by Ernie Mundell

More than half of all American adults, almost 137 million people, could be candidates for the blockbuster GLP-1 drug semaglutide, a new analysis finds.

Sold as Ozempic for treating diabetes and Wegovy to spur weight loss, the medication could be indicated for those two purposes or to help prevent heart disease, explained a team led by Dr. Dhruv Kazi, of Beth Israel Deaconess Medical Center in Boston.

The medicines are made by Novo Nordisk and can cost nearly a thousand dollars per month, however, so it's not clear who might pay for all those tens of millions of prescriptions.

Right now, insurance companies typically only cover the cost of semaglutide if a doctor indicates its use against type 2 diabetes.

"Since more than half of U.S. 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," Kazi and colleagues wrote in a study published Nov. 18 in the journal JAMA Cardiology.

The researchers based their numbers on data from a major U.S. federal health survey conducted for the years 2015 through early 2020.

Among a cohort of more than 25,500 adults, the team calculated the total number of people who either:

• had diabetes

• were obese (a BMI of 30 or above)

• were overweight (BMI of 27 or higher) with an illness such as high cholesterol or high blood pressure

• were aged 45 or older and deemed to be at risk for heart disease

All of these four patient categories might be helped by semaglutide, the researchers said.

They calculated that 8,504 adults in the database—the equivalent of 136.8 million people for the U.S. population as a whole—fell into at least one of the four categories.

That's far above the 82 million Americans currently eligible for today's most-prescribed drug, cholesterol-lowering statins.

There were a roughly equal number of men and women eligible for semaglutide and the typical patient averaged just over 50 years of age, the study authors said.

Dividing the drug candidates by condition type, 129.2 million could benefit from semaglutide for weight control, 35 million could use it to help manage diabetes and 8.9 million might use it to prevent heart disease, the Boston team said.

However, many who need semaglutide might not have the means of paying for it.

For example, among the 39.3 million adults who could use semaglutide to help manage their diabetes and/or heart disease, less than half (17.7 million) were covered by either Medicare or Medicaid, the analysis found.

Currently, only 15 million adults are taking any type of GLP-1 to manage diabetes or heart disease, according to the researchers.

Even so, in 2023, semaglutide was already the top-selling drug in the United States, with net sales of $13.8 billion, Kazi and team noted.

There's been pressure put on Novo Nordisk to lower the cost of Ozempic and Wegovy. In late September, company CEO Lars Fruergaard Jørgensen faced tough questions in Congress over the drugs' pricing.

He shifted the blame to pharmacy benefit managers (PBMs), explaining that Ozempic and Wegovy would likely no longer be offered by PBMs if they had a lower list price.

More information: Find out more about semaglutide and other GLP-1 medications at the Cleveland Clinic.

Ivy Shi et al, Semaglutide Eligibility Across All Current Indications for US Adults, JAMA Cardiology (2024). DOI: 10.1001/jamacardio.2024.4657

Journal information: JAMA Cardiology 

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