It’s complicated: Hollywood Elites didn’t use everyone’s diabetes medication

No, Hollywood elites on crash diets don’t buy up all the semaglutide (Ozempic, Wegovy) and leave none for diabetics. The reasons behind the recent shortage of GLP-1 agonists are numerous and complex, doctors say.

W. Scott Butsch, MD, director of obesity medicine at the Bariatric and Metabolic Institute at the Cleveland Clinic, called it a “perfect storm of events.” He and others say semaglutide maker Novo Nordisk’s supply chain problems with semaglutide may have tipped the scale amid increased demand for GLP-1 agonists from a wider range of patients and providers, increased awareness of the drugs and better access for some patients.

GLP-1 agonists that were available for diabetes and then approved for obesity, like semaglutide and liraglutide (Victoza, Saxenda), gave obesity specialists the confidence to prescribe them, Busch said. The new indications also led to “an increase in demand from primary care physicians or providers who may not normally treat their patients or who may be nervous or uncomfortable prescribing an anti-obesity medication due to bias [against] obesity as a disease,” Butsch said MedPage today.

With positive clinical trial results for the type 2 diabetes drug tirzepatid (Mounjaro), a dual GLP-1/GIP agonist that led to 20% or more reduction in body weight for half of trial participants, “people kind of jumped” in prescribing it off-label for obesity, Butsch said, knowing it will likely get approval for that indication after being fast-tracked by the FDA.

Doctors confirmed that patients without diabetes are prescribed Ozempic and Mounjaro off-label for obesity, even though the two diseases often go hand in hand. The majority (80% or more) of people with type 2 diabetes are also overweight or obese, although a smaller proportion of people with obesity have type 2 diabetes.

Ethan Melillo, PharmD, an ambulatory diabetes pharmacist working in primary care in Rhode Island, said MedPage today that doctors might prescribe a GLP-1 agonist intended to treat type 2 diabetes to an obese patient “because they don’t meet the BMI criteria for Wegovy or Saxenda, so they’re trying to see, ‘Oh, can we get [insurance approval] to Ozempic?'”

He added that providers may indicate that the patient is pre-diabetic, “and then some patients will pay out of pocket for that as well.”

Fatima Cody Stanford, MD, MPH, MPA, MBA, an obesity medicine specialist at Massachusetts General Hospital in Boston, said she has also had diabetes patients who never wanted to use needles change their minds about GLP-1 agonists based on, what they hear from friends, family or online.

“All of a sudden they heard about that Mounjaro, ‘Can I start?'” Stanford said. “Like, ‘wait, I’ve been trying to get you on an injectable for four years.'”

Doctors also say that since a first wave of semaglutide patients have had time to see their health markers improve, popular media has caught on.

“It’s been on TikTok, it’s been on national news, it’s been in the papers. My friends and my interns had been on 60 Minutes, and it’s everywhere,” Butsch said.

Melillo also believes that social media has stimulated demand. He cited a popular corner of TikTok and Instagram, #mounjarojourney, which is “all these people using Mounjaro for weight loss.”

Some patients whose insurance would not have covered the anti-obesity drugs now may, Stanford said. Voucher programs have also made it easier for those without insurance coverage to pay for them, at about $25 a month, Butsch and Melillo said.

Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center in Boston, said she suspects inappropriate prescribing may also play a role in shortages.

It is easy to find offers for semaglutide at med spas and compounding pharmacies, which may be using versions of the drug whose integrity is difficult to verify. The prescribers have also spread in a pandemic telehealth boom. These alternative routes to GLP-1 agonists are available to people with the means to pay themselves or pay a monthly subscription fee, and some prescribers may not follow clinical guidelines to the letter.

“There have been these things written by some doctors saying, ‘No, inappropriate prescribing doesn’t affect supply,'” Dushay said. “But it just seems impossible. Right? It seems absolutely impossible. There isn’t an infinite supply.”

Butsch said these practices in particular contribute to further stigmatizing obesity. “You have this inappropriate prescribing with people probably without obesity or diabetes who are just fanning the flames that obesity is a cosmetic problem, and that discredits the reality that it is a disease, which further fuels this controversy.”

Fortunately, experts don’t think the shortage will last – but they’re not sure.

Stanford said she has been able to start new patients on Wegovy recently as the shortage of some doses has eased, and she is cautiously optimistic.

“Let’s say you like Reese’s Peanut Butter Cups and your local CVS carries them and they say, ‘Oh, we’re going to restock.’ And you say, ‘Okay, that’s great.’ And then you go, you get some … and then you go back in a week and you’re like, ‘What? There’s nobody — where did it go?'” Stanford said. “That’s how I feel right now,” but she added, “I’m hopeful.”

  • Sophie Putka is a business and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire and more. She joined MedPage Today in August 2021. Follow

Information

Butsch reported consulting Novo Nordisk.

Stanford disclosed consulting and other financial relationships with Novo Nordisk, Currax, Eli Lilly, Boehringer Ingelheim and Rhythm.

It’s complicated: Hollywood Elites didn’t use everyone’s diabetes medication

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