Semaglutide Rocketing Past Statins as Millions Eligible

About 40% of American adults — some 137 million — are eligible to take the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide, said authors of a new study.

Currently, statins are the most commonly prescribed medication for American adults, with some 192 million prescriptions written in 2022, according to one estimate. The authors of a research letter published online in JAMA Cardiology estimate that at least 82 million American adults are eligible for statins.

Semaglutide will quickly overtake statins as the most-prescribed pharmaceutical for American adults, said the authors. It was the top-selling drug in the United States in 2023, with sales of almost $14 billion, which made it worth taking a closer look at who might be eligible, said lead author Dhruv S. Kazi, MD, MS, associate professor of medicine at Harvard Medical School, Boston.

“We’re hoping to stimulate a transparent public conversation about the number of adults who are eligible,” Kazi told Medscape Medical News.

Kazi said it seems the United States doesn’t really have what he calls a “game plan” to ensure broad and equitable access to a high-cost, but effective medication. “If we can’t afford to treat everybody or offer the treatment to everybody,” he said, then there needs to be something like a “risk-based approach where individuals at greatest risk for adverse consequences related to either overweight or obesity or cardiovascular disease or diabetes are prioritized.”

He and his colleagues at Beth Israel Deaconess Medical Center, Boston, the Harvard T.H. Chan School of Public Health, Boston, and the Feinberg School of Medicine at Northwestern, Chicago, used data from the National Health and Nutrition Examination Survey from 2015 to 2020 to determine how many American adults might be eligible for semaglutide. They focused on diabetes, weight management, and secondary prevention of cardiovascular disease, using inclusion and exclusion criteria from major randomized clinical trials of semaglutide in those indications.

The authors report that 35 million adults are eligible for semaglutide for diabetes, 129 million for weight management, and 8.9 million for secondary cardiovascular disease prevention.

Semaglutide for secondary prevention is likely to be an area of increased growth, as there is more insurance coverage for that indication, the authors wrote.

“The numbers are staggering, but not entirely surprising,” said Beth Abramson, MD, MSc MD, Paul Albrechtsen Professor in Cardiac Prevention and Women’s Health in the Division of Cardiology at the University of Toronto, Toronto, Ontario, Canada. “Most of us will have many patients that would qualify for this new intervention,” she told Medscape Medical News.

The data are a “call to action” because “it gets us thinking about the issues at hand,” said Abramson, a member of the Prevention Council for the American College of Cardiology.

While millions of American adults might require these expensive medications, their use can ultimately lead to cost savings, said Abramson. Studies have shown that at high doses, semaglutide has reduced cardiovascular events, she said. “Cardiologists need to think about this when they’re seeing their patients and learn about this newer class of drugs,” Abramson said.

She also said semaglutide should only be one piece of the puzzle for patients who need help with weight management. Many patients “need help with making some healthier lifestyle choices,” said Abramson.

Kazi and his coauthors said that American policy makers and clinicians should not ignore the train that’s barreling down the tracks. “We’re going to have to figure out pricing, we’re going to have to figure out supply chains,” said Kazi. And, he said, the medical community will have to get past “the stigma of treating overweight and obesity.”

But, he said, even if clinicians become more comfortable prescribing semaglutide and other GLP-1s, “the cost issue doesn’t go away.”

“We’re going to have to have serious conversations as a society,” said Kazi.

Kazi and his coauthors reported grants outside of the work in the paper. Co-author Sadiya Khan, MD, is an associate editor of JAMA Cardiology but was not involved in any of the decisions regarding review of the manuscript or its acceptance. Abramson reported honoraria from CPD Network Association, Amgen, AstraZeneca, Bayer, BioSyent, BMS-Pfizer, Boehringer Ingelheim, CHRC, HLS Therapeutics, Novartis, Novo Nordisk, Sanofi, and Servier.

Alicia Ault is a Saint Petersburg, Florida–based freelance journalist whose work has appeared in publications, including JAMA and Smithsonian.com. You can find her on X @aliciaault.