Updated on August 15, 2024 at 2:49 p.m.
By the time Lisa started destroying Maunjaro’s pen with pliers, there was no other option. He weighed 300 pounds. He’d already tried bariatric surgery (with limited success). He’d tried to get his insurance company to cover Maunjaro (they dropped him after a month). Compound Interest pharmacy(When that didn’t work out, she began to worry about what she would actually get for it.) “I really wanted to keep going,” she says, but she couldn’t afford the full price.
Then she learned online about a money-saving loophole: She could split the full-strength Munjaro pen into the amount she needed. (The disposable injection pens come in multiple strengths for the same price.) One pen turned into up to six. After a year of splitting her dose, she’d lost 75 pounds, at a fraction of the cost of the original.
Lisa is one of a small number of patients who have turned to hacking injection pens. (To protect medical privacy, Lisa and other patients are referred to by their first names in this article.) As new drugs used for weight loss (brand names include Mounjaro, Ozempic, Zepbound, and Wegovy) soar in popularity, patients may find that a one-size-fits-all dose isn’t actually for everyone. Most people who split doses are trying to save money, while others are managing side effects. They exchange information online, and many are taking the risk because they want to stay on a completely life-changing drug.
Break the pen teeth There are risks: microbes can get into the injected medicine and cause an infection. “We do not condone this practice,” a spokesperson for Novo Nordisk, which makes Ozempic and Wegovy, told me. “No one should ever be restricted from using Maunjaro or Zepbound,” reiterated a spokesperson for Eli Lilly, the manufacturer. The drugs are sold in pens of different strengths because patients must start with a low dose and gradually increase it to minimize side effects, then take the highest dose indefinitely for weight maintenance.
Doctors uniformly told me they don’t recommend opening the pens, but understand why patients might have to. Maunjaro, Ozempic, Zepbound, and Wegoby (all of which mimic a natural hormone called GLP-1) are far more effective at helping people lose weight than any obesity drug to date. They’re so powerful, but so expensive that demand far outstrips insurance’s willingness and ability to pay.
“We’re seeing a lot of desperate situations in our clinic, and people are looking for all kinds of workarounds,” said Laura Davison, director of medical weight management at West Virginia University School of Health Sciences, where many patients lost their insurance after the state’s public health insurance program was eliminated. Stopped reporting on new drugsSarah Law, director of the University of North Carolina’s weight management program, practices in rural areas where obesity rates are high and few patients can afford to pay out of pocket. She’s heard patients split their medications to save money. “Oh, that’s tough,” she told me. “I’m not going to give up on that.” What have we created?“
Cost aside, a fixed-dose pen isn’t ideal for patients. After Ozempic was approved in 2017 (the first drug of its kind), doctors found that the standard regimen of increasing the dose every four weeks didn’t work for everyone. Some patients experienced side effects, such as nausea, diarrhea, or constipation, even at the lowest dose of 0.25 mg. They might need to start with half or a quarter of that amount. Others might need to gradually increase to an intermediate dose. And some “super responders” might lose weight so quickly that they never need the full dose.
Ozempic’s dose is actually very easy to adjust, even if patients don’t technically need to adjust it. Unlike subsequent medications, Ozempic is packaged in a multi-dose pen with a dial. Although only the official dosages (0.25 mg, 0.5 mg, 1 mg, 2 mg) are listed on the label, people quickly reverse-engineered how many clicks equate to 1 milligram. Novo Nordisk officially Notes Novo Nordisk encourages users not to “count clicks to determine the dose.” But doctors told me they think counting clicks is pretty safe, and some even recommend that patients taking Ozempic count clicks if a dose adjustment is needed. “I don’t have a problem with that,” Davison told me. Novo Nordisk Same pen It has a patent on insulin, allowing diabetics to choose the amount of insulin they need.
Wegovy contains the same active ingredient semaglutide as Ozempic, but is approved to treat obesity, not diabetes (using Ozempic for weight loss is off-label and typically not covered by insurance). Wegovy also has a slightly higher maximum dose and is packaged differently, in a disposable, single-dose pen. That means patients taking Wegovy can’t adjust their dose by counting clicks, even though it contains the exact same drug as Ozempic. “It’s so frustrating,” says Katherine Sanders, an obesity physician at Weill Cornell Medicine. Sanders told me that she rarely follows the drug company’s dose-increasing schedule exactly, tweaking it based on how much weight patients are losing and how many side effects they’re experiencing. A single-dose, fixed pen doesn’t allow her to tailor the regimen to the individual. When I asked her if, as a physician, she would prefer flexible dosing, she said, “Yes, absolutely, yes, yes.” Canada In Europe, Wegovy is actually sold in the form of a clickable pen. “We want that flexibility,” says Fatima Cody Stanford, a Harvard obesity medicine physician.
In the United States, Maunjaro and Zepbound are packaged only in single-dose pens that cannot be adjusted. (Both contain the same active ingredient, tirzepatide, in the same dose, but Maunjaro is approved to treat diabetes and Zepbound to treat obesity.) This forces patients taking tirzepatide (thought to be slightly more effective than semaglutide, the drug found in Ozempic and Wegovy) to resort to the more extreme measure of opening these pens, a process that is much more complicated and requires sterile medical supplies and calculations to get the exact dose.
Nicole started dose splitting because she had severe vomiting and dizziness the day she increased her dose from 2.5 mg to 5 mg. “I really considered going to the emergency room,” she told me. She learned how to split her first pen, so she could increase more slowly with intermediate doses. It also saves money. Phil, another dose splitter, told me he’s taught a few friends how to split Maunjaro pens. “To me, it’s really a principle of harm reduction,” he said. “There are so many people for whom this drug is life-changing, and it’s just totally, catastrophically expensive.”
Meanwhile, Lisa compared the risks of splitting the dose with the risks of her other options: going to a compounding pharmacy or a counterfeit pharmacy. May be unreliable or impureor to continue living obese. “I feel like that’s an acceptable risk for me compared to the risk of carrying an extra 130 pounds,” she says. She needs to lose another 55 pounds to reach her goal of losing 130 pounds. Over time, as is typical, the dosage she needs has increased. She went from six doses per pen to four, three, two, and now just one and a half. Eventually, she’ll probably need to take the full maximum dose. Although she’s happy with the money she’s already saved, splitting the doses won’t last long. For most people, it’s not a long-term solution to chronic medication.
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The article originally stated that the patient experienced bloodshot eyes while taking Munjaro, when in fact she had experienced this side effect with another medication.
