AI Solutions for Healthcare

Weight-loss Drug Shortages: Breeding Ground for Fraud and Future Health Issues 

Weight-loss drugs containing semaglutides, specifically Wegovy and Ozempic, have stolen headlines due to high demand and product shortages. Patients may seek alternative sources for weight-loss medications and are impacted financially as the out-of-pocket costs for Wegovy and Ozempic exceed $1,500 per month. Some of those patients may unwittingly threaten their future health when they become the victims of unscrupulous businesses that sell compounded drugs in very similar packaging to the branded products, yet these products do not contain any semaglutides. 

Novo Nordisk, the pharmaceutical manufacturer of Wegovy and Ozempic, filed multiple lawsuits against wellness spas and compounding pharmacies for marketing and selling products claiming to contain semaglutides that included counterfeit injectable pens [Ozempic only] with compounded drugs. To combat this, Novo Nordisk created a resource hub for consumers to help identify counterfeit Ozempic packaging and pens. Patients who receive counterfeit medications, i.e. without semaglutides, would not see the expected weight-loss and health benefits; rather, they may have unexpected interactions as the contents of the counterfeit, compounded drugs are undisclosed.   

Patients who cannot afford expensive out-of-pocket options may also seek less expensive alternatives for weight loss treatments. Social media influencers are promoting a natural supplement called Berberine as a replacement for semaglutides, calling it “nature’s Ozempic”. Informatively, Berberine may help lower blood sugar, lower blood pressure, or lower cholesterol when taken with prescribed medications.  Berberine alone is not a substitute for prescribed medications and there are no human trials that substantiate social media claims that Berberine is a substitute for semaglutides. While the out-of-pocket expense for Berberine is very low compared to Wegovy or Ozempic, Berberine might impact the patients’ health by reducing the effects of the prescribed drugs as well as how quickly the liver breaks down the prescribed medications.   

While Fraud Scope strives to help identify areas of healthcare risk, the above occurrences are primarily “off the claims radar” as out-of-pocket or cash only, patient expenses. If you have not notified your members about the dangers of off-brand drugs or unknown supplements, consider an outreach or alert to your members with Wegovy, Ozempic, or other weight-loss drug prescriptions who may be experiencing shortages.   

Depending on your payment policies regarding unlisted drugs, your plan may receive claims for HCPCS code J7999 – Compounded drug, not otherwise classified. Should your plan receive claims for HCPCS J7999, consider reviewing the diagnosis codes attached to the claim, which may help identify services related to weight loss. Table 1 is a reference of diagnosis codes related to obesity and diabetic conditions often linked to Wegovy and Ozempic claims.

Table 1: Diagnoses Associated with Ozempic or Wegovy Prescriptions 
ICD-10 CM codes  Code description
E11.0 – E11.9 Type 2 diabetes mellitus
E13.0 – E13.9  Other specified diabetes mellitus
Z79.4Long-term [current] insulin use
E66.0 – E66.9  Overweight and obesity  
Z68.30 – Z68.45  Body mass index 30.0 to 70.0 or greater [adult] 
Z68.54  Body mass index greater than or equal to 95th percentile for age [pediatric]

Manufacturer lawsuits against compounding pharmacies for off-brand versions of weight-loss drugs

Novo Nordisk resource identifying authentic and counterfeit packaging and injectable pens

Washington Post article refuting Berberine as “nature’s Ozempic”

WebMD overview of Berberine