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Some of the most popular drugs today may still be underused. A study released this week found that most American adults are able to take semaglutide, the active ingredient in the drugs Wegovy and Ozempic.
Scientists at Harvard and elsewhere have conducted research, trying to measure the possible accessibility of these already best-selling drugs. Based on nationally representative survey data, they estimate that 136.8 million Americans currently meet the criteria for semaglutide treatment, or more than half of the US adult population. Although many eligible users may take semaglutide for their obesity, about 30 million Americans will benefit primarily from taking it to manage type 2 diabetes or reduce the risk of heart disease—three conditions that cause premature death and health care costs.
“The large number of US adults eligible for semaglutide highlights the potential impact on drug use and public health,” the researchers wrote in their paper, published Monday. JAMA Cardiology.
Semaglutide and similar GLP-1 inhibitors have proven to be more effective in helping people lose weight than diet and exercise alone. Although these drugs have side effects and do not work for everyone, research has continued to confirm their benefits in treating not only obesity but possibly other conditions such as substance use disorders.
Unfortunately, GLP-1 drugs are not cheap. The average list price for Wegovy (the only semaglutide-based drug currently approved for obesity) is about $1,300 per month, while Ozempic (approved for diabetes but sometimes prescribed a non-weight loss label) is about $1,000 monthly. Many insurers, both public and private, also do not cover these drugs, at least because of these high costs. The demand and cost of GLP-1 therapy has helped the emergence of a gray and black market for it, where people often turn to cheap synthetic or counterfeit versions that may not be as safe as the real article.
Survey data suggests that approximately 12% of Americans have recently been prescribed GLP-1 medications, and 6% are currently on them. A reputation that has helped Novo Nordisk—makers of Wegovy and Ozempic—make more than R50 billion in revenue this year alone. But this number is still far from the number of eligible users estimated by the JAMA researchers. The researchers note that many recent users report having trouble paying for their drugs, even if their insurance pays for them. High prices also affect public payers such as Medicare, which can lead to a limited set of patient eligibility (Technically Medicare cannot pay for obesity medications in general, but it can cover GLP-1 if it is prescribed for conditions such as diabetes or heart disease).
“[S]”more than half of American adults who took GLP-1 receptor agonists said the treatment was difficult to afford, interventions to reduce economic barriers to access are urgently needed,” wrote the JAMA researchers.
There is no doubt that there are many eligible Americans who would not benefit from taking semaglutide or would not want to take it even if the cost were not there. But the large gap between the actual and potential number of GLP-1 users suggests that there are many missed opportunities to improve people’s health. A study published this past October, for example, estimated that the high use of GLP-1 drugs could prevent the death of 42,000 people a year in the US from health problems related to obesity or diabetes.
Prominent lawmakers such as Vermont Senator Bernie Sanders have argued that any effort to improve access to these drugs should include reducing their cost. “As important as these drugs are, they will do nothing to help the millions of patients who cannot afford them,” he wrote in a letter to Novo Nordisk earlier this April.
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