Looks like Voy is offering click counting and using pens over 6 weeks

[WeAllHaveWings]

https://www.reddit.com/r/mounjarouk/s/W3o3HRh9zW

hopefully others will do the same soon and we can stop pretending and wondering what to do with the build up of pens in our fridges!!!!

Thanks for sharing - very interesting!

Very interesting indeed! I’ve been doing this all along. Makes complete sense.

That is helpful! Reassuring that there seems to be some testing going on of efficacy and safety of using beyond 30 days.

6 weeks is actually only 35 days from opening to final dose so barely over the recommended ‘use by’ for a pen kept at room temperature. I’m surprised but interested in this development as didn’t think prescribers could do this other than case by case.

@janedoe26Perhaps they are able to with a Dr approval of parameters to follow (not the Dr approving every prescription).

I wonder how other pharmacies do it for things like, for example, testosterone for women was off licence but Superdrug prescribed if patients provided regular blood tests of testosterone levels

About time. By ‘allowing’ 6 weeks it’s makes it more affordable especially given that EL is rolling out a new pen design to remove the fifth dose. Pharmacists are not idiots they know lots of us take the fifth dose and that some of us have built up a stockpile due to the August Pendemic and pen change. WLI is a massive market and this is all about market share and gaining those long term lifers.

I see this as a really positive step for mounjaro users. Health professionals in other countries prescribe higher dose pens to be used over 2 or even 3 months, so I'm happy that it's being acknowledged here. (Also I'm a click counter, and someone who has used pens past 30 days, so acknowledging my bias).

There's a risk that sits with the prescriber as they're doing it off licence, so if something goes wrong and it's deemed to be their fault, they could be liable. So I hope it works out for Voy and other pharmacies find the confidence for it too - it could open up prescribing to so many people who couldn't afford it otherwise.

Good on Voy for publically recognising what an awful lot of users are doing.

They should reward loyalty then! I’ve hopped around for every pen. It’s much cheaper if your a new customer

Yes I’ve had that email a few times this week. Pretty hypocritical after the lecture about not following doses that they gave me in November when I had gone over 6 weeks since purchasing and they “couldn’t possibly let me have my usual 7.5mg, I’d have to restart on 2.5mg because I’d gone outside guidelines. The gap was because I’d bulk bought elsewhere, but they wouldn’t have it. And they’re wanting to charge £250 a month for making a pen last six weeks!

wish I had the emails (never used Voy before) as I would say I was nervous about using beyond the in use period as before they said it was a big no, and if they could give more information on the independent laboratory tests they have had done…..

I’m sure they’d happily speak to you about it if you called them. They have clinicians that you can talk to.

This is basically what the email said, it’s a “why don’t you come back to us?” email. I’ve not bought from them for months, but they regularly send them.
Their contact email is on one of my photos if you want it.

thanks @Gingercar , is the flat fee dosing for any strength pen?

I don’t know, I’m not with them and am planning on coming off MJ when these pens run out, so I haven’t looked into it. Give them a ring and ask.

Went onto the Voy site and think I can see how they can do this and other pharmacies won’t be able to -

Voy are regulated by both the GPhC and CQC.

This is because they are a clinic with healthcare providers registered for treatment services. Most pharmacies are only GPhC registered and restricted by their tighter regulations. CQC allows off licence prescribing if evidence is available to supporting.

I think, is other pharmacies won’t be able to do this unless they are CQC registered.
If they do go for CQC registration and the processes/resources needed around that it is likely their costs / prices will increase.

Oushk have a live on tonight and “smart dosing” is one of the questions that has been asked in advance.

Interesting, @WeAllHaveWings. So do you think Voy are using some evidence from a clinical trial somewhere to support going against Lilly's 30 day rule? (And then there's overseas docs who happily prescribe a pen for 2-3 months - I'm sure they haven't all done independent research).

I'm not with Oushk so am curious what they'll say.

@OneThirdLessit says at the end of Gingercar’s second screen shot that “This recommendation is based on external stability testing we have conducted.” So I guess that would be their evidence to support this off licence prescribing.

I am planning to listen to the Hira live with Oushk tonight but recently what she says and what they do don’t always line up.

The WLI market is only set to get bigger and suppliers know they need to capture the ‘Lifers’. Pharmacies have changed their attitude and approach to maintenance, at least some have. Originally we were all going to be cut off at a certain time or once our BMI 23 or whatever, most have become more flexible.

You can’t seem to join Voy just for maintenance. You have to go through the standard questions and it just says no due to weight. No other options.

Yes I saw that, I guess I was just curious about details; have they run their own entirely in-house tests (seems complicated and costly) or are they relying on something else. I'm not with Voy and I'm not likely to be, I just find it interesting how their approach has changed, and thinking with my wallet, hoping it's a positive shift where others follow suit. I'm so, so grateful I can afford the medication - but I split dose from larger pens already due to cost, and I have friends who would start in a heartbeat if they could, but they can't afford it.

"External" and "independent" to me means that they have paid a specialist company to run tests on keeping pens open for longer than the 30 days to check for degradation and contamination.

I'm not interesting in switching to Voy either as they are still expensive and by the sounds of it would not take me on for maintenance as my BMI would be too low for them.

Nothing unexpected in the Oushk live.

Hira said she was aware of the "smart dosing" from Voy (I guess after it was shared in their customer chat room), she said Voy is a Dr led pharmacy and Dr's can do more off license prescribing and pharmacists are more constrained by GPhC and BNF.

She said it was something of interest and they could potentially look at bringing a Dr on board, but there wasn't anything concrete.

Some customers mentioned in the chat they have had off license prescribing from Oushk and there were a few "can I....." questions as the chat progressed about click counting, dosing outside the 7 day schedule etc but she wouldn't get drawn into commenting about anything specific off license.

She explained they have a team of 16 prescribers who are all independent prescribers and it is up to them independently to decide if they will prescribe off license or not based on whether they think it is in the best interests of the patient and they will be held to account for their prescribing decisions by the GPhC. It is random which prescriber your order goes to, so one prescriber might feel they can justify prescribing to you off license but another might not.

Based on that I doubt other pharmacies will follow Voys lead unless they are clinic style and have Drs onboard, or decide to bring Drs on board.

For me, 5mg pens on maintenance, using pens for 6-8 weeks, ordering every 6 weeks, Voy is still not a cost effective option (other pharmacies will be even cheaper than Oushk).

Voy - £239/6 weeks between orders = £40
Oushk - £168/6 weeks between orders = £28

That's interesting to know about them having a dr on board so more flexibility. It is still a very expensive option.

But they are allowing 6 weeks between ordering which is better than enforcing 4 weeks.

interestingly she said the new pens have arrived! It depends which factory supplies the pens but Oushk have had several batches which do not have the 5th dose. She didnt mention a specific dose at all