Prescription of semaglutide has increased over the past year

Prescriptions for semaglutide jumped 150% in the past year, with an 80% increase in prescriptions written per provider, new data suggests.

Among more than 350,000 prescribers in the national DrFirst network between December 2022 and June 2023, prescriptions for the Wegovy weight loss formulation increased sixfold while those for Ozempic, the lower dose version to treat type 2 diabetes, increased by 65%.

Before December 2022, the prescription of the two drug formulations of semaglutide was relatively stable. Ozempic was approved in the United States for the treatment of type 2 diabetes in 2017, and Wegovy for weight loss in 2021. Prescription of oral medications for type 2 diabetes also increased during the period. study, but to a lesser extent.

General and family medicine providers were the most common semaglutide providers, accounting for 30% of the total, followed by internists at 15%, endocrinologists at 4%, obstetrician-gynecologists at 2%, and pediatricians at 1%. Other specialists writing less than 1% of prescriptions included cardiologists, emergency physicians, hospitalists, psychiatrists and surgeons.

“What I find interesting is that in a relatively short period of time, primary care providers have become accustomed to writing [prescriptions] for a relatively new drug. It’s not always the case. To me, it’s quite telling that in a year or a year and a half, the primary care field has become very comfortable writing [prescriptions] for these [glucagon-like peptide 1 receptor agonists]” said DrFirst Chief Medical Officer Colin Banas, MD. Medscape Medical News.

Asked to comment, S. Sethu K. Reddy, MD, president of the American Association of Clinical Endocrinologists, said: “This is to be expected when there is an agent that not only lowers blood sugar , but can also lead to weight loss. These medications are conveniently packaged so that a primary care physician can prescribe them. The public is sufficiently aware to the extent that patients themselves often ask their doctors about the drug.

Additionally, Reddy noted, “there is clinical evidence that these medications not only improve diabetes control but also reduce the risk of cardiovascular events.” The lack of cardiovascular safety data was a missing piece of the puzzle in the past. suffers from type 2 diabetes and is at greater risk for cardiovascular disease, there is little controversy over whether the patient receives GLP-1 analogs.

Are patients actually receiving prescribed medications?

However, Sharon W. Lahiri, MD, of Wayne State University School of Medicine and Henry Ford Hospital in Detroit, Michigan, pointed out that prescription data does not correspond to actual drug use. “It depends on what type of insurance a person has. We write prescriptions for semaglutide every day. At least five or more come into our inbox every day telling us the request is denied.”

Earlier this year, Lahiri co-authored the results of a survey of 125 healthcare providers conducted between February 9 and March 14, 2022, seeking to identify factors influencing medication choices and barriers to prescribing GLP-1 agonists and sodium-glucose cotransporter 2 inhibitors. High cost and the need for prior authorizations have been reported as the main barriers to prescribing drugs in these two classes, as well as lack of experience of certain specialists.

Lahiri told Medscape that many insurers don’t cover Wegovy at all, or impose stepped care paradigms in which the patient must enroll in behavior modification programs for a period of time or try medications first older, cheaper weight loss medications such as phentermine, topiramate or orlistat before allowing coverage for Wegovy or even the older GLP-1 agonist weight loss drug, Saxenda. “And then they ask you to document why previous medications didn’t work or couldn’t be tolerated.”

Additionally, Wegovy coverage is often time-limited, varying from 3 months to 2 years, and some insurers require a visit during which the patient must have lost at least 5% of their body weight for coverage to continue.

Lahiri said recently that she also encountered such “step” requirements when trying to prescribe Mounjaro “twincretin” to treat type 2 diabetes, where insurers would first require trials on other GLP-1 agonists. “So it’s very complicated. I would say the barriers are significantly worse now. I don’t think the number of orders written reflects that at all.”

Indeed, Banas noted, “more patients will pay out of pocket for Wegovy than for Ozempic if they have an indication of diabetes.” And he added: “Based on my clinical observation, insurance coverage for obesity medications appears to be holding up. I haven’t seen a massive increase in the number of these drugs covered for obesity per se, but I’m certainly seeing more coverage for diabetes use cases. “

The study was funded by DrFirst. Banas is an employee of DrFirst. Reddy and Lahiri have no disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, and other work appears in the Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on Twitter @MiriamETucker.

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