Mounjaro: out of sight, out of stock. Why the price hike will hit patients hard… again

ABSTRACT:
When Trump decides to triple the price of a life-changing medication overnight, you would expect uproar. But when Eli Lilly announced a 170% price hike for the Mounjaro weight-loss and diabetic injection, the comment was the "higher price will not affect those who get it through the [NHS]".
That's a comforting line - but it's disingenuous. 

METHODOLOGY: 

Guardian Article on Mounjaro Price Hike:
https://www.theguardian.com/business/2025/aug/28/weight-loss-drug-mounjaro-uk-price-rise-eli-lilly-pauses-shipments

NHS Drug Tariff Online:
https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff

DISCUSSION AND RESULTS:

In reality, this price surge triggers a domino effect that pharmacy know too well but the public don't - until it hits them. 
There's spiralling demand, worsening shortages, desperate patients and impossible friction between everyone. While the headlines move on, pharmacy teams are left managing the chaos - without the resources or recognition to do so safely. 



Why don't I believe that the price hike will have 0 impact? 

1. Pharmacies buy medicines and are paid by getting reimbursed by the NHS, in arrears. 

The NHS has a 'drug tariff' (link in methodology for you pharmacy students), which lists the price it will reimburse pharmacies for each medicine it dispenses to patients. 
The price the NHS are reimbursing pharmacies for dispensing Mounjaro 2.5mg injection (at the time of writing) against an NHS prescription is £92. 
If Mounjaro suddenly costs £156.40 (with the 170% increase), pharmacies will lose £64.40 every time it dispenses Mounjaro 2.5mg injection. 
That doesn't sound like much for a business to lose - but multiply this by the 1000s of patients on Mounjaro, multiply that by the different strengths the medicine comes as (2.5mg, 5mg, 10mg, 15mg...), multiply that by the 100s of different medicines and strengths that this problem already exists for - and you have an exponential financial loss that community pharmacies are fronting. No wonder hundreds of pharmacies are closing per year. 

Don't the NHS adjust the tariff price? 
Kinda. But that argument needs a dedicated post. So, in short: When prices surge, negotiations begin between the NHS and pharmacies to ammend the drug tariff. This takes time, doesn't cover every medicine, and you often find it's still less than the cost of the medicine because the NHS see that another region of England can still get a medicine for a little cheaper than you can. 

2. Panic Buying and Artificial Shortages.

With the news of impending doom, a lot of pharmacies who have a large number of patients on the medicine begin to panic buy so that they will have enough stock for their patients to ride the storm. 
This causes its own shortage. 
Wholesalers begin to impose quotas on medicines and all of a sudden pharmacies have a limit on how many they're allowed to buy, which is less than the number of patients they have on the medicine. 
They can fight to get more but this includes sending evidence of prescriptions to the wholesaler but that's not easy when the team is overloaded with work and prescriptions are coming last minute from the GP. 
So, even if a pharmacy is willing to bankrupt itself to support its patients, it still might not be able to source the medicine or get it on time. 

3. Regional Supplies. 

The country is not stocked and supplied evenly - classic example of health inequalities. 
As a wholesaler gets stock, it is not distributed evenly throughout the country, nor is it distributed evenly within a region. 
I'm not sure how it gets decided (potentially on usuage? maybe afluence?) but if part of the country is receiving stock, you can be sure that you aren't getting it and will be told different resupply dates from the wholesaler. 

I also had a lovely argument with a prescriber once, who said they were looking at the wholesaler website on their account and a medicine we couldn't source showed as available. 
I was simultatneously looking at the wholesaler website on our own account, where it was steadfast in its unavailability. 
So it is clear that it matters what accounts you hold with wholesalers too - if you're an iddy biddy independent pharmacy in your local community, you aren't going to get the preferential treatment that a chain like Boots might get. 

So, even if the price hike of Mounjaro has a minor impact on availability, this could have a longer-term strain on trying to source any. 



Why don't I think the price hike will have 0 health impact? 

1. The shortage is real, and so are the patient's conditions. 

Mounjaro is a GLP-1 receptor agonist that mimics the hormone GLP-1. GLP-1 (Glucagon-like peptide-1) triggers the pancreas to release insulin, which helps the body's cells take in glucose from the bloodstream and use it as energy, or signal the liver to convert the glucose into glycogen to store it for later energy needs.
As a side effect, it also slows down how fast your stomach is emptied and can surpress appetites. 
Together, this makes GLP-1 medicines a good medicine for managing diabetes as well as weight. 
Managing diabetes as well as weight are going to have other complementary benefits such as supporting blood pressure and general health, which reduces the risk of heart disease.

