um , but right now it's a problem for a lot of patients.

Speaker 2:

So if you had to guess if something costs $500, what's an average insurance gonna pay for that?

Speaker 3:

Um, you mean if you just guess like if the , if the pen ,

Speaker 2:

If the , if the pen costs you 500 bucks for the , the shot per the , for the month or whatever, what would insurance usually cover?

Speaker 3:

Okay, well, well, okay. The way to look , first of all, it , it costs more than that. The medicines cost . Yeah , absolutely. Yeah . 12 to $1,400. We have some patients that have had copays that have been as little as $25. Wow . And we have had some patients where their formulary says it's covered, but the copay is almost the whole $1,200 <laugh> . So there's huge variability out there. And this is why a lot of patients are going to the compounded generic form, which we provide to our patients. 'cause generally that's available at about a third, the cost that is not an F D A approved medication, but very, very widespread use now. And it cuts the cost to about a third of that 12 to $1,400 out-of-pocket monthly cost .

Speaker 2:

So it's a generic version of wago V . Correct. Basically they, they put some supplemental vitamin B or something like that . Correct . Yeah . And then they release it as a generic. Right. And how much cost difference is there between the generic and the , uh,

Speaker 3:

Branded? It , it's about a third, a third, you know, it , it depends on the dosing. And we're gonna get into this at lower dosing. Yeah . The cost is less, but at higher dosing, because it's more medicine, the cost goes up. So one of the themes that we have in our practice right now is trying to work with patients on lower doses, because lower doses are better, I think, for a variety of reasons. Uh, and it keeps the cost down as well.

Speaker 2:

Okay. And, and when we met this morning, we were covering the topic of a little bit about this was the demand, right? Yeah. And I didn't realize this until you brought it up that this thing is off the charts, people can't find it because it's so popular. Right ? Right. And now is that the same thing with generics or is that different?

Speaker 3:

Much , much less. So , uh, with wavy , I have patients that are started at a low dose and they wanna move to the higher doses , um, as is the standard protocol for that medicine. Um, and they can't find it. I had a patient yesterday that we started at 0.25 milligrams, moved no to 0.5 milligrams. They're ready to go to one milligram and, you know, call 12 pharmacies and nobody has it. That's

Speaker 2:

Amazing. Yeah . So is that something, have you heard that that's something the manufacturer's trying to address?

Speaker 3:

Oh, they are. Yeah . Or

Speaker 2:

Do they, like some manufacturers like this thing where the demand's so high, they can't keep track , it's good for their stock prices , all that stuff.

Speaker 3:

No, the , the drug companies are trying to ramp up their production. They're trying to get there. Um, but it , you know, I , that could take months pro maybe even I think years for that to happen.

Speaker 2:

And generic, because you are an a physician, you're able to prescribe a generic, but most doctors wouldn't be doing this because it's not in their toolkit .

Speaker 3:

Well, you have to have a special relationship with compounded licensed pharmacies to be able to do this. Okay . And we've developed those relationships with several pharmacies over the course of the year.

Speaker 2:

Just curious, I remember you're licensed in Ohio, Indiana, Florida, and Arizona. Correct. That means you can only prescribe to those people in those states?

Speaker 3:

In those states.

Speaker 2:

Right. Now is that, is that something easy to get changed if you wanna go to Oklahoma or someplace like that? I ,

Speaker 3:

I , I need to apply and obtain a medical license. Okay. And , and I'm looking at additional states as well. Got it.

Speaker 2:

Okay. So , uh, let's just real quickly cover the , the supply issue. Again. How do people get around this supply issue? Is there a way around it today?

Speaker 3:

Um, well, for the branded medicines, there's not a way around it that I'm aware of today. Okay. So the way around it is to look at considering compounded medication. So first of all, let's talk about how these medicines are taken. You start a low dose, some of these medicines have side effects. Oh yeah.

