No, Hollywood elites on crash diets aren’t buying up all the semaglutide (Ozempic, Wegovy) and leaving none for diabetes patients. The reasons behind recent shortages of GLP-1 agonists are numerous and complex, physicians say.
W. Scott Butsch, MD, director of obesity medicine at the Bariatric and Metabolic Institute at Cleveland Clinic, called it a “perfect storm of events.” He and others say that semaglutide maker Novo Nordisk’s supply chain issues with semaglutide may have tipped the scales in the midst of increased demand for GLP-1 agonists from a wider swath of patients and providers, increased awareness of the drugs, and better access for some patients.
GLP-1 agonists that were available for diabetes and then subsequently approved for obesity, like semaglutide and liraglutide (Victoza, Saxenda), gave obesity specialists the confidence to prescribe them, Busch said. The new indications also led to “an increase in demand from primary care physicians or providers who might not normally treat their patients, or might be nervous or not confident about prescribing a medication for obesity, because of bias [against] obesity as a disease,” Butsch told MedPage Today.
With positive clinical trial results for type 2 diabetes drug tirzepatide (Mounjaro), a dual GLP-1/GIP agonist that led to 20% or more reduction in body weight for half of trial participants, “people sort of jumped the gun,” in prescribing it off-label for obesity, Butsch said, knowing it will likely gain approval for that indication after being fast-tracked by the FDA.
Physicians confirmed that patients without diabetes are being prescribed Ozempic and Mounjaro off-label for obesity, though often the two diseases go hand-in-hand. The majority (80% or more) of people with type 2 diabetes are also overweight or obese, though a smaller fraction of people with obesity have type 2 diabetes.
Ethan Melillo, PharmD, an ambulatory care diabetes pharmacist who works with primary care practices in Rhode Island, told MedPage Today that doctors might prescribe a GLP-1 agonist intended for treatment of type 2 diabetes for an obesity patient “because they don’t meet the BMI criteria for Wegovy or Saxenda, so they try to see, ‘Oh, can we get [insurance approval] for Ozempic?'”
He added that providers might indicate the patient is pre-diabetic, “and then some patients they will just pay out of pocket for it too.”
Fatima Cody Stanford, MD, MPH, MPA, MBA, an obesity medicine specialist at Massachusetts General Hospital in Boston, said she’s also had diabetes patients who never wanted to use needles change their minds about GLP-1 agonists based on what they hear from friends, family, or online.
“All of a sudden, they heard about that Mounjaro, ‘Can I start?'” Stanford said. “Like, ‘wait, I’ve been trying to get you on an injectable for four years.'”
Physicians also say that since a first wave of semaglutide patients have had time to see their health markers improve, popular media has caught on.
“It’s been on TikTok, it’s been on national news, it’s been in the newspapers. My friends, and trainees of mine had been on 60 Minutes, and it’s all over the place,” said Butsch.
Melillo also thinks social media has stoked demand. He cited one popular corner of TikTok and Instagram, #mounjarojourney, which is “all these people who are using Mounjaro for weight loss.”
Some patients whose insurance wouldn’t have covered the drugs for obesity may now do so, Stanford said. Coupon programs have also made it easier for those without insurance coverage to pay for them, for around $25 a month, Butsch and Melillo said.
Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center in Boston, said she suspects inappropriate prescribing could be playing a role in shortages, too.
It’s easy to find offers of semaglutide at med spas and compounding pharmacies, which may be using versions of the drug where integrity is difficult to verify. Prescribers also have proliferated in a pandemic telehealth boom. These alternate routes to GLP-1 agonists are available to people with the means to pay out-of-pocket, or pay a monthly subscription fee, and some prescribers may not be following clinical guidelines to the letter.
“There have been these things written by some physicians saying, ‘No, inappropriate prescribing is not affecting the supply,'” Dushay said. “But it just seems like that’s impossible. Right? That seems absolutely impossible. There is not an infinite supply.”
Butsch said these practices in particular contribute to further stigmatization of obesity. “You have this inappropriate prescribing with people probably without obesity or diabetes, which just flames the fire that obesity is a cosmetic problem and it discredits the reality that it’s a disease, which further promotes this controversy.”
Luckily, experts don’t think the shortages will last — but they’re not sure.
Stanford said she’s been able to start new patients on Wegovy recently since the shortage of some doses have eased, and she’s cautiously optimistic.
“Let’s say you like Reese’s Peanut Butter Cups, and your local CVS carries them, and they’re like, ‘Oh, we’re gonna restock.’ And you’re like, ‘Okay, that’s great.’ And then you go, you get some … and then, you go back in a week, and you’re like, ‘What? There’s no — where’d it go?'” Stanford said. “That’s how I feel right now,” but, she added, “I’m hopeful.”
Butsch reported consulting with Novo Nordisk.
Stanford disclosed consulting and other financial relationships with Novo Nordisk, Currax, Eli Lilly, Boehringer Ingelheim, and Rhythm.