Americans desperate for the hot weight-loss drug Ozempic are turning to Canada and Mexico because they can't afford it at home
- Demand for prescription drugs that help with weight loss, such as Ozempic and Wegovy, is surging.
- But the drugs' high cost and a lack of insurance coverage means they're are out of reach for many.
Mounjaro worked miracles for Vicki Delp.
The 63-year-old from a town outside of Indianapolis has always struggled with her weight. She's tried countless fad diets and Weight Watchers, worked with a nutritionist, and took phentermine pills. None of it was much help.
Then Delp's doctor prescribed Mounjaro, a new diabetes medication that can help people lose 15% to 20% of their weight. Insurance wouldn't cover it, but a coupon from the drug's manufacturer, Eli Lilly, allowed her to get it for just $25.
On Mounjaro, Delp lost weight and her blood pressure dropped.
"It's more than weight loss," she said. "I feel better about myself. I think I've gotten more mental clarity. I really feel like I'm going to win this battle."
But after a few months, she could no longer use the coupon. Facing a bill of $1,000 a month and determined to keep taking the medication, Delp looked to the north.
She found CanShipMeds.com, one of many websites that says it ships a similar drug, Ozempic, from Canada at a lower cost. Armed with a prescription, she ordered two injection pens for a little more than $300 each, enough for two months. They arrived to her doorstep on ice in a week.
Demand for injections that help with weight loss, known as GLP-1 agonists, has surged in the past year, turning Ozempic into a household name. Its use in Hollywood has been mocked on "Saturday Night Live" and served as a punch line at the Oscars. Celebrities and influencers have touted the shots; ads for startups prescribing the drugs have flooded social media.
Delp is hardly the only American searching for weight-loss drugs across the border in Canada or Mexico. Americans have long ventured to our neighbors for low-cost prescriptions and more affordable medical procedures. But the practice is now becoming a popular way to get weight-loss drugs, as social-media sites like Reddit and TikTok are flooded with advice on how to buy them abroad.
The drugs are effective and could potentially help a huge swath of the US population. About 70% of Americans are overweight or obese. But the drugs are expensive and many health plans don't cover them.
While buying medicines outside of the US to bring home can be risky, people's willingness to do so underscores the failure of the US healthcare system to ensure Americans can afford effective treatments as they become available. In many cases, only wealthy people will be able to get their hands on obesity treatments, even though the disease disproportionately affects people with lower incomes.
"It's flabbergasting that there's still such stigma around treating obesity that it's OK to have patients jump through hoops to get a treatment for a condition that they have," said Dr. Dan Azagury, the medical director of Stanford Lifestyle and Weight Management Clinic. He said a growing number of his patients are taking their prescriptions to pharmacies outside the US when their insurers won't pay.
"I'm not surprised that people get creative to get around the prohibitive costs if insurance won't cover any portion of it," he said.
Trendy new weight-loss drugs are unaffordable
At the root of the problem is that obesity has long been viewed as a personal failing, not a medical diagnosis. The American Medical Association only recognized it as a disease in 2013.
Even today, health insurers often categorize weight-loss medications as a cosmetic treatment, and by one estimate, only about a fifth of employers cover the new weight-loss drugs. Medicare, the federal program that provides health coverage for people 65 and older, doesn't cover weight-loss drugs at all, though there's a push to change that. Medicaid programs cover them in fewer than 20 states.
Dr. Angela Fitch, the president of the Obesity Medicine Association, said that because obesity is a disease, treatments should be covered just like they are for diabetes or cancer. Fitch is also the chief medical officer of the startup Knownwell, which offers primary-care and metabolic-health services.
"It should be something that everybody has access to, not just the lucky few who have an employer that decides to add it to coverage," she said.
People are looking to Canada and Mexico for cheaper Ozempic
Until insurance coverage improves, people will look abroad to afford the weight-loss drugs.
According to a spokesperson for British Columbia's Ministry of Health, 9% of the 30,000 prescriptions for semaglutide, the drug sold as Ozempic, filled across the province each month of 2022 were for US citizens. That's 22 times higher than the percentage of prescriptions filled for US citizens for all drugs, the spokesperson said. Insider was unable to find data that covers all of Canada.
After this story was published, the BC Ministry of Health on March 28 said it plans to limit the sale of Ozempic to non-Canadians in areas where there are potential drug shortages. The move follows a surge in Ozempic being dispensed to Americans, it said. In January and February, 15% of the 15,798 prescriptions for Ozempic in BC were filled for US residents.
Crossing the border into Mexico is another strategy.
