Dr. Sarah Molasky

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127 appearances 1 recordings 1 series first heard Mar 2024 last heard Mar 2024

Dr. Sarah Molasky’s voice in public audio — every appearance, attributed to the second.

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Health Chatter · Weight Loss Meds · 28 Mar 2024 podcast

I mean, if you look at the health issues that many bulimic patients have, one of them is, you know, erosion of their esophagus, erosion of the valves that, you know, keep the acid in their stomach and not in their esophagus.

So all of that is really important to consider and a good reason why, you know, we really need to think about should this patient even be on this if they're having this level of side effect. And another thing that is much more serious that I mentioned before is gastroparesis. I'm not going to go through the whole list because we don't have time.

But gastroparesis is the biggest one that I wanted to talk about. And that's when the GI tract is paralyzed. So suddenly you just can't move things through your system anymore because the smooth muscle that's supposed to move things along is just like, no. I'm good. We're full. We don't have to move things right now.

So it can go a little too far because slowed gastric emptying is one of the potential benefits of this medication that you feel full for longer because your stomach isn't just taking in food and then dumping it into your intestines. It's taking in food and then like slowly moving it into your intestines. But if that gets way too slow, it is horrible.

And like I said, there are some things with like potential pancreatic cancer risk, potential thyroid cancer risk, but that hasn't really been supported with data yet because we don't have long-term data.

Yeah.

Right. Via shot, by yourself, hopefully. Yeah, right. So the two main ones I wanted to discuss when it comes to the injectables is Victoza and Ozempic, because those are the only two brands that also have specific weight loss injections. So Victoza's weight loss version is Saxenda.

Same thing. And then for semaglutide, there's Ozempic and Ligovi. However, there is also an oral version of semaglutide called ribelsis, which is strictly for diabetes. And that comes in three different doses. And the complaints I've gotten from my patients on side effects have been the same as the complaints I got from them about the injections.

Um, so despite it being a daily pill, which, you know, my, my thought process was, well, if it's daily, maybe the side effects are less noticeable because it's more steady over time and you're not like doing an injection and then whatever. Uh, no, I haven't noticed a difference. I'm still noticing patients complaining about, you know, nausea, upset stomach, et cetera. Yeah.

But Ozempic or Wegovy are once a week dosing, whereas Victoza and Saxenda are daily. So there's definitely a, not only does Ozempic show a higher weight loss than Victoza did, but also it's once a week. So for people who really don't like poking themselves, it's much more convenient.

Yeah, and Munjaro is once a week, sorry.

Yeah, they are hideously expensive, and actually pharmacies have been suffering because we take a bath on these medications. I think a lot of people don't realize that it's possible for a pharmacy to take a loss, but because... many insurances aren't a fan of these medications, they don't reimburse at a great rate.

And if you work in a location where it's high Medicare and high Medicaid patient population, you're more likely to be taking a loss on these medications. So we are sometimes taking like hundreds of dollars of a loss for every prescription we fill for these, depending on the patient's insurance.

So even if the patient's copay is only, you know, zero to four dollars and 60 cents or something, I might be losing six hundred dollars just filling that medication for them. Just on cost of medication, not even talking about the overhead, my pay, my technicians pay the power. Right. Just on the cost of the drug, we're taking like a six hundred dollar bath.

So that is pretty rough on top of all the phone calls we get all the time about them. Like it's these medications are not doing pharmacies any favors right now.

I think it's supposed to be due in 2026 sometime.

So I've been dealing with generic forms of insulin.

And it's very tricky because these... The pill forms being generic would potentially be helpful, right? But when you have a new generic, we're talking, okay, the brand name costs us $500 to order. The generic may cost anywhere from like $50 to $450 to order. It really depends on the pricing that they decide on. And anytime there's a drug shortage, we see drug prices go up.

Because why not charge more for our product right now? You all want it. So so I don't know that a generic is going to help that much when it comes to cost. Also, you know, I don't have a whole lot of private pay patients. Right. And I don't have a whole lot of patients on fancy work insurance. I mostly have patients on government insurance at my location.

So my colleagues at other stores have said that there are people who are

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