Ozempic. Oprah, doctors and aunts everywhere seem to be raving about its miraculous weight loss effects. Since its approval by the FDA in 2017, the drug has somehow made its way into bariatric clinics and spas alike. But beyond the infamous brand name, what is it?
The golden child of Danish pharmaceutical giant Novo Nordisk, Ozempic is 2.5 milligrams of injectable semaglutide, a type of GLP-1 receptor agonist. To translate: it’s an artificial way of feeling full, reducing the amount you eat, and leading to weight loss. As simple as it seems, Ozempic and similar drugs yield an average weight loss of a staggering 15-20%. For reference, multiple studies show that in the best of cases, a combination of dieting, exercise and counseling only lead to a 5-10% reduction in weight within the same time frame.
Currently, only 34% of employers cover GLP-1 drugs for both obesity and type 2 diabetes. Covering semaglutide medications for weight loss could be a promising solution to the nation’s long-standing obesity epidemic. So why do insurers hesitate?
First, understand that Ozempic is actually just one of the brand names for injectable semaglutide. In fact, if someone talks about taking Ozempic solely for weight loss, they are probably not taking Ozempic at all. There are three different types of semaglutide drugs, and Ozempic is only prescribed to individuals with type 2 diabetes. During pre-approval studies, researchers noted its effect on weight loss. It wasn’t until 2021 that Wegovy — another drug entirely — was approved for the purpose of chronic weight management. Unlike Ozempic, Wegovy (the red-headed step-child of Novo Nordisk, in opposition to golden child Ozempic) is not typically covered by public or private insurance, because weight loss medications are often considered “lifestyle medications” as opposed to necessary treatments. But whether it's unregulated, prescribed, compounded, or borderline illegal, people want these life-changing medications. And, given the fact that obesity is the United States’ most prevalent health issue and costs (or is valued at, depending who you ask) nearly $210 billion per year, the dangerous off-label semaglutide market has exploded.
The medical urge to prioritize preventative healthcare is not felt by insurance companies; many aren’t exactly eager to swoop in and cover a medication simply because it “works well” and “helps people.” They do swoop in when there is a much more alluring, secret other thing: profit. When Novo Nordisk reduced Wegovy prices last May, the goal was to make gains in coverage. However, because of the limited production of semaglutide due to a complex manufacturing process, prices remain high. This explains why so few employer plans cover GLP-1 drugs.
Lawsuits against Novo Nordisk have been filed since August 2023 on the basis that doctors were not properly warned against potentially harmful side effects of Ozempic, most commonly gastrointestinal issues. In true pharma style, Novo Nordisk cited a misinterpretation of an obscure product liability law in the complaint and attempted to dismiss it, then sued several companies that had been falsely advertising counterfeit Ozempic and made a big deal about it. In spite of this, the general medical consensus is that it is safe, and research continues to reveal the unexpected benefits of semaglutide. A study conducted by Novo Nordisk Canada that was launched to determine if the medication had any adverse cardiovascular effects ended up finding not only that there are no adverse effects, but that semaglutide actually reduced the risk of a heart attack, stroke or heart-related death by up to 20%. And it doesn’t end there: semaglutide has been shown to positively impact brain health, kidney health, cardiovascular health, inflammation and liver disease, to name a few. TLDR: amid the worldwide shortages and cost barriers, they just keep finding reasons why they should be making and charging more for the drug.
Research estimates that semaglutide drugs could reduce obesity prevalence in the United States by about 46% and prevent more than 1.5 million cardiovascular disease events over the next ten years. So how do we shoo off the pharmaceutical vultures, counterfeit compounders and celebrity tabloids alike, so that the viability of semaglutide can potentially reintroduce itself in the context of population health? Firstly, providers must clearly delineate that GLP-1 drugs are not a cure-all, and that lifestyle changes must come alongside taking the medication. Secondly, the controversial use of semaglutide for purely cosmetic purposes, often by celebrities not at all at risk for obesity, clearly should be frowned upon. Finally, it has been proven that even at lower doses, semaglutide medications are still effective at reducing blood sugar and curbing appetite, all while reducing the severity of side effects. Lower doses could also mean lower prices and increased production.
Ozempic (and the rest of the semaglutide family) works. As with most things pharma-related, it comes down to finding the right balance between profit and patient access.
