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More than half of all adults in the U.S. are eligible for semaglutide (Ozempic, Wegovy, Rybelsus), researchers estimated.

Among 25,531 participants in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2020, 8,504 were eligible for semaglutide, representing an estimated 136.8 million adults across the country. All met the criteria for at least one of three indications that the drug is currently approved for -- diabetes, weight management, or secondary cardiovascular disease (CVD) prevention, reported Dhruv S. Kazi, MD, MSc, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

"This exceeds the number of adults eligible for statins (approximately 82 million), currently the most prescribed pharmaceuticals among U.S. adults," they wrote in a research letter in .

The findings were also presented at the American Heart Association annual meeting.

Despite semaglutide's quick rise in popularity, more than half of adults who have taken a GLP-1 receptor agonist said the drugs are "difficult to afford," making interventions to reduce financial barriers "urgently needed," noted Kazi's group.

"Quantifying the number of U.S. adults eligible for semaglutide may guide future policies for this high-cost therapy and clarify potential implications for pharmaceutical spending," they wrote. "Efforts to increase equitable uptake should be coupled with strategies to ensure that the cost of semaglutide is commensurate with the value of the health benefits it produces."

Of the estimated 136.8 million eligible adults, there was a lot of overlap in which indications qualified people, with 4.5 million adults qualifying for all three indications:

• Weight management: 129.2 million adults, 97.5 million of whom exclusively qualified for this indication
• Diabetes: 35 million adults, with 7.6 million exclusively qualifying for this indication
• Secondary CVD prevention: 8.9 million adults, with all also qualifying for one or both other indications

Of note, an estimated 39.3 million eligible adults qualified for an indication other than weight management. This is important because there are higher rates of insurance coverage for secondary CVD prevention compared with weight management, Kazi's group pointed out.

"Although most of these individuals are eligible for semaglutide based on the weight-management indication that is not universally covered by payers, we estimate that more than 39 million adults qualify for indications other than weight management alone, a substantial increase over the estimated 15 million currently taking a GLP-1 receptor agonist," they wrote.

Semaglutide, under the trade name Ozempic, was first approved in late 2017 in 0.5-mg and 1-mg injectable doses for the treatment of type 2 diabetes. In 2019, an oral form of semaglutide was approved in 7- and 14-mg tablets for type 2 diabetes, sold under the trade name Rybelsus.

In 2021, semaglutide was approved in a 2.4-mg dose for chronic weight management in adults with obesity, or overweight with at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol, and is sold under the trade name Wegovy, which also picked up an indication to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.

All three are to be used in conjunction with a reduced calorie diet and an exercise regimen.

For this study, Kazi and colleagues included nonpregnant U.S. adults from NHANES surveys who would be eligible for semaglutide treatment. Semaglutide eligibility was determined by applying the inclusion and exclusion criteria of key randomized clinical trials across the three treatment indications. Those with end-stage kidney disease undergoing dialysis or those with a history of weight-loss surgery were excluded.

Those qualifying for the weight management indication tended to be younger than those qualifying for diabetes or secondary CVD prevention (50.1 vs 59.6 and 66.2 years, respectively).

Among semaglutide-eligible adults, an estimated 26.8 million were insured by Medicare, 13.8 million were insured by Medicaid, and 61.1 million were covered by private insurance.

A key limitation to this study was the inability to accurately identify certain rare contraindications to semaglutide, such as medullary thyroid cancer, due to data availability, "but these are unlikely to substantially bias our estimates," the authors wrote.

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