Semaglutide Eligibility Expands to Over Half of US Adults

Over half of the US adult population may benefit from semaglutide, a drug primarily used for weight loss and diabetes, although concerns about access and cost persist, especially considering its potential for wider health applications. | Image Credit: Andreas Prott- stock.adobe.com

More than half of the US adult population is considered eligible for semaglutide therapy, according to research using national data presented at the American Heart Association Scientific Sessions and published in JAMA Cardiology.¹

The study was conducted at Beth Israel Deaconess Medical Center (BIDMC) and utilized 5 years’ worth of data from the National Health and Nutrition Examination Survey.² Researchers at BIDMC estimated that 137 million adults in the US are eligible for semaglutide for weight loss or obesity treatment, diabetes management, or prevention of recurrent cardiovascular events.

Semaglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist, and it became the top-selling drug for total pharmaceutical spending in 2023. An average of 1 in 8 US adults reported using a GLP-1 agonist medication in their lifetime across a poll of 1500 participants.³ Additionally, over half of the respondents who used a GLP-1 agonist previously also reported trouble affording the medication, even when their health insurance plans covered it.

Emerging data suggest that semaglutide could be effective for addressing other health conditions like sleep apnea symptoms and some forms of heart failure, and can slow the progression of chronic kidney disease.² Other potential treatment uses include for liver and kidney diseases, substance use disorders, and dementia. However, patient reports provide an emphasis on the need to increase equitable access to this new class of pharmaceuticals.

The BIDMC study considered US adult patients based on the currently approved indications for semaglutide prescriptions.¹ The analysis included 25,531 individuals who underwent in-person interviews, physical examinations, and laboratory testing.

Based on the survey participants, the investigators extrapolated that 136.8 million US adults would be eligible for semaglutide. The mean age of participants was 50.7 years, and there were slightly fewer women than men (49.1%).

Insurance coverage of the predicted semaglutide-eligible population included 26.8 million insured by Medicare, 13.8 million insured by Medicaid, and 61.1 million covered by private insurance. By indication, 35 million US adults would be eligible for semaglutide for diabetes management, 129.2 million for weight management, and 8.9 million for secondary prevention of cardiovascular disease.

Of the 39.3 million US adults eligible for semaglutide for diabetes or secondary prevention of cardiovascular disease, 13 million are insured by Medicare and 4.7 million insured by Medicaid. Despite most individuals being eligible for semaglutide due to weight management, which is an indication not always covered by payers, more than 39 million adults may qualify for indications other than weight management alone.

The study was limited due to the inability to accurately identify rare contraindications to semaglutide based on the data available. However, the large proportion of US adults who qualify for semaglutide emphasizes the possible impact of broader uptake on pharmaceutical spending and population health.

Other individuals who reported using semaglutide medications stated that the therapy was difficult to afford,³ so interventions that reduce economic barriers to access that are urgently needed, especially with obesity’s prevalence projected to dramatically increase to 250 million Americans by 2050.⁴

“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,” concluded the study authors.¹

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 21, 2024. doi:10.1001/jamacardio.2024.4657

2. Mitchell J. More than half of US adults could benefit from GLP-1 medications, researchers find. Newswise. November 20, 2024. Accessed November 21, 2024. https://www.newswise.com/articles/more-than-half-of-u-s-adults-could-benefit-from-glp-1-medications-researchers-find/?sc=dwhr&xy=10046402

3. Harris E. Poll: roughly 12% of US adults have used a GLP-1 drug, even if unaffordable. JAMA. 2024;332(1):8. doi:10.1001/jama.2024.10333

4. Klein HE. Overweight, obesity to affect 64% of Americans by 2050. AJMC^®. November 18, 2024. Accessed November 21, 2024. https://www.ajmc.com/view/overweight-obesity-to-affect-64-of-americans-by-2050