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Trimming Costs continued...

Phentermine was not taken off the market. It is also one of the two ingredients in Qsymia, along with topiramate, a medication also used to control seizures and prevent migraines.

While phentermine, a stimulant similar to an amphetamine, is more likely to cause insomnia, palpitations, and anxiety than Qsymia and Belviq, Apovian says, it costs only $11 a month. “That explains everything,” she says.

The companies that market Qsymia and Belviq offer 2 weeks of their drugs for free, and then $75 off the retail price for each of 12 30-day filled prescriptions. But patients still end up paying as much as $200 a month out-of-pocket, Apovian says. “Believe me, they tell me about how much it costs them.”

If people are willing to pay for Qsymia or Belviq, Apovian says, she considers their medical history, family history, and other medications they’re taking in trying to decide which drug to prescribe. “Sometimes you try one, and then you try the other,” she says.

“The drugs seem to be just as effective as in the trials,” she says of her experience with her patients. But, she adds, it’s “hard to keep people on them as long as 1 year due to price.”

Loss of Appetite, Pounds

One of Apovian’s patients, 29-year-old Versey Bell, took Qsymia for a month but had to stop because her insurance didn’t cover it, and she couldn’t afford to pay out of pocket. But several months later, Bell’s financial situation improved, and she started taking the drug again.

After 3 months back on Qsymia, the 5-foot-5-inch Bell says she had dropped nearly 20 pounds from her starting weight of 214. (This may not represent typical weight loss on the drug.)

“It suppresses your appetite,” she says. “Stuff that I normally eat, I no longer have the desire to eat.” Or, she says, she’ll eat a much smaller portion. On top of that, she’s taken up running again, a pastime she had given up after moving from California to Boston 2 years ago.

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