Xinhua News Agency, New York, Aug. 25 The new generation of hypoglycemic and weight loss drugs such as Semaglutide and tilpotide, such as Ozempic, have been very popular in the United States since their listing, and the market demand has grown rapidly, and even become the "net red" products on the street.
But the high price of these drugs, and the many restrictions on using insurance to pay for them, vary widely in their availability to people of different income levels in the United States. This has raised concerns among some medical professionals and reflects longstanding inequities in the U.S. health care system.
Semaglutide, developed by Novo Nordisk in Denmark, is a glucagon-like peptide-1 (GLP-1) receptor agonist, which can promote insulin secretion, inhibit glucagon secretion, delay gastric emptier and increase satiation, inhibit hypothalamic feeding center and inhibit appetite, and achieve the effect of lowering blood sugar and weight loss.
Tilpotide, developed by Eli Lilly, is a double agonist of glucose-dependent insulin-stimulating polypeptide receptor and GLP-1 receptor, which has more mechanistic advantages in lowering blood sugar and weight loss.
These drugs were originally developed for the treatment of diabetes, and were found to significantly reduce weight and have controllable side effects. In some countries and regions, such as the United States, they have been approved for the treatment of obesity, which has been publicly supported by some well-known people in the United States and even become a hot topic on social media, which has led to a surge in demand for them in the United States market.
Approved forms of Semaglutide include Rybelsus, an oral tablet for the treatment of type 2 diabetes; Ozempic, an injectable injection for the treatment of type 2 diabetes; and Wegovy, an injectable injection containing higher doses of semaglutide for the treatment of obesity.
An article by the Pew Research Center in the United States, citing Novo Nordisk's annual report, said that in 2023, the three forms of Semaglutide combined to create sales of up to $21.1 billion for the company, a sharp increase of 89% from the previous year; In 2023, 71% of the global sales revenue of Simeaglutide will come from the US market.
However, as a new generation of hypoglycemic and weight loss drugs, GLP-1 receptor agonists are difficult to benefit all patients who meet the drug conditions. In the United States, injections of such drugs can cost up to about $1,000 to $1,300 a month for a course of treatment, and often require long-term medication.
According to US media reports, commercial insurance in the United States can generally cover the cost of diabetes treatment, but the reimbursement of weight loss drugs is inconsistent; Medicaid, the government health insurance program for low-income Americans, does not cover the cost of weight-loss drugs in most states, and only 10 states include them in the program, with strict limits on the types of drugs used.
This makes the low-income people who are suitable for GLP-1 receptor agonists, especially low-income obese patients, face the dilemma of "drug difficulty".
At the same time, in the United States, the risk of chronic diseases such as obesity and diabetes is related to income level, and the prevalence is higher in low-income people.
According to the results of a survey released by the Centers for Disease Control and Prevention in 2022, between 2011 and 2014, the prevalence of obesity among adults in the United States whose household income is more than 3.5 times the federal poverty line was 31.2%, and among those whose household income is 1.3 to 3.5 times the federal poverty line and less than 1.3 times the federal poverty line, The corresponding proportions were 40.8% and 39.0%, respectively.
The gap between rich and poor in the United States and the risk of diseases such as obesity and diabetes are also closely related to race. According to data released by the Federal Reserve in 2021, the average income of a black, Hispanic or Latino family in the United States is about half that of a white family, and the net wealth is only 15 to 20 percent of that of a white family.
According to 2021 data from the Centers for Disease Control and Prevention, 49.9% of black adults and 45.6% of Hispanics have a body mass index (BMI) of 30 or higher (the CDC defines a BMI of 30 or higher as obese), compared with 41.1% of whites.
Due to a combination of factors, some minority populations in the United States face serious barriers to access to GLP-1 agonist drugs. In a paper published in the Journal of the American Heart Association, Yale New Haven Hospital researchers said that among Americans eligible for Semaglutide, a greater proportion of black and Hispanic adults than adults of other ethnic groups face financial barriers.
In addition to objective economic factors, medical professionals sometimes have unconscious biases, such as the belief that "patients of certain races and ethnicities are less likely to be able to afford, understand, or accept the use of certain classes of drugs," which can exacerbate the problem of racial disparities in prescribing semiglutide, the researchers wrote.
In addition, due to the hype about the weight-loss effects of GLP-1 agonists, irregular prescribing has also led to competition among patients with diabetes and obesity, complicating the problem.
At one point, Wegovy was in short supply due to production problems, and many people on social media touted Ozempic as an "off-label" alternative to Wegovy, leaving many diabetics without access to the drug, according to the Washington Post.
Muhammad Ali, co-director of the Global Diabetes Research Center at Emory University in the United States, said in a report that a year or two ago, many of his patients were covered by insurance for such drugs, but recently some patients with similar conditions have been denied coverage by insurance companies, meaning that those who cannot afford to pay out of pocket are left behind. He thinks it may be that the drugs are so sought-after that insurance systems are starting to think about how to limit their use.