Speaker 2:

I

Speaker 3:

Remember you . Nausea EP being the primary side effect. Yeah . So you start at a low dose, it's one shot per week, and then you, you use the same dose for four weeks when you start, generally that's 0.25 milligrams. And then after four weeks, you bump the dose to 0.5 milligrams and you do that. So you can kind of get used to those side effects, go to the next dose, might have a little bit of side effects, 0.5 milligrams. And then you , you continue that process, one shot a week at the same dose for a month, and then it bumps up continually to a milligram milligram and a half, even 2.4 milligrams. Um, and I actually in general, do not agree with going with those higher doses because people become more dependent upon the medication if you do that.

Speaker 2:

So if you, if you start low and stay low, it gives you, is the benefit relatively the same?

Speaker 3:

Um, it depends. It's a , there's a patient by patient variability. Uh , but one of the big points I wanted to get across in this podcast is I have a lot of patients that are at 0.5 milligrams or one milligram. A lot of patients at 0.5 milligrams that we keep at a low dose and they get very good appetite suppression at those lower doses. There's no need to go to the higher doses. And remember, unless you're having a patient come to you and you're saying, you know what, we're just gonna start this medicine and you know, you're gonna be on it for the rest of your life. Right. You know, unless you're prudent in saying, I want to control the dose, I want to titrate it up slowly because I wanna put you in a position to titrate it down slowly. So that does two things. Number one is you, you can keep the patient at a , at a point where they can eventually get off the medicine. And number two is you can keep the cost down because the lower doses are less cost.

Speaker 2:

So , uh, what's interesting is this is a tool in your tool bag of many tools, right .

Speaker 3:

Of many tools. Right.

Speaker 2:

This is one of those things that you get along, you get, you're , you're trying to change the way they live, the way they think, the way they eat, the way they behave. At the same time you're giving them this little aid that kind of is a shot once a week and then eventually say, let's get you off that shot because you now are on a better path to health. Right. And that's kind of your , your philosophy. Correct? Correct.

Speaker 3:

Yeah. And if you, if you drive people up to those higher doses, you're , you're really is , it is just a medication program. It's not really a comprehensive program. So the other things we do, which we feel are the foundation of a program like this is an appropriate diet. And of course, you know, I'm a big advocate of low carb diets , um, because that decreases insulin resistance, which is the problem for most overweight middle-aged Americans. Yes. So we use continuous glucose monitors and, you know, so I , I believe in continuous glucose monitors for non-diabetics so much. You know, Terry , I wrote a book about it. You did

Speaker 2:

Write a book about it , which we'll talk about here at the end. Okay.

Speaker 3:

Um, so we use low carb diets, intermittent fasting, and then strength training. Strength training is real important for two reasons. Number one, when you increase your muscle mass a little bit, you're increasing the quality and receptivity of the insulin receptors on your muscles. So you're soaking up more insulin, you're lowering your blood glucose. When your blood glucose is lower, your body turns to burning fat and that's when you lose weight. Um, so that's really one of the very important reasons. And then the other important reasons is when you're losing weight, especially on these medicines, you're losing muscle mass. And that's an issue for all of us as we get older. Sure. You know, so you're losing 7% of your muscle mass a decade. So we want to have our patients on strength training routines, both to decrease insulin resistance and to help maintain those mu that muscle mass, muscle mass. Very important issue, especially for women because of the risk is of osteoporosis as you get older. So if you're gonna be looking , anybody on these medicines really at any dose, I believe should be doing strain training as well. Alright .

