LAST year, semaglutide emerged as the top-selling drug in the USA, generating $13.8 billion in sales. A recent analysis, using data from the National Health and Nutrition Examination Survey (NHANES), estimates that over half of all US adults (approximately 137 million individuals) are eligible for semaglutide treatment. This revelation has highlighted the drug’s potential to reshape pharmaceutical spending and healthcare policies.
Semaglutide is approved for managing diabetes, weight loss, and the secondary prevention of cardiovascular disease (CVD). Eligibility criteria were modelled after clinical trials, including factors such as diabetes diagnoses, elevated haemoglobin A1c levels, or a body mass index (BMI) over 30. Adults with BMI over 27 and a weight-related condition or history of CVD also qualify. Exclusions included individuals with end-stage kidney disease or those who had undergone weight-loss surgery.
The study, conducted between 2015 and March 2020 and adjusted for the 2020 USA census, revealed that 129.2 million adults are eligible for semaglutide for weight management alone. Additionally, 35 million meet the criteria for diabetes treatment, and 8.9 million qualify based on CVD prevention. Of these, 39.3 million were eligible for diabetes or CVD prevention rather than weight loss alone.
The population breakdown highlighted a mean age of 50.7 years among eligible individuals, with near-equal gender representation. Insurance coverage varied, with 26.8 million eligible adults on Medicare, 13.8 million on Medicaid, and 61.1 million covered by private insurers.
Despite its efficacy, affordability remains a significant barrier. More than half of GLP-1 receptor agonist users reported challenges in accessing the drug due to cost. This raises concerns about equitable access, particularly as insurance coverage varies widely between weight management and CVD indications.
The findings highlight the importance of balancing semaglutide’s growing role in public health with its economic implications. Researchers advocate for policy measures to reduce financial barriers while ensuring the drug’s cost aligns with its health benefits. These efforts could enable broader access and mitigate the potential strain on pharmaceutical budgets.
With more individuals eligible for semaglutide than statins, traditionally the most widely prescribed drug in the USA, the implications for healthcare spending and policy reforms are profound.
Reference
Shi I et al. Semaglutide eligibility across all current indications for US adults. JAMA Cardiol. 2024;DOI:10.1001/jamacardio.2024.4657.
