I have been paying close attention to the news about glucagon-like peptide 1 (GLP-1) agonist medications because they may provide a ray of hope for many patients with chronic wounds – over 60% of whom are obese and nearly half of whom have diabetes. However, I also notice that my physician colleagues are looking thinner these days. When I have congratulated friends on their transformation – they have all said, “Thanks to GLP-1 medication!” Use of these medications is now so mainstream that people are not afraid to talk about it. About 1 in 8 US adults aged 18 years or older (12% of US adults!) report having used a glucagon-like peptide 1 (GLP-1) agonist medication, according to results from a KFF (formerly Kaiser Family Foundation) poll – often for weight loss rather than for diabetes.
A recent study published in JAMA Network Open examined spending trends on GLP-1s among adults, using data on patient and insurer spending from Symphony Health that captured 85% of retail and 74% of mail-order prescription fills. From 2018 to 2023, spending on GLP-1s rose by more than 500%, from $13.7 billion to $71.7 billion. Spending on Ozempic (semaglutide) grew the most, rising from $410 million in 2018 to $26.42 billion by 2023. In 2022, after it was approved for Type 2 diabetes, spending on Mounjaro grew rapidly to $2.51 billion. By 2023, Mounjaro spending rose to $12.42 billion. Of medications indicated for obesity at the time of the analysis, Saxenda (liraglutide) rose from $560 million in 2018 to $890 million in 2023. Spending on Wegovy (the form of semaglutide indicated for obesity) grew from $580 million in 2021 to $6.99 billion by 2023. The study did not take into account drug rebates, discounts, or price concessions, so actual spending might be lower than reported. However, the study also did not include sales from compounding pharmacies for which many patients pay cash.
This same group of researchers and Lindsay Zasadzinski, MPH, of the American Medical Association (AMA), teamed up for another study that was published in the Journal of the American Heart Association to examine how spending on these drugs varied by state. The researchers compared GLP-1 use and spending by state-level prevalence of obesity across the country, drawing on a Symphony Health dataset for 2023. They noted that many southern states with high prevalence rates of obesity also have higher prescription fill rates for GLP-1s.
Soaring demand for obesity drugs has fueled a booming global market for cheaper, and sometimes even counterfeit versions of GLP-1 medications. However, the U.S. Food and Drug Administration (FDA) is tightening oversight of imports of GLP-1 drug ingredients amid concerns that many of the items may be adulterated and pose a safety risk. Also in the news, The World Health Organization has added GLP-1 drugs (to treat diabetes) to its “essential medicines” list, alongside treatments for cystic fibrosis and cancer.
Although there are concerns about adverse events and side effects (including a rare cause of sudden blindness) and the loss of muscle as well as fat, there seem to be a number of beneficial side effects such as improvements in sleep apnea, and their possible use for addiction and inflammatory conditions. In my professional life, I can’t remember a new drug with such a global impact.
Caroline
Additional Resources:
- GLP-1 RAs and Peripheral Arterial Disease? – Caroline Fife M.D.
- What Most People Want for Christmas is to Lose Weight – Caroline Fife M.D.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