Speaker 2:

And you, you've , you've seen a ton, and I mean a ton of patients and most of them , how many of the patients you say ever get on this medicine? Is it ,

Speaker 3:

You know, for me it's a minority of patients. We have patients come in and establish those lifestyle changes first. Um, basically the low carb diet, the intermittent fasting, the strength training. And then for people that either want to add this medicine in or hit a stall and want to add the medicine in, then we, we vary judiciously, add the medicine in at low doses, for example, I , I , I really don't have patients on high doses. I keep patients on moderate doses so that I can titrate them off the medicine eventually. Um, and the other reason is to keep the cost down and to talk about the cost issue. The , the reason the cost is lower with lower doses is because there's literally less medicine that has to be purchased. Sure. Um, and, and you can reduce the cost . Um, you know, the compounded medicine is , uh, excuse me, the brand name medicines are, you know, 12 to $1,400 out of pocket for mo for most people. Not doable. Have

Speaker 2:

We ever looked at Canada? What , what goes on in Canada? Do they pay the same fee? Or is it , does it, you know , how people go

Speaker 3:

Across the board countries? It's, it , the , the , the costs are cheaper, but, you know, I don't think that issue's gonna be solved anytime soon,

Speaker 2:

<laugh> . No, I don't either.

Speaker 3:

Okay. Um , so there's that 12 to 14. Yes . Um , 12 to $1,400 per month issue for , uh, the compounded medicine, when you start out, it's a lower cost, but when you, if you move to those moderate to high doses, it can still be, you know, $450 a month. Wow. Um, so it can still be not doable for a lot of people, but if you stay at the lower doses, which I do with many, if not a majority of my patients , um, then you , you can actually provide this medicine for as little as $75 a week. Wow. So if you, if you stay at 0.25 or 0.5 milligrams , um, is just a little boost to this comprehensive program because the patients are doing other things. Correct. You can really, really keep the cost down. Now ,

Speaker 2:

What happens when somebody knocks on your door and says, Hey, I want this Hollywood shot doc and you give it to me. Do you say maybe, but you gotta do all these fo following things? Yeah.

Speaker 3:

I want people to , I , I feel that I'm not doing a service to patients if , uh, I'm just y you know, sending them a medicine and saying Good luck. You know, all you gotta do is Google semaglutide the generic name or ozempic, and, and you'll get all kinds of places that will do that popup on the internet. Yeah . Meet with a provider for 15 minutes and they'll send you the medicine. But again, I I , I think you're committing people to potentially a lifetime worth of medicine when there's a better way to do this in terms of integrating this useful tool as part of a comprehensive program to get people to their goals and then hopefully, you know, get them titrated off the medicine eventually. And, and you know, I mean, based on the Google reviews, which you've seen, our patients have had great success with that approach,

Speaker 2:

That that is true. Is there anything we didn't talk about for Ozempic before we land this podcast?

Speaker 3:

No, no. Other than I think people that are looking at this need to do it again as part of a comprehensive program. And I'd like to emphasize the value of lower doses , um, for most people, not only for the cost considerations of keeping that dose that that cost down, but also in terms of your, your long-term health , uh, and maintaining , uh, uh, optimal lifestyle long-term with the other components of the program. Alright .

Speaker 2:

Well for those folks who are, even if they're not your patient, right, they could be in a state where you don't provide service. Yeah. That information's very valuable to those folks who are, who are interested in this Yeah . Who see entertainment tonight and they see these things.

Speaker 3:

Don't get lured in to just, you know, starting the medicine, not doing other things, going to higher dosing, you know, every , everybody wants a shot to fix everything. But, but quite honestly, from a medical standpoint and a personal standpoint in terms of you , you know, your long-term health and happiness, I , I don't think it's the right thing to do. So comprehensive program, lower doses, lower cost . Alright ,

Speaker 2:

Well this is the time of the podcast where we get to do our shameless book plug. Alright . So what's going on with the book? How's that going so far?

