Semaglutide Prescription Fills Increased More Than 400% Since 2021

Christopher Scannell, MD, PhD

Credit: UCLA

The number of semaglutide prescription fills increased by more than 400% between January 2021 and December 2023, reaching 2.6 million fills, according to a research letter published in JAMA. Ozempic accounted for more than 70% of fills during this time, although increases were reported among other brands as well, including Wegovy.

Despite its initial approval as a first-line treatment for patients with type 2 diabetes at high cardiovascular risk, semaglutide products have gained popularity in recent years due to their ability to promote weight loss. The SELECT trial evaluated the effects of a 2.4 mg of weekly dose of subcutaneous semaglutide on weight loss among a cohort of geographically and racially diverse patients. The drug safely and effectively produced clinically significant weight loss and improvements in anthropometric measurements compared with placebo over 208 weeks, which were maintained over 4 years. The drug was also linked to fewer serious adverse events.

Investigators believe these increases in prescription fills are tied to an increased awareness of these weight loss benefits, which began in late 2022. These benefits also led to the shortage of Ozempic and Wegovy announced by the US Food and Drug Administration (FDA) in March 2022. Wegovy, which was approved for weight loss in June 2021, was the first FDA-approved treatment for chronic weight management since 2014.

“Semaglutide’s limited supply and insurance coverage, including coverage prohibitions for weight loss drugs in Medicare Part D and coverage restrictions (prior authorization, nonpreferred status, or step therapy) in many state Medicaid plans, may contribute to barriers and disparities in accessing semaglutide due to its high out-of-pocket costs,” wrote lead investigator Christopher Scannell, MD, PhD, a postdoctoral researcher at the University of California, Los Angeles.

In the cross-sectional study, researchers delved into dispensed prescriptions trends for the injectables at retail pharmacies between 2021 and 2023 using data from IQVIA’s National Prescription Audit PayerTrak, which has prescription information on 92% of patients in the United States. Investigators calculated the monthly fills for semaglutide products—Ozempic, Wegovy and Rybelsus—as well as the payment method, including commercial insurance, Medicare Part D, Medicaid and cash.

The number of semaglutide fills swelled from 471,876 in January 2021 to 2,555,308 in December 2023, marking an increase of 442%. However, the extent and timing of these increases varied across brands. Ozempic, for example, peaked in August 2023 with 1,968,892 fills before plateauing (an increase of 392%). Wegovy showed the highest growth between January 2023 (157,554 fills) and May 2023 (519,510 fills), demonstrating an increase of more than 1361% between its approval and December 2023.

Although increases in fills were observed across brands, commercial insurance accounted for most of the prescription fills, especially for Wegovy. Commercial insurance accounted for 89.4% of Wegovy fills compared with 61.4% of Ozempic fills and 58.1% of Rybelsus fills. Medicare Part D accounted for 32.9% of Rybelsus fills, 28.5% of Ozempic fills and only 1.2% of Wegovy fills. Medicaid reported the lowest percentages, accounting for less than 10% of prescription fills across brands in 2023.

These data are noteworthy because of the disproportionate burden of obesity among patients who use Medicaid and Medicare Part D coupled with recent increases in public spending on weight-loss medications.

Investigators noted the lack of data on demographics, including age, race and ethnicity, as well as indications for use—either diabetes or obesity—limited the results of the study. They encourage future research to focus on how changes in Medicaid and Medicare Part D coverage restrictions may influence access disparities.