Whether a pharmacy doesn't have Mounjaro because it will bankrupt them or they can't source it from a wholesaler at all; the reality is that there might not be enough for everyone, there will be delays sourcing it, or there might not be any at all. 

What if they buy it privately? This brings many questions as well, and it will be personal for all patients. 
At the moment I have seen Mounjaro cost upward of £150 privately on a monthly basis, and the price hike could change this to over £300. 
Patients will have to consider the value of Mounjaro to them - does the impact on health and quality of life justify £300 a month? For a lot of patients, £150 a month isn't affordable let alone £300. 

The result? Patients may go without this medicine for long periods or may have to switch medicine completely if the problem worsens. 
Most obviously - patients will be facing uncontrolled blood sugar levels and diabetes. 
Obviously - weight-loss patients will face months of progress being thrown into the wind and lead to reversals.
Less obvious - who knows when the problem will resolve? Patients will worry about managing their conditions and finding treatment, all the while facing other daily woes that don't allow them time to go around tens of pharmacies or to contact their GPs to get an alternative. 



Why don't I think the price hike will have 0 impact on the health service? 

This business of buying medicines and making margins is messy and has left a lasting stain on the opinions that prescribers and patients hold about pharmacy. 
I've always sensed a friction and distrust from some patients and prescribers when dealing with stock shortages, and Mounjaro is going to be the next example to exacerbate them all.

1. Friction and Distrust with Patients.

It will cause more friction and distrust between the patient and the pharmacy. 
Patients are often bewildered and understandably frustrated when they are told a pharmacy can't get a medicine. 
What makes it worse is when a larger pharmacy still has stock or connections to source the medicine so it looks like their original pharmacy was lying or didn't want to help. 
What makes it criminally worse is when a prescriber tells the patient that they aren't aware of any shortages (as if they're the ones trying to source it), and to go elsewhere. It discredits us and is a giant moral slap when that same prescriber calls the following week begging for an alternative once they realise this is a real problem. 

I fear that patients won't use a pharmacy because of this impact on trust, even if the pharmacy is the easiest for them to access and has an effective service.
I'd love to have every medicine for every patient so that it doesn't disrupt the treatment or management of their condition. 
I'd love it more for them to feel the sincerity and truth when we say that there is a huge problem with stock and sometimes it's just not possible to get something. 

2. Friction and Distrust with Prescribers.

It will cause more friction and distrust between the prescriber and the pharmacy. 
Prescribers are often cunning to the way that pharmacy is reimbursed. They are also aware of their own prescribing budget. However, they less often put the two together - yes an alternative suggestion is expensive to prescribe but equally, the price of that alternative for the pharmacy to buy often exceeds the cost the medicine will be to prescribe. 
In the past I have had prescribers tell me to "just buy it", to something that isn't available. 
In the past I have had prescribers refuse to switch to an alternative because it is too expensive for their prescribing budget. 
In the past I have had prescribers tell me they think I want them to switch to the alternative just to make a profit - despite it being the only remaining alternative, and or despite us sourcing it at a huge loss. 
This difference of opinion is going to flare up again with the shortage of Mounjaro - where there will be an opion that pharmacy doesn't want to source Mounjaro at a loss (irrespective of if its not available at all), and therefore the patient won't have alternative treatments discussed with them. 

LOGICAL CONCLUSIONS:

The suggestion that a 170% increase in the cost of Mounjaro won't have an impact on NHS patients frustrates me. 

It pokes at my experience with the level of adversity pharmacy faces - how many fights we go through just to source a medicine; how many arguments we have to prove that there is a real shortage; how many months we have to wait for NHS payment just to make ends meet.
All of these things happened when Trulicity (another GLP-1 agonist) came out with shortages, and now there's new medicine in the light, EVERYONE HAS FORGOTTEN.
Patients are shocked as if it's the first time or unheard of, prescribers are calling weekly for advice on what to prescribe as if last week's shortages never happened, pharmacy staff are back to the drawing board of calling wholesalers and surgeries.
Perhaps it's amnesia from the trauma of all the other shortages.

So, in the slim event that there isn't an impact on patients from the 170% price increase of Mounjaro, it will certainly come with a 170% increase in pain.