Pre-Ozempic Obesity Drugs: Effective and Budget-Friendly

April 26, 2024 – Before there was Ozempic, Wegovy, or Zepbound, there were cost-friendly, safe, and effective weight loss drugs. FDA-approved obesity medication like orlistat (brand name: Xenical), phentermine/topiramate (Qsymia), and naltrexone/bupropion extended release (Contrave) have been on the market for decades.

“Some older obesity medications go all the way back to the ’50s and ’60s – like phentermine, which is still one of the most widely prescribed medications in the world,” said Anthony Auriemma, MD, medical director of Ascension Illinois Weight Loss Solutions.

While newer GLP-1 drugs like semaglutide (Ozempic, Wegovy) often lead to greater degrees of weight loss, the benefits of more established drugs – like lower costs, ample supply, and ease of access – also makes them valuable options, said Andres Acosta, MD, an obesity expert with the Mayo Clinic.

“Many people say that the GLP-1s are the first medications to give you weight loss at double digits,” he said. “That is not true. Qsymia was already at double digits, giving you 11% [of total body weight loss] at the medium dose and 13% at the high dose.” 

And two cost-friendly and effective drugs offer lower degrees of weight loss: Contrave (around 9%) and Xenical (5% to 6%). 

Some patients can get drugmaker coupons for Qsymia and Contrave for as low as $100 per month, and generic phentermine as low as $20 per month, Auriemma said. You can find Xenical for $200 to $300 per month. Compare these costs to GLP-1s, like Ozempic, where you are shelling out a minimum of $500, all the way up to thousands of dollars, per month. 

An independent assessment by the Institute for Clinical and Economic Review found that Qsymia is the most cost-effective medication among semaglutide and other obesity drugs that came before it. Qsymia’s “dual mechanism” suppresses your appetite in the morning, and the extended-release function can keep you satiated into the afternoon – which means less snacking and excess calories, according to John Amos, CEO of VIVUS, the drug company behind Qsymia. 

Another key difference between older obesity drugs and newer GLP-1s is that the former are taken orally, and you get the latter as shots.

“The really nice thing about older medications like phentermine, Contrave, or Qsymia is that most of them avoid many of the gastrointestinal side effects that you hear about with GLP-1 drugs, where people often have concerns about nauseavomiting, and some talk about gastroparesis, or stomach paralysis,” said Auriemma. 

Keep in mind: Some patients may need to take obesity medications for longer periods of time, which makes seeking a cost-friendly drug even more critical. It is also important to remember that obesity medicine is not “one-size-fits-all,” because our bodies do not have the same reactions to medications, nor do we all have similar eating habits and lifestyles. So current fads or waves of popularity should not be the decision-maker when considering a medication. Speak to your doctor about which, if any, obesity drug could be right for you, Auriemma said.

“If you cannot afford GLP-1s, your insurance does not want to cover them, or you do not have access, there are other options that are already FDA-approved,” said Acosta. “When we do that map between cost and outcome, that is when these other medications, particularly phentermine/topiramate, become the most cost effective.”

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