More than 50% of US Adults Considered Eligible for Semaglutide with Current Labeling

Dhruv Kazi, MD, MsC, MS
Credit: PCSK9 Forum

A new study suggests nearly 140 million, or half of all US adults, could be considered candidates for semaglutide (Ozempic/Wegovy) based on the agent's current labeling.

Leveraging data from the National Health and Examination Survey (NHANES), a team of investigators, which included representatives from Harvard, Northwestern, and other leading institutions, concluded 35.0 million adults qualified for use based on its diabetes indication, 129.2 million were eligible based on its weight management indication, and 8.9 million were considered eligible based on its indication for secondary prevention of cardiovascular disease.

“A total of nearly 137 million adults, representing more than half of all US adults, are eligible for semaglutide therapy. This exceeds the number of adults eligible for statins (approximately 82 million), currently the most prescribed pharmaceuticals among US adults,” wrote investigators, who were led by Dhruv S. Kazi, MD, MSc, MS, of Harvard Medical School. "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 glucagon-like peptide-1 receptor agonist.”

Permeating the public consciousness, and even pop culture, in a way no pharmaceutical agent has in modern times. After years of being regarded as an antihyperglycemic agent, real-world data, clinical trial programs, and new approvals have thrust semaglutide and GLP-1 receptor agonists into a new realm of patient care. Although the agent boasts approval for type 2 diabetes, weight loss, and secondary prevention of cardiovascular risk, recent studies have found it can also provide benefits among patients with obesity-related heart failure with preserved ejection fraction, osteoarthritis, and kidney disease in people without diabetes.

For the current study, Kazi and team designed an analysis leveraging data from NHANES cycle occurring from 2015 to March 2020 with the intent of using the inclusion and exclusion criteria of key randomized clinical trials supporting the aforementioned indications to create population-wide estimates. Investigators noted 95% CIs were adjusted using NHANES survey weights and scaled to the 2020 US census count for adults.

From the 25,531 survey participants, investigators identified 8504 individuals eligible for semaglutide, which is representative of 136.8 million (95%CI, 128.4 million to 145.2 million) US adults. Results of the analysis suggested the mean age of the cohort was 50.7 years (95% CI, 49.9 to 51.6) and 49.1% (95% CI, 47.5% to 50.8%) were women. Additionally, investigators pointed out this group included 26.8 million adults insured by Medicare, 13.8 million insured by Medicaid, and 61.1 million covered by private insurance.

When examining breakdowns of eligibility by indication, investigators found 35.0 million adults qualified for use based on its diabetes indication, 129.2 million were eligible based on its weight management indication, and 8.9 million were considered eligible based on its indication for secondary prevention of cardiovascular disease. Investigators also noted, among those eligible based on its diabetes and secondary prevention indications, 39.3 million (95% CI, 36.3 million to 42.4 million) were considered eligible and this group included 13.0 million insured by Medicare and 4.7 million insured by Medicaid.

“The large number of US adults eligible for semaglutide highlights its potential impact on pharmaceutical spending and population health. Moreover, since more than half of US adults who have taken GLP-1 receptor agonists state the therapy was difficult to afford, interventions to reduce economic barriers to access are urgently needed,” investigators added. “Efforts to increase equitable uptake should be coupled with strategies to ensure that the cost of semaglutide is commensurate with the value of the health benefits it produces.”

References:

1. Shi I, Khan SS, Yeh RW, Ho JE, Dahabreh IJ, Kazi DS. Semaglutide Eligibility Across All Current Indications for US Adults. JAMA Cardiol. Published online November 18, 2024. doi:10.1001/jamacardio.2024.4657
2. Johnson V. SEMAGLUTIDE reduces knee osteoarthritis pain in people with obesity. HCP Live. November 7, 2024. Accessed November 18, 2024. https://www.hcplive.com/view/semaglutide-reduces-knee-osteoarthritis-pain-people-obesity.
3. Campbell P. SEMAGLUTIDE shows promise, reduces UACR in nondiabetic kidney disease. HCP Live. October 25, 2024. Accessed November 18, 2024. https://www.hcplive.com/view/semaglutide-shows-promise-reduces-uacr-in-nondiabetic-kidney-disease.