April 26, 2024 – Before there was Ozempic, Wegovy, or Zepbound, there were cost-effective, safe, and effective weight loss medications. FDA approved obesity medications like Orlistat (brand name: Xenical), Phentermine/Topiramate (Qsymia), and extended-release Naltrexone/Bupropion (Contrave) have been on the market for decades.
„Some older obesity medications date back to the 50s and 60s – like Phentermine, which is still one of the world’s most commonly prescribed medications,“ said Anthony Auriemma, MD, Medical Director of Ascension Illinois Weight Loss Solutions.
While newer GLP-1 drugs like Semaglutide (Ozempic, Wegovy) often lead to more significant weight loss, the benefits of more established medications – such as lower costs, ample availability, and easy access – also make them valuable options, said Andres Acosta, MD, an obesity expert at the Mayo Clinic.
„Many people say that the GLP-1 medications are the first medications to achieve double-digit weight loss,“ he said. „That is not true. Qsymia has already achieved double-digit weight loss at 11% [of total body weight lost] at the medium dose and 13% at the high dose.“
And two cost-effective and effective medications lead to lesser weight loss: Contrave (approx. 9%) and Xenical (5 to 6%).
Some patients may obtain drug manufacturer coupons for Qsymia and Contrave for as little as $100 per month and for generic Phentermine for as little as $20 per month, said Auriemma. Xenical is available for $200 to $300 per month. Compare these costs with GLP-1s like Ozempic, where you may spend at least $500 up to thousands of dollars per month.
An Independent Evaluation A study by the Institute for Clinical and Economic Review found that Qsymia is the most cost-effective medication compared to Semaglutide and other obesity medications that preceded it. The „dual mechanism“ of Qsymia suppresses your appetite in the morning, and the extended-release function can keep you feeling full until the afternoon – which, according to John Amos, CEO of VIVUS, the pharmaceutical company behind Qsymia, means less snacking and excess calories.
Another significant difference between older obesity medications and newer GLP-1 medications is that the former are taken orally, while the latter are administered as injections.
„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 medications and that often worry people – nausea, vomiting, and some talk about gastroparesis or stomach paralysis,“ said Auriemma.
Keep in mind: Some patients may need to take obesity medications for an extended period, making the search for a cost-effective medication even more crucial. It is also essential to remember that obesity medicine is not a „one-size-fits-all“ solution, as our bodies do not all respond similarly to medications, and we also do not all have similar eating habits and lifestyles. Therefore, current trends or waves of popularity should not dictate the choice of medication. Talk to your doctor about which obesity medication might be right for you, said Auriemma.
„If you cannot afford GLP-1, your insurance does not cover it, or you do not have access, there are other options that are already FDA approved,“ said Acosta. „When we create this cost-outcome card, these other medications, especially Phentermine/Topiramate, are the most cost-effective.“