More than half of all US adults are eligible for semaglutide therapy

Semaglutide eligibility surpasses statins as more than 137 million US adults are now eligible, driven by expanding indications beyond weight management.

In a recent study published in JAMA Cardiology, researchers from the United States (US) assessed the eligibility of US adults for the diabetes medication semaglutide based on three major indications, namely diabetes status, weight management, and cardiovascular disease prevention.

By analyzing demographic and clinical data, they aimed to estimate how many individuals might qualify for this costly but widely used medication — information that could be used to inform future policies on diabetes management and pharmaceutical budgets.

Background

Semaglutide has been approved by the US Food and Drug Administration (FDA) for managing type 2 diabetes, weight loss, and cardiovascular risk reduction in adults. It functions as a glucagon-like peptide-1 receptor agonist, promoting insulin release and reducing blood glucose levels, which also supports weight management.

Initially, semaglutide was primarily prescribed for diabetes, but its usage has broadened significantly due to its effectiveness in weight control and reducing cardiovascular events. Given its benefits, the demand and use of semaglutide have surged, making it one of the highest-selling drugs in the United States.

However, with growing demand comes an increase in healthcare costs, as many eligible patients may not have adequate coverage for the broader indications of semaglutide. Thus, understanding the demographics of eligible populations across various indications is essential for informing healthcare policies and effectively managing associated costs.

About the study

In the present study, the researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020 to identify eligibility for semaglutide among US adults. NHANES is a large, cross-sectional survey that samples non-institutionalized adults across the US and gathers health information through interviews, physical exams, and lab tests using a multistage probability approach.

The researchers determined the eligibility for semaglutide using three main indications: diabetes management, weight management, and secondary cardiovascular disease prevention. For diabetes management, the eligibility criteria included a diabetes diagnosis, a hemoglobin A1c (HbA1c) level of at least 7.0%, or current use of diabetes therapies.

The weight management criterion consisted of a body mass index (BMI) of 30 or higher or a BMI of 27 or above if the adults also had conditions such as hypertension, hyperlipidemia, or a history of stroke or myocardial infarctions. For cardiovascular disease prevention, the criteria included an age of 45 or older with a BMI of 27 or more and a history of stroke or myocardial infarctions.

The study excluded end-stage kidney disease patients on dialysis and those who had previously undergone weight-loss surgery. The sample data were then scaled to represent the 2020 US adult population.

Results

The study found that approximately 136.8 million US adults, which constituted over half of the adult population of the country, were eligible for semaglutide treatment. For diabetes management, an estimated 35 million adults qualified based on self-reported diabetes diagnoses, elevated HbA1c levels, or existing use of diabetes treatments.

A much larger group of approximately 129.2 million adults qualified under the weight management criteria, which included individuals with a BMI of 30 or more or those with a BMI of at least 27 who also had conditions such as hypertension or high cholesterol.

Furthermore, the cardiovascular disease prevention criteria resulted in the qualification of around 8.9 million adults aged 45 and older who met the eligibility criteria due to a high BMI and a history of major cardiovascular events, such as myocardial infarction or stroke.

The study also highlighted demographic variations within these groups. The mean age of eligible individuals was 50.7 years, with about half identifying as female. Additionally, the analysis revealed that insurance coverage differed widely. Approximately 26.8 million were insured through Medicare, about 13.8 million through Medicaid, and another 61.1 million had private insurance.

Among the eligible adults, about 39.3 million qualified for semaglutide under either diabetes or cardiovascular prevention, but not weight management alone. This subgroup included 13 million Medicare recipients and 4.7 million Medicaid recipients.

Conclusions

Overall, the study underscored the extensive eligibility for semaglutide treatment among US adults, highlighting the significant healthcare costs associated with its widespread use. With over half of US adults meeting eligibility criteria across the three major indications, understanding the distribution of eligible individuals and their insurance status is crucial.

These insights can help policymakers design strategies that address coverage gaps while ensuring the cost-effectiveness of expanding semaglutide access to every individual who requires the medication.