By Dr. Samuel Shatkin Jr., MD, FACS
Board Certified Plastic Surgeon
Weight Management Program
Dr. Shatkin’s Medical Weight Management Program is now offering semaglutide, the active ingredient in the newest Rx-only weight loss medications Wegovy and Ozempic that you’ve seen advertised on TV. You can receive this active ingredient as part of a B-12 vitamin shot once a week for as long as you’re achieving your weight loss goals. Based on approval studies, a 15-18% weight loss is achievable!
Ozempic was first approved in 2017 as a medication for Type 2 Diabetes. Type 2 diabetes is associated with obesity, compared to type 1 diabetes which is often associated with a genetic cause of diabetes seen in juveniles that are not necessarily overweight. In the process of reducing blood sugar and regulating insulin, Ozempic was found to also help patients lose weight.
While it’s legally permissible to use Ozempic for its weight loss benefits rather than to treat type 2 diabetes (off label use), the company that makes Ozempic, Novo Nordisk, also obtained FDA approval for Wegovy in 2021. So rather than obtaining Ozempic for the off label treatment of obesity, Wegovy can be prescribed for the express purpose of weight loss rather than diabetes. But treatment comes at a cost, especially if insurance coverage is not available.
The Cost of Wegovy
A month supply of Wegovy (just the medication),
can cost anywhere from$1300 to $1400 permonth.
Insurance won’t necessarily cover this medication
if you don’t have the risk factors required to be a
candidate – diabetes, high blood pressure or high
cholesterol. To clarify, even without these risk
factors, you can still get these medications but
insurance won’t cover it and you’ll
need to pay out of pocket.
And since Ozempic (the sister medication
to Wegovy) isn’t technically approved for the
off-label use of treating obesity (remember,
it’s only approved to treat type 2 diabetes)
you definitely won’t have luck with
insurance coverage since insurance
typically only covers on-label use.
A less expensive alternative
At the Aesthetic Associates Centre, the semaglutide injections you receive for weekly injection as part of our Medical Weight Management Program will be significantly less per month during the 6-month program. In addition to the medication, you’ll receive oversight and coaching by a our team of health professionals. Keep in mind insurance does not cover our program or the medication we provide but at least it’s a less expensive alternative than purchasing the brand name medications without coverage.
Our Plan vs Purchasing the brand name medications without a program (No Plan)
Sign up for the Weight Management Consult here.
You can purchase the six-month Weight Management Program online today. Semaglutide injections will be charged separately each month after confirming you’re a candidate. Limited spots available in each weight loss cohort.
We’re sure you have lots of questions so don’t hesitate – call(716)839-1700 or email firstname.lastname@example.org
What medications are we talking about and how do they work?
Ozempic, Wegovy, generic semaglutide, Rybelsus, Saxenda (iraglutide and approved in kids 12-17), Mounjaro (tirzepatide) are all Glucagon Like Peptide-1 (GLP-1) receptor agonists. The active ingredient in this class of drugs all end in “tide.” This will make it easier to spot these drugs in the future.
GLP-1 drugs stimulate the pancreas in type 2 diabetes to produce insulin. After initially producing too much insulin in patients with type 2 diabetes because of too much food intake and stimulating the pancreas to produce more and more insulin leading to insulin resistance, the pancreas gets “burned out.” GLP-1 drugs enhance insulin secretion in this scenario.
In addition to producing insulin, these medications suppress appetite and make you feel full by slowing the movement of food from the stomach to the intestines. Based on the studies of the various medications above, some result in a 15% weight loss (semaglutide that we have in the office) or up to 25 pounds in other studies.
These medications are all injections except for Rybelsus which is an oral tablet. However, Rybelsus didn’t result in as much weight loss in studies.
Ozempic was approved for type 2 diabetes in 2017 and found to have a side benefit of weight loss. Therefore, the manufacturer took the same medication and got approval specific for weight loss under the name Wegovy. So using this drug for weight loss is not off label. It is a legitimate, FDA-approved use.