Gina has taken both routes. The California resident, who works at a tech company, told Insider she's been overweight most of her life. She was diagnosed with polycystic ovary syndrome with insulin resistance that causes her to feel hungry all the time. Insider is identifying her by her first name to protect her privacy.
Gina's endocrinologist prescribed Ozempic to help her lose weight. Based on her health-plan documents, she figured insurance wouldn't cover the drug because she isn't diabetic. So she paid for one Ozempic pen in the US to try it out.
She finally felt full after eating and knew she wanted to keep taking it, but the cost at home was "astronomical," she said.
In September, Gina flew to Cabo San Lucas, Mexico, bought five Ozempic pens from a Costco pharmacy for about $250 each — no prescription required — and brought them back home.
She felt safe doing it. "The thing is I'm under a doctor's care. I know what my dosage is," she said.
When she needed more, she ordered two pens for $285 each, plus a $40 shipping fee, from BuyCanadianInsulin.com, which she learned about through Reddit. Gina's lost 25 pounds so far.
Ozempic pens can dispense different doses of the medication, and one pen typically lasts about a month, depending on how much of the drug a person is taking.
Some US telehealth companies are helping patients fill prescriptions abroad
Reddit forums overflow with advice on how to get prescriptions for Ozempic filled abroad. Users on the site generally point to US telehealth companies like Push Health and Hello Alpha.
Libby Baney, an attorney specializing in internet pharmacies at the law firm Faegre Drinker, said it's illegal for US companies to facilitate drug transactions outside of the US supply chain. Canadian pharmacists also aren't supposed to fill US prescriptions, but there are ways around the law, she said. Baney is a senior advisor to the Alliance for Safe Online Pharmacies, a group that lobbies against illegal online pharmacies.
Amber Bahr, 42, from Appleton, Wisconsin, said a nurse practitioner at Hello Alpha helped her get a prescription for Ozempic filled at a Canadian pharmacy. She turned to Hello Alpha after her primary-care doctor refused to prescribe Mounjaro off-label to help her lose weight.
Bahr, who is prediabetic and has several other health conditions, said she was initially hesitant to use a weight-loss drug because she didn't want to be seen as "taking the easy way out" and was worried about potential side effects. But Weight Watchers and working with a nutritionist hadn't helped, so she decided to try medication.
Bahr said her company health plan wouldn't cover drugs that could help with weight loss. She found PolarBearMeds.com, which says it ships Ozempic from a licensed Canadian pharmacy for about $340 plus a $30 shipping fee. She pays $49 a month to see her clinician at Hello Alpha for the prescription.
Though it costs less than she'd pay in the US, it's still expensive and doesn't go toward Bahr's deductible, or the amount she must pay before her insurance kicks in for other services. But she makes it work because she's lost 25 pounds in just a few months, she has fewer muscle aches, and her A1C level, a measure of her blood sugar, has improved.
Hello Alpha said in an emailed statement that weight loss is one of more than 100 medical conditions its licensed providers treat. The company said it works with mail-order pharmacies in the US but patients can request prescriptions be sent to a pharmacy they choose. Push Health didn't respond to requests for comment.
Buying drugs outside the US can be risky
Going outside of the US for medicine or care can be risky. An extreme example came earlier this month, when four US citizens were kidnapped and two of them killed when visiting the Mexican city of Matamoros for a medical procedure.
Purchasing prescription drugs from unlicensed online pharmacies can be dangerous, too, Baney said. Websites that say they ship medicines from Canada may actually ship them from somewhere else. And there's a chance a person could end up with a fake product, with no recourse if they're harmed, she said.
"You have no way of actually knowing as an American patient if you're getting the real deal or if you're getting a counterfeit, because it's really easy to lie on the internet and it's super easy to counterfeit a drug," Baney said.
Technically, importing drugs for personal use is illegal in most cases, but the US Food and Drug Administration turns a blind eye to it.
Some feel the risks are worth it.
Delp of Indiana said she felt she did enough due diligence to choose a safe pharmacy and the chance she'll get a fake medication is slim. Both of her parents underwent bypass surgery, and she's hoping to avoid that fate. It's been a battle to manage her weight and the medication has made it much easier. She's lost 55 pounds and plans to keep buying Ozempic from Canada.
"Just losing the weight and being able to keep it off with the use of these medications is definitely worth the risk of not being regulated by the FDA," Delp said.
Want to tell us about your experience with weight-loss drugs like Ozempic and Mounjaro? Email the author at email@example.com.
Editor's note: This story was initially published on March 20 and was updated on March 29 after the British Columbia Ministry of Health said it would ban pharmacies in the province from filling Ozempic prescriptions for non-Canadian residents.
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