Most Americans qualify for semaglutide

Semaglutide was first approved under the brand name Ozempic in 2017 as a treatment for Type 2 diabetes and was later approved in 2021 under the brand name Wegovy as a treatment for adults with obesity or for overweight adults with at least one weight-related condition like high blood pressure or Type 2 diabetes.

A recent study published in JAMA Cardiology found that among 25,531 participants in the National Health and Nutrition Examination Survey between 2015 and 2020, 8,504 met the eligibility criteria for semaglutide, representing an estimated 136.8 million adults nationwide.

"This exceeds the number of adults eligible for statins (approximately 82 million), currently the most prescribed pharmaceuticals among U.S. adults," the researchers wrote.

Specifically, the researchers found that:

• 97.5 million adults exclusively qualified for semaglutide as a treatment for weight management
• 7.6 million adults exclusively qualified for semaglutide as a treatment for diabetes
• 8.9 million adults qualified for semaglutide as a treatment for secondary cardiovascular disease prevention while also qualifying for one or both other treatments

In addition, the researchers found that 4.5 million adults qualified for all three semaglutide treatments.

Other research has also found that an increasing number of Americans are overweight or obese. A recent study published in The Lancet looked at obesity rates nationwide since 1990 and found that nearly three-quarters of American adults are either overweight or obese.

The study also found a steady increase in rates of people who are overweight or obese over the past 30 years, noting obesity rates in adults between 1990 and 2021 doubled to more than 40%.

The researchers defined "overweight" as those who were age 25 or older with a body mass index (BMI) at or over 25. "Obese" was defined as adults with a BMI at or over 30. The researchers acknowledged that BMI is an imperfect measurement, but noted that BMI is correlated with other measures of body fat and works as a practical tool for studying obesity at a population level.

Drugmakers lobby employers to cover semaglutide

While semaglutide has been approved as a treatment for diabetes and weight management, the high cost of the medication remains a significant barrier to wide adoption. Currently, only around half of large employers cover anti-obesity medications, the Wall Street Journal reports. This means that without coverage, patients either have to pay the full list price or roughly $650 a month if they qualify for the manufacturers' discount programs.

In the JAMA study, researchers noted that an estimated 39.3 million eligible adults qualified for a semaglutide treatment for a reason other than weight management. This is significant because there are higher rates of insurance coverage for secondary cardiovascular disease prevention compared to weight management.

"Although most of these individuals are eligible for semaglutide based on the weight-management indication that is not universally covered by payers, we estimate that more than 39 million adults qualify for indications other than weight management alone, a substantial increase over the estimated 15 million currently taking a GLP-1 receptor agonist," the researchers wrote.

However, the list prices of more than $1,000 a month alongside a very large eligible patient population has made employers hesitant to cover the drugs.

"That's a hard investment choice [for employers] to make when all you're seeing is the cost, especially in year one and year two," said Bill Coyle, global head of biopharma at industry consultant ZS. "That's why Lilly and Novo engage employers, to help them understand that story."

In an effort to get more employers to cover the drugs, some manufacturers of semaglutide like Eli Lilly and Novo Nordisk have made efforts to convince employers that obesity and its related complications are currently a huge cost in healthcare, workers' compensation, and disability. They claim that providing employees coverage of semaglutide will ultimately save employers money, the Journal reports.

"I think the real unlock here is helping them understand and realize the economic benefit of these products," said Frank Cunningham, Lilly's group VP of global value and access.

"The communication from Novo and Lilly has helped to establish the case that this is a chronic disease," said Neil Goldfarb, president of the Greater Philadelphia Business Coalition on Health, which both Lilly and Novo have joined as affiliate members. "There's a strong argument for covering these drugs in the right circumstances because obesity is having an impact."

Advisory Board's weight-related resources

To help you address the growing use of weight management drugs, Advisory Board offers several resources:

This expert insight outlines the five biggest questions about weight management drugs and their answers. Similarly, this expert insight addresses what headlines get wrong about weight management drugs and what healthcare leaders should know instead.

Radio Advisory's Rachel Woods has also covered GLP-1 drugs on the podcast, discussing the potential future of these drugs and how they could help — or hurt — health systems' finances. Other useful resources include this expert insight on the five catalysts that will impact the future of obesity care and this research on three potential pathways for the future of obesity care.

Our weight management and obesity care resource library can also help leaders understand the current care landscape, manage innovations, and prepare for transformations in care. (Monaco, MedPage Today, 11/18; Agrawal, New York Times, 11/14; Loftus, Wall Street Journal, 11/19)