Surge in Semaglutide Prescriptions

Semaglutide Prescribing Surged in the Past Year

In the past year, prescriptions for semaglutide have surged by 150%, with an 80% increase in the number of prescriptions written per provider, according to recent data. From December 2022 to June 2023, over 350,000 prescribers in the nationwide DrFirst network contributed to a sixfold increase in prescriptions for Wegovy, a weight loss formulation, and a 65% increase for Ozempic, a lower-dose version used to treat type 2 diabetes.

Before December 2022, the prescribing rates for both formulations of semaglutide were relatively stable. Ozempic was approved for type 2 diabetes treatment in the US in 2017, while Wegovy received approval for weight loss in 2021. Prescriptions for oral type 2 diabetes medications also increased during the study period, though not as dramatically.

Provider Specialties and Prescription Rates

General and family practice providers were the most frequent prescribers of semaglutide, accounting for 30% of the total prescriptions. Internists followed with 15%, endocrinologists with 4%, ob/gyns with 2%, and pediatricians with 1%. Other specialists, including cardiologists, emergency medicine physicians, hospitalists, psychiatrists, and surgeons, each accounted for less than 1% of the prescriptions.

DrFirst chief medical officer Colin Banas, MD, highlighted the rapid adoption of semaglutide by primary care providers. He noted that it is unusual for a new drug to be so quickly and widely prescribed in primary care. “It’s actually pretty telling that within a year or year and a half, the primary care field got very comfortable writing prescriptions for these glucagon-like peptide 1 receptor agonists,” Banas said.

Expert Opinions on the Surge

S. Sethu K. Reddy, MD, president of the American Association of Clinical Endocrinologists, explained that the increased prescribing is expected due to the dual benefits of these medications in lowering blood sugar levels and promoting weight loss. These benefits, combined with convenient packaging, make the medications attractive to primary care physicians. Reddy also pointed out that public awareness and patient inquiries about the medication play significant roles in the increased prescribing rates.

Reddy emphasized the clinical evidence supporting the use of these medications for improving diabetes control and reducing the risk of cardiovascular events. Previously, the lack of cardiovascular safety data was a significant barrier. Now, for patients with type 2 diabetes at higher risk of cardiovascular disease, there is little controversy in prescribing GLP-1 analogs.

Barriers to Patient Access

Despite the increase in prescriptions, not all patients are receiving the medications. Sharon W. Lahiri, MD, of Wayne State University School of Medicine and Henry Ford Hospital, highlighted that insurance coverage often determines whether patients can obtain the prescribed drugs. Lahiri noted that many insurers deny coverage for Wegovy or require patients to undergo behavior modification programs or try older, less expensive weight loss drugs before approving Wegovy.

Lahiri co-authored a survey earlier this year that identified high costs and the need for prior authorizations as major barriers to prescribing GLP-1 agonists and sodium-glucose cotransporter 2 inhibitors. She reported that many insurers don’t cover Wegovy or impose time-limited coverage, requiring patients to achieve specific weight loss goals to continue receiving coverage.

Lahiri also encountered similar barriers when prescribing the “twincretin” Mounjaro for type 2 diabetes, with insurers requiring trials of other GLP-1 agonists first. “It’s very complicated. I would say the barriers are definitely worse now. I don’t think the number of written prescriptions reflects that at all,” Lahiri said.

Banas added that more patients are likely to pay out of pocket for Wegovy than for Ozempic if they have a diabetes indication. He observed that insurance coverage for obesity medication appears to be holding steady, with more coverage seen for diabetes use cases rather than obesity per se.

Conclusion

The surge in semaglutide prescriptions reflects a significant shift in the primary care field’s adoption of new treatments for diabetes and obesity. However, despite the increased prescribing rates, barriers such as insurance coverage and high costs continue to impact patient access to these medications. As the medical community and insurers navigate these challenges, the demand for effective diabetes and weight loss treatments remains high.