Who is a candidate?
While some may believe this medication is being unfairly taken away from type 2 diabetics, this really isn’t an accurate assessment of the situation. Wegovy (semaglutide) is specifically approved for weight loss as long as you fit the criteria for obesity, which is to have a BMI of greater than 30 or greater than 27 if you have other comorbid conditions like type 2 diabetes or high blood pressure (calculate your BMI here). If you’re a candidate and a New York resident, you can purchase a month’s supply of semaglutide injections (the active ingredient found in Wegovy and Ozempic) from our office.
We can teach you how to give yourself the weekly injections in person or virtually once you’ve joined the weight management program. The initial consult (a cost of $100 that will go towards the cost of the program) and subsequent sessions can all be done virtually. Again, you must be a New York resident because we can not ship these medications to other states.
Can the office just send the medication to me?
These medications are real medications and patients need to be monitored while on them. For that reason, all patients that are deemed candidates (more on this in a minute), must join our 6-month weight management program to get a health assessment, including bloodwork, followed by weekly coaching sessions.
How much does it cost? Will insurance cover it?
Our 6-month weight management program is $1199 and each month’s supply of injectable semaglutide is $400 per month. Insurance does not cover our program and it is difficult to get coverage in general. Sometimes, even with insurance, your out of pocket cost may still be more expensive than the “all in” cost of our program with medication.
What are the side effects?
Side effects include burping, bloated feeling, diarrhea and most severe, but rare, pancreatitis. This is why we continue to monitor patients on semaglutide in our weight management program rather than distributing the medication unmonitored. Based on study results, it’s unclear if someone who previously had pancreatitis can take this medication.
Many ask about risks of cancer. Studies on lab rats showed an increase in thyroid cancer but is not necessarily the case in humans. If you have a history of medullary thyroid cancer or Multiple Endocrine Neoplasia (MEN) type 2, you should not take these medications.
Do you have to take it forever? What happens when you stop?
Based on current recommendations, you can continue to take the medication as long as it’s beneficial.
Many asked if you will gain the weight back if you stop the medication. A better way to look at it is, if you stop the medication but continue with other behavioral changes like a healthy diet and exercise, you would not gain the weight back.
But even more important, if you lose weight with the medication in combination with diet and exercise, then stop the medication and conscientiously continue the diet and exercise, not only will you keep the weight off, you’ll no longer have type 2 diabetes and won’t need the medication! Why?
Type 2 diabetes is caused by obesity and is reversible. So try this: Consider using the medication to jump start your weight loss journey but don’t stop there. Use this opportunity to start life anew with a healthy diet and exercise, reverse type 2 diabetes and stay off diabetes medications for good. (This advice does not apply to type 1 diabetes which is a very different disease and generally not curable in the same way type 2 diabetes is).
Is there a shortage of this medication?
Currently, we have a robust supply of semaglutide in our office for patients that meet the criteria for obesity. We obtain this generic, less expensive version of Ozempic and Wegovy from a compounding pharmacy.
Never heard of a compounding pharmacy? That’s ok, chances are you’ve used medication from a compounding pharmacy before.
Examples of what a compounding pharmacy offers:
Allergic to a dye or certain ingredient in a medication? A compounding pharmacy would recreate that medication without the dye or allergen
A child, or elderly parent that can’t swallow the pill form of a medication? A compounding pharmacy can recreate the medication in liquid form
Ever received botox or filler at a doctor’s office? The topical numbing cream placed on the skin prior to treatment was made at a compounding pharmacy
On bioidentical hormone replacement therapy (BHRT)? From a compounding pharmacy.
Medications that are in short supply, including medication for COVID, can be produced by compounding pharmacies too
This last example is why we’re able to get semaglutide. It’s on the FDA’s shortage list, and as such, the FDA allows a compounding pharmacy to duplicate a commercially sold drug that’s currently unavailable or in short supply.
