A calm and supportive thread to discuss the Price Increases: Mounjaro

[TryingAgainAgainAgain]

For anyone who would like a calmer place to share support and information about the price increases.

Because it can start to degrade after being open longer than 30 days. So the risk is small but I can’t imagine any professional pharmacist risking their own practicing licence to help someone use a medicine beyond what the manufacturer suggests and has licences it for.

Yes people do it at their own risk. But this person is being injected by the pharmacy staff. The risk to them is huge if anything goes wrong and I can’t believe that someone who studied for at least 7yrs to become a pharmacist would risk it in this way.

I’m sure this price increase will result in more people doing thing like taking 7.5 from a 15, especially as many pharmacies have allowed multiple pen buying so people will be able to explain gaps in future orders.
It’s an issue that also exists in long term maintenance where people (like me) would eventually like to microdose but it would mean pushing pens out to last 8/10 weeks.
I’m surprised a pharmacy is actually willing to do this for a patient, sounds very risky for them (the pharmacy).

I don’t disagree with taking half a dose out of a higher dose pen for longer. I will be doing this myself.
I am wondering how a pharmacist would go about it though. They inject you monthly but they can’t give you medication that has been open for over the 30 day guideline & the pens can’t be shared between different customers.
What happens if you need to go up a dose before the agreed 4 pens are used?

No reputable pharmacy would do this.

I was thinking for me personally, not this particular situation which is all kinds of wrong. Thanks for the answer.

Lots of people do take a lower dose and it’s fine. The risks are small. Just make sure the pen is kept in the fridge at all times at the back where it’s coldest. And practice good hygiene wiping the pen before and after injection to minimise contamination/infection risk.

I have to admit I’ve never really done the microdosing thing, but I think I’d consider staying on 12.5 from my first 15 pen if it continues to work for me like it has. But I think anything more than one or two extra doses would really put me off!

I wonder if the pharmacy are doing this for multiple customers and working through a pen kept at the pharmacy? Therefore it won't be open more than 30 days and saves the customer money?

I’d hope not! If you’re attaching the needle to the pen isn’t there a small risk of contamination? I’d also not trust that they’re drawing up the same ml per dose.

Reminds me of during covid when the nail bar had to use individual files for each person, they would have needed to store hundreds of them so we took them home. Inevitably forgot to bring them next time and they used whatever was at hand! My hair extension lady offers to dispose of my used hair and I wonder if she sells it on.

I was thinking they were withdrawing it first, not injecting each person with the same pen. Certainly not ideal, but I just can't imagine any way a qualified pharmacist would risk their license by keeping the pen open longer than stated.

I can’t see a way they’d do it any way - each pen is prescribed to a person, so they’d be sharing prescription medication between multiple people. I also don’t think they’d be injecting you each week

That's true, I forgot each pen is prescribed to a person. In that case surely not.

There’s just no way it would happen is there 🥴

As an ex ward-nurse, who administered lots of meds like this, I can confirm 100% that each pen is prescribed to an individual and is never injected into someone else.

I’m speculating here, but if the Pharmacy has a number of clients that they inject, perhaps they use a single vial for multiple clients?

It’s still not good practice. But I for me comes under shocked but not surprised.

Compounded tirzepatide (vials) isn’t licensed in the UK. The only way this would be happening would be if they used one pen to draw from and inject multiple people, which would be a breach because each pen is prescribed to a specific person

Like I say, I don’t think it’s good practice. It would in theory be possible though for an independent prescriber to prescribe a single dose each time, (not for PGD users which is how most Pharmacists are currently supplying the pens).

To clarify - I’m not necessarily saying this is what is happening, just working through how they might be doing it. If I really thought a Pharmacist was using a single, higher dose pen to withdraw multiple single doses, I would be inclined to report to the GPHC.

There is of course a risk that this sort of practice could increase with higher prices as it’s a sneaky way to make additional profits. It puts patients at risk though and I would suggest not supporting any Pharmacists who are doing this.

As a retired prescriber I can tell you, as others have said, it definitely shouldn't happen but I have seen some shocking rule-bending in pursuit of profit by some pharmacies and some pharmacists (and I have reported some to the GPhC, it's a fun retirement hobby) .
As many of you will know, there is provision for prescribers to prescribe "off-licence" but there are strict requirements for the conversations that have to be had, the documentation required to support it and the reasons why that arrangement has been agreed so I could, for example, document use of HRT in a patient with contra-indications after discussions about individual assessment of risks involved, patient's wishes, quality of life, any steps taken to minimise risks, etc, expert advice taken and, above all, the fact that both patient and prescriber have understood and agreed that arrangement.

I wouldn't like to be the prescriber trying to justify to the GMC or GPhC that I had agreed to breach the manufacturer's guidelines on use, stability, etc in pursuit of savings for the patient and my own longer term business interests.
@HereIGoOnceMore I would doubt they are prescribing in single doses as it is a 4 dose unit. In the NHS we get angry e-mails from the ICB if someone accidentally enters 4 for a month, thinking of doses, as each one upgrades on the computer to a full pen as even the computer knows that they can't be split. Any GPhC inspector would spot a disparity as documentation would require one pen per dose in that case

This ‘pharmacy’ is acting like you might expect a backstreet beautician to act in terms of bending the rules re prescription dosages etc. I would be surprised if they are a registered pharmacy rather than an aesthetician who has got hold of some Mounjaro and is injecting multiple people with various doses from the same pen till it is used up and then starting the next pen.

If the pens are £250 15mg pens and they are giving 10 people 7.5 mg doses at a £40 each they could make £150 for every pen they use up. And if they are doing 2.5mg doses for £35 each they are making way more than that - the lower the dose they recommend to customers the more they would make from each pen! Note that the poster says they might stay on 7.5mg instead of keep moving up.

@QueenOfHiraeth It is shocking, There was a thread started on here not long ago about microdosing. The op said it was Healand clinic she was using and said “I called clinic and am 2 weeks in, just moved to 2mg. get send exact doses so no clicking of pens, just inject the amount in the needle.
I had a look online to be nosey & it’s clearly advertised on their website & prices start at £175. I can’t believe they get away with it.

@Beachcomber74 if this "pharmacy" cannot be trusted to follow GPhC they cannot be trusted to safely provide medication. They have shown themselves to take part in unsafe and unprofessional practices. If they are willing to cut corners like this for a bit of extra money, even if you asked them to prescribe properly to you now can you trust them to store the medication properly?

It is both a regulatory and safety issue, they need to be reported to the GPhC for patients safety.

The Healand Clinic is charging £300 per month no matter the dose and I couldn’t see a registered pharmacy number. Doesn’t seem legit at all!

£175? Maybe I didn’t read the pricing properly as I thought it was £300?

@Choux On the treatment page, below the medical weight loss there is another one for microdosing