The newest Hollywood weight-loss fad isn't a trademarked diet, but a drug called Ozempic. Typically marketed as a diabetes drug, Ozempic, which is also sold under the brand name Wegovy, is formally known as semaglutide. Celebrities and the rich rave about the drug, including Tesla and Twitter CEO Elon Musk who credits the drug with his weight loss.
"Everyone is on Ozempic," comedian Chelsea Handler said in January. "My anti-aging doctor just hands it out to anybody." In recounting her own experience with the drug, Handler claimed she "didn't even know" she was on it.
Handler's comments imply that Ozempic is readily available to anyone who wants it, yet that is not exactly the case. Indeed, as buzz builds about the drug's weight-shedding potential, reports have surfaced that the drug has become increasingly harder to access, especially for those with type 2 diabetes who take it for its originally intended use. As recently reported by the Houston Chronicle, type 2 diabetes patients are struggling to refill their prescriptions, a situation endocrinologists have called a "headache."
"I see this every week, all the time," Dr. Jill Crandall, chief of the division of endocrinology at Albert Einstein College of Medicine/Montefiore Health System, told Salon in an interview. "The patients that I treat are people who have been on these medications for a long time, and they can't get it anymore."
Danish biotech giant Novo Nordisk, which manufactures the drug, said that the company has been experiencing "intermittent supply disruptions on the Ozempic pen" in the United States. They anticipate these shortages will continue through the middle of March. Specifically, they are experiencing a shortage of the Ozempic pen that delivers 0.25 mg and 0.5 mg doses – not the drug itself. For managing type 2 diabetes, a patient usually takes the injection once a week in the arm, stomach or thigh.
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"While product continues to be manufactured and shipped, patients in some areas of the country will experience delays with these doses," Novo Nordisk told Salon in an emailed statement. "While we recognize that some healthcare providers may be prescribing Ozempic® for patients whose goal is to lose weight, Novo Nordisk does not promote, suggest, or encourage off-label use of our medicines and is committed to fully complying with all applicable US laws and regulations in the promotion of our products."
"The patients that I treat are people who have been on these medications for a long time, and they can't get it anymore."
When asked why the company is experiencing supply disruptions, the company said it's "due to the combination of incredible demand coupled with overall global supply constraints."
According to the World Health Organization (WHO), there were 422 million people with diabetes in 2014, nearly four times the 108 million people diagnosed with the condition in 1980. Type 1 diabetes occurs when the pancreas produces little to no insulin. Type 2 diabetes occurs when one's body either resists or does not produce enough insulin, which is the hormone that manages the glucose level in the body. There are conflicting theories over whether type 2 can be reversed, as Salon previously reported, though it is well-established that it can be managed through diet and exercise. As a whole, diabetes remains one of the primary causes of heart attacks, kidney failure, strokes, blindness and lower limb amputation.
Ozempic was first approved by the Food and Drug Administration (FDA) in 2017 for type 2 diabetes. A new formulation, Wegovy, was approved in 2021 for obesity.
As previously reported for Salon, semaglutide can help with obesity and diabetes because it works on GLP-1 receptors, which control blood sugar. Dr. Ahmet Ergin, founder and entrepreneur of SugarMD, told Salon that Ozempic works as a "gastrointestinal hormone mimicker," by creating the hormones that signal appetite or fullness. "Then it notifies the pancreas to inform that there's food that needs to be processed and insulin is needed," Ergin said. "With type two diabetics on most obese insulin resistant-patients, that mechanism is broken and they are resistant to the effect of that hormone not that they don't have it— it's just that hormone does not work anymore."
Ozempic helps the body overcome that resistance. If a person can't refill their prescription, Ergin said a person's blood sugar can go up. He clarified that Ozempic is not a replacement for insulin, and hence patients don't become dependent on it; rather, if they can't refill their prescription, "their sugar goes up and they gain weight back, then they're not happy about it, but doctors typically try to find an alternative."
Dr. Crandall, from the Albert Einstein College of Medicine, told Salon she tries to prescribe alternatives, but those are typically unavailable right now, too.
"Each time we have to change prescriptions and try a different, maybe similar medication, frequently that initiates a whole sequence of prior authorization requests and calling the insurance company and providing them data and filling out forms," Crandall said. "And there's a cost to that for the healthcare system."
"These medications are phenomenally expensive, whether they're being used for obesity or being used for diabetes."
Crandall emphasized that treating obesity with semaglutide is an important use for the drug. She believes that it is important to differentiate between the demand for the drug to treat clinical obesity, and the demand for those who use it for cosmetic purposes. If a type 2 diabetes patient is unable to refill their prescription, the situation is not quite "as acute and critical" as when someone can't refill their insulin prescription, which has also been an issue for people with diabetes. High costs, supply chain disruptions and patent issues have been to blame for insulin's inaccessibility. In 2018, a study in the Lancet Diabetes and Endocrinology journal estimated that 79 million people with type 2 diabetes will need insulin by 2030, and half of them will not be able to receive it.
"Some patients who have been taking Ozempic or similar medications who can't get it now, we're having to temporarily have them start using insulin, which is not to say that insulin is a bad drug or that's a big tragedy," Crandall clarified. "But the side effect profile with insulin is different, the requirement for frequent blood sugar monitoring because of the risk of low blood sugar is greater." Crandall added that many people who use insulin gain weight, which is "not a good thing for most people with type two diabetes."
Crandall said the interconnectedness of both Ozempic and insulin shortages speak to hardships diabetes patients face in accessing treatment.
"These medications are phenomenally expensive, whether they're being used for obesity or being used for diabetes," Crandall said. "And that said, lots of people even though it may be covered by their insurance, their payment is still several hundreds of dollars a month and they can't afford it."
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