So what if semaglutide is removed from the shortage list? Then the compounding pharmacy we work with could no longer manufacture semaglutide. That’s why we’re actively stockpiling semaglutide for our patients in our 6-month weight management program, so they’ll have access to the medication during their program, and if supplies last, well after their 6-month program.
But we’re also hoping they won’t need the medication forever. Because our primary goal here is not for our patients to become medication-dependent for the rest of their lives.
We want our program to coach patients to a healthier lifestyle with diet and exercise. That way, if accessing medication becomes a problem, they would’ve at least had 6 months to strive for their goal weight with medication and then maintain it with newly developed behavioral changes learned in the 6-month program.
Quality standards of compounding pharmacies
In regards to the quality of medications produced by a compounding pharmacy, the facility we get semaglutide from is considered an “outsourcing facility,” as defined in The Drug Quality and Security Act, of 2013. That law created a new section, 503B, in the Federal Food, Drug, and Cosmetic Act. As such, an outsourcing facility is overseen and inspected by the FDA, along with state regulators.
Under the law, outsourcing compounding pharmacies must comply with section 503B and current good manufacturing practice (CGMP) requirements. In other words, they have very high standards to keep.
And we’ve seen other practices have a great experience with this compounding pharmacy providing our semaglutide. So for now, we have a robust supply of semaglutide and will maintain at least a 6 month availability while supplies last. This ensures anyone in our 6-month program will receive their meds even if the name brand medication goes off the shortage list and the compounding pharmacy is no longer able to make it.
As an aside, we’re hearing the shortage of the brand name drugs are actually a shortage of parts for the pen (think epipen) to administer the brand name versions. We don’t have a shortage in this sense either since we’re sending 4 prefilled syringes (not a pen) to patients as part of their medication regimen.
Also, patients that take these medications for type 2 diabetes or obesity do have other medication options as well as starting a healthy diet and exercise regimen to reverse and cure themselves of type 2 diabetes. Of course that’s easier said than done, but still true. Sometimes when we have medications to treat disease, we can lose sight of non-medicinal, behavioral-based cures.
If you’re serious about joining this program and want to be seen as soon as possible to get started, then you can pay the consult fee online here and be prioritized for the next earliest appointment. But before you do… 1) are you a New York State resident, 2) is your BMI > 27 with obesity related issues (type 2 diabetes, high blood pressure, etc) or a BMI > 30 and 3) don’t have any thyroid or pancreatic issues. If you can answer affirmatively to all three questions, then pay the consult fee here and our office will follow up with you ASAP to get you on the schedule for an in-person or virtual consult. Once we confirm you’re a candidate during your consult, then you can move forward with paying for the 6-month weight management program and the semaglutide monthly subscription.
What if I have excess skin after the weight loss?
Our office has been running weight loss clinics and classes for about 10 years. Many patients that visit our office are not yet surgical candidates because they have too much excess body fat and their BMI is over 30. It is known that patients that have a BMI over 30 have an increased risk of complications following surgery. In addition, we always want the best end result for our patients. This is why we have insisted that patients develop a healthy lifestyle and loose weight prior to surgery so they can heal better, have the pest results and also maintain this immpoved shape throughout their life. Now, with the addition of the use of Semaglutide medication, we have an additional method to help our patients achieve their goal by helping them lose weight and if after the weight loss they did have too much leftover skin, we could help them with a body contouring procedure like tummy tuck, breast lift or liposuction. We have seen some patients lose weight and no longer needing surgical body contouring!
Either way, we could help them achieve their goals. And for those patients that go through our program, lose weight and still want a body contouring procedure, the $1,199 fee paid for the program will be applied to any body contouring procedure. If you do feel you’re ready for a tummy tuck or other body contouring procedure, check current pricing on all of our services.
Questions? Call (716)839-1700 or email email@example.com. Or book a consultation online.