Semaglutide has gone viral. Ozempic and other glucagon-like peptide-1 (GLP-1) receptor agonists are so popular that more than 24 million Americans—about 7% of the population—could be taking them for weight loss by 2035, according to the latest estimates.

The medications have been hailed as “a significant leap forward in tackling obesity,” which affects 41.9% of the U.S. population and is linked to higher rates of heart disease, stroke, type 2 diabetes, and certain cancers. Research shows that the drugs led to substantial, sustained weight loss and adults who took Semaglutide for two years lost an average of 15% of their body weight.

“We’re seeing a lot of the data about the increased use of weight loss medications in individuals with different medical conditions, after undergoing weight loss surgery, and in different age and gender brackets,” says Russell Robbins MD, Chief Medical Information Officer at PurpleLab. “Data about the social determinants of health can also help us understand which segments of the population are or are not receiving medications for weight loss.”

Understanding SDoH and Weight

The social determinants of health (SDoH) include education, housing, geography, disability, income, and other conditions where people are born, raised, live, and work that impact their health, including weight. 

Low-income individuals and those living in food deserts have limited access to healthier food choices; lower levels of education and Medicaid/Medicare coverage were also correlated to higher obesity rates. In some studies, SDoH was associated with up to a 70% higher presence of overweight and obesity. 

Prescriptions for weight loss drugs are also highest in states with a greater prevalence of obesity and PurpleLab data found that age, race, and healthcare coverage have little effect on who receives prescription weight loss drugs. It’s data that can help companies better understand the footprint of these drugs in the market and their impact across populations.

“Having data that shows the areas where weight loss drugs are being prescribed more than others is good information for non-healthcare providers who want health data to figure out business strategies,” Robbins adds. In addition, “this information helps life science companies understand where their distribution areas are and how to support the patients and providers in these regions.”

The Payer Predicament

Semaglutide offers a long-term solution weight loss. Weight loss drugs can decrease daily calorie intake by up to 30% and GLP-1 medications have been linked with improved cardiovascular risk factors, including reductions in blood pressure and lipid levels, and sustained weight loss. The costs of these medications can be expensive, and are often not covered by commercial health insurance.  The out-of-pocket costs for semaglutide can top $1,300 per month. 

“With any new treatment, it’s often not a covered benefit in the beginning; it goes under prior authorization and there is regulation and monitoring by the plan and the payer,” Robbins says. “Those [restrictions] gradually go away as payers monitor that information over time.”

Currently, the medications are being covered under many commercial and government insurance programs.  However, benefit designs, state and other regulations may make access difficult to some segments of the population seeking the medications.  As research continues to provide data on long term use of the medications   demonstrating potential health benefits beyond diabetes management and weight loss, which could expand insurance coverage for the medication.

Although more than 68% of patients stopped taking semaglutide in the first 12 months because of the side effects—and payers who experience similar discontinuation rates could be faced with 26% waste in drug spend—the medications have the potential to decrease medical costs from obesity and comorbid conditions.

A combination of factors including the obesity-related risks for chronic disease and associated costs, pharmacy benefit manager recommendations and patient demand has more plans considering coverage for weight loss drugs. Robbins believes the medications will remain popular, especially as a tool to address the links between obesity and the social determinants of health.

“Weight loss drugs are pretty well prescribed and established at this point,” he says. “It’s not just the 25-to 40-year-old, commercially insured people who are seeking this medication; it’s all ages, all income levels. Everybody who needs to get the medications is getting access to it.”

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