Speaker 3:

The book sales are going great. It's been a lot of fun, you know, writing a book and then getting it out there. The , the , uh, topic of the book, the title of the book is the Continuous Glucose Monitor Revolution for Non-Diabetics. So we use CGMs and non-diabetics to help guide low carb diets. Um, and the reason we do that is because, again, if you can decrease your carb intake, you can keep your blood glucose lower . Um, rather than having excess blood glucose in your system that goes to the liver and becomes fat, you have lower blood glucose in your system. So your organs are looking around for another source of energy, and that's those fatty acids that fat around the middle. So that gets broken down to help you lose weight . So continuous glucose monitors, which you've seen on the back of the arms of diabetics, are tremendously useful in non-diabetics as well. And you know, again, I believe in this so much. I wrote a book about it and we have various chapters on these different topics that we've talked about today. Low carb, intermittent fasting , uh, strength training, right? Even semaglutide, the , uh, the , the, you know, GLP one weight loss medications that we just talked about. So there's really a comprehensive information in there for patients on, on how to make significant lifestyle changes, lose weight and improve your metabolic health. So

Speaker 2:

One , one question I've, I've kind of wanted to ask for a while, and I keep forgetting to ask this question. If you're walking through the mall, and this is a hypothetical, right? And the mall's packed full of, you know, folks who are a little overweight or are greatly overweight, what's the odds of them being diabetic are needing to monitor their glucose with the C G M?

Speaker 3:

Okay, so, so these are the numbers. Um, you know, about 12% of American adults are diabetic, of course most of them are overweight. Yep . Another 30% are pre-diabetic.

Speaker 2:

So 12%, 30%, that's 42, right?

Speaker 3:

That's 42% of American adults and , um, uh, half of the pre-diabetics do not know they're pre-diabetic. And this is what we , you know, this is another reason the CGMs are very effective, right. You'll see it because I , I have patients come in and their , their goal, they come to me because I wanna lose 20 or 25 pounds. I say, well that's great, we'll help you do that. And then we put a C G M on them for a week , uh, and they see that it's not just a weight loss issue, right. That they are pre-diabetic. I have patients that come in C G M for the first time, they find out they're diabetic for the first time. Yeah. Spiking blood sugars on the cgm, which gives you a 24 7 blood glucose reading , um, to , uh, to 2 20, 2 30. And , and so people, once they see those curves on the app on their phone, because these devices , uh, connect to the app on your phone, you , you know, once you see those curves spike and it can be life changing for people. Oh, absolutely. You know, they , they don't un they have not understood up to that point what's going on with their body and their blood glucose. And then after we use the CGMs diagnostically, we can then use them therapeutically to help guide their low carb diet and help them lose weight in the manner we just discussed. So

Speaker 2:

Last question, again, being a scientist kind of , not engineering kind of guy, 42% are either pre-diabetic or diabetic. What percentage of the population are overweight?

Speaker 3:

60% of American adults are overweight. So as

Speaker 2:

You're walking through the mall, odds are really, really high. That overweight person is either diabetic or pre-diabetic and may not know it.

Speaker 3:

Right. And then, and then if you have a family history of diabetes in your family, the numbers go up. So you , you know, the issue here is getting a good assessment of your blood glucose, getting a good assessment of your level of insulin resistance because that's why people are pre-diabetic and diabetic because they have insulin resistance. Um, and then attacking that insulin resistance with a low carb comprehensive approach.

Speaker 2:

Well, sorry for the bonus question, but I just, I just remembered I always wanted to ask that question and uh, I thank you for the answer. Alright, well this has been another thrilling episode of the Metabolic MD with Dr. Paul Kozik . Dr. Klok , thank you very much. Thanks Terry. And we're gonna see you again in a week or two and we'll do another episode. I don't know what the topic will be, but I'm sure it's gonna be just as fun as this one. Alright guys. Terry O'Brien with Tri-Level Records signing off.

Speaker 1:

Thank you for joining us on this episode of the Metabolic MD with Dr. Paul Kozik . Please join us again for the next episode to hear how your metabolic health means everything, and to learn tips on how to lose weight and possibly reverse some serious health conditions. This information is not meant to be medical advice . Please seek consultation from your own medical professional.

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