Some of the most popular drugs today might still be underused. A study released this week has found that a majority of American adults are eligible to take semaglutide, the active ingredient in the medications Wegovy and Ozempic.
Scientists at Harvard and elsewhere conducted the study, trying to quantify the potential reach of these already best-selling blockbuster drugs. Based on nationally representative survey data, they estimated that 136.8 million Americans currently meet the criteria for semaglutide therapy, or more than half of the total U.S. adult population. While most eligible users would take semaglutide for their obesity, about 30 million Americans would primarily benefit from taking it to manage their type 2 diabetes or reduce their risk of cardiovascular disease—three conditions that contribute to premature death and healthcare costs.
“The large number of U.S. adults eligible for semaglutide highlights its potential impact on pharmaceutical spending and population health,” the researchers wrote in their paper, published Monday in JAMA Cardiology.
Semaglutide and similar GLP-1 drugs have proven to be far more effective at helping people lose weight than diet and exercise alone. Though these medications have their side-effects and aren’t effective for everyone, research has continued to validate their benefits in treating not only obesity but possibly other conditions like substance use disorders.
Unfortunately, GLP-1 drugs aren’t cheap. The average list price of Wegovy (the only semaglutide-based drug currently approved for obesity) is around $1,300 a month, while Ozempic (approved for diabetes but sometimes prescribed off-label for weight loss) is around $1,000 monthly. Many insurers, public and private, also do not provide coverage for these drugs, at least partly due to these high prices. The demand and cost of GLP-1 therapy has helped drive the emergence of a gray and black market for it, with people often turning to cheaper compounded or counterfeit versions that may not be safe as the genuine article.
Survey data suggests that roughly 12% of Americans have been prescribed GLP-1 drugs recently, while 6% are currently on them. It’s a popularity that has helped Novo Nordisk—makers of Wegovy and Ozempic—make over $50 billion this year alone. But this figure is still far from the tally of eligible users estimated by the JAMA researchers. The researchers note that many recent users report having trouble paying for their drugs, even when their insurance does cover it. High prices also affect public payers like Medicare, which can lead to restrictive criteria for patient eligibility (Medicare technically can’t pay for obesity medications in general, but can cover GLP-1s if they’re prescribed for conditions like diabetes or heart disease).
“[S]ince more than half of US adults who have taken GLP-1 receptor agonists state the therapy was difficult to afford, interventions to reduce economic barriers to access are urgently needed,” the JAMA researchers wrote.
There are undoubtedly many eligible Americans who wouldn’t necessarily benefit from taking semaglutide or who simply wouldn’t want to take it even if cost was no issue. But the large gap between the actual and potential number of GLP-1 users suggests that there’s a lot of missed opportunity for improving people’s health. A study published this past October, for instance, estimated that higher uptake of GLP-1 drugs could prevent 42,000 deaths annually in the U.S. from obesity- or diabetes-related health problems.
Prominent lawmakers like Vermont senator Bernie Sanders have argued that any efforts to improve people’s access to these drugs should include reducing their costs. “As important as these drugs are, they will not do any good for the millions of patients who cannot afford them,” he wrote in a letter to Novo Nordisk earlier this April.
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