What People With Diabetes Need to Know

What Is Ozempic, or Semaglutide, Anyway?

Ozempic is a type 2 diabetes drug used to manage blood sugar. It also aids weight loss, and is sold as Wegovy to treat obesity. Wegovy is sold at higher doses than Ozempic.

Some experts speculate the people driving the shortage of these drugs, both of which are injected, have neither obesity nor diabetes. “I worry more that people who do not have obesity or diabetes are buying semaglutide at its out-of-pocket cost to get skinnier, likely stirred on by TikTok videos or Variety articles,” says Beverly Tchang, MD, an endocrinologist and assistant professor of clinical medicine at Weill Cornell Medicine and New York Presbyterian Hospital in New York City.

“Patients with diabetes and patients with obesity both deserve treatment, and the shortage of semaglutide in general affects both populations,” adds Dr. Tchang.

Amid the current shortage, dieters may be more likely to turn to Ozempic because it has a lower retail price and is more likely to be covered by insurance compared with Wegovy. Wegovy has a steep retail price of $1,500 for a 30-day supply.

The good news is people with diabetes still have other medicines they can take instead of Ozempic, including several in the same family of medicines as semaglutide, Tchang says. Ozempic is what’s known as a glucagon-like peptide-1 (GLP-1) receptor agonist, a class of drugs that also includes liraglutide (Victoza), dulaglutide (Trulicity), and exenatide (Bydureon).

Newcomer tirzepatide (Mounjaro), a dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, is another diabetes treatment option for blood sugar management and weight loss.

That said, there is robust research on the perks of semaglutide, a drug that has been on the market longer than tirzepatide, that may be compelling celebrities and lay dieters alike to flock to their doctors’ offices for off-label prescriptions of this drug specifically.

Research on the Weight Loss Benefits Linked to Semaglutide

In a clinical trial published in 2021 in The New England Journal of Medicine (NEJM), researchers followed 2,000 adults with obesity who didn’t have type 2 diabetes for more than five years. All of the participants were asked to make lifestyle changes to improve their eating and exercise habits. Two-thirds of them were randomly selected to receive a weekly semaglutide injection at a 2.4-milligram (mg) dose — the highest available dose for the weight-loss drug Wegovy — while the remaining one-third received a placebo injection.

By the end of this trial, people on semaglutide lost about 15 percent of their body weight on average — compared with about 2.4 percent for the placebo group. Most participants receiving the drug (1,047 participants, or about 86 percent of the medication group) lost at least 5 percent of their weight, the minimum target doctors recommend to help prevent or reverse a wide range of health problems associated with obesity. Meanwhile, only 182, or about 32 percent in the control group, lost at least 5 percent of their weight.

Many people taking semaglutide in this trial did even better. More than two-thirds of them lost at least 10 percent of their body weight. And about one-third shed at least 20 percent of their weight, a result similar to what people can typically achieve with weight-loss surgery, the study authors note.

A separate trial, published in 2021 in The Lancet, tested two doses of semaglutide — the 1 mg dose that’s the maximum available with Ozempic and the maximum Wegovy dose of 2.4 mg — in about 1,200 people with type 2 diabetes who were also overweight or obese. Everyone in the trial got regular support to improve their eating and exercise habits, and three equal groups were randomly assigned to take a placebo or one of the two semaglutide doses.

After more than five years in this trial, people on the higher semaglutide dose lost 9.6 percent of their body weight on average, and those on the lower dose lost an average of 7 percent of their weight, compared with 3.4 percent for the placebo group.

“This is by far the best result we have had with any weight loss medicine in patients with diabetes,” senior study author Ildiko Lingvay, MD, MPH, a professor and endocrinologist at the University of Texas UT Southwestern Medical Center in Dallas, said when this study came out. “With this drug, results are getting [closer] to what we see with bariatric surgery, which is 20 to 30 percent weight loss.”

Other weight loss drugs don’t come close to the results patients get with semaglutide, according to a review of anti-obesity treatments published in January 2021 in Current Obesity Reports. In this study, researchers calculated weight loss in participants with obesity for lifestyle interventions alone or combined with medications. They found participants lost an average of 6.8 percent of their body weight with Qsymia (hentermine-topiramate), followed by 5.4 percent with Victoza (liraglutide), 4 percent with Contrave (naltrexone-bupropion), and 2.9 percent with Xenical (orlistat), also sold over the counter as Ally.

Semaglutide Side Effects and the Complicated History of Weight Loss Drugs

While the weight loss seen with semaglutide seems dramatic, the medicine isn’t risk-free.

In clinical trials, the majority of people on semaglutide experienced gastrointestinal side effects, such as nausea, diarrhea, vomiting, and constipation. Most side effects were mild to moderate, but around 5 percent of individuals discontinued trials due to treatment-related gastrointestinal problems and around 10 percent of patients experienced serious adverse events.

When the FDA approved Wegovy for weight loss in 2021, it warned that the drug carries a risk of serious side effects, such as pancreatitis, gallstones, dangerously low blood sugar, acute kidney injury, eye damage, increased heart rate, and suicidal behavior or thoughts.

None of the clinical trials that prompted the FDA to approve Ozempic and Wegovy involved people at a healthy weight. This makes it unclear how safe or effective the drug would be for dieters without overweight or obesity who still want to lose a few pounds.

The FDA has withdrawn approval for several weight loss drugs over the years due to concerns about severe or potentially life-threatening side effects, an editorial accompanying a semaglutide obesity study in The New England Journal of Medicine noted. These include several amphetamines that caused addiction; fenfluramine, which caused heart valve damage; and lorcaserin, which increased the risk of cancer.

A High Price for Weight Loss

As often happens with prescription drugs that are approved for different uses, the cost of semaglutide is drastically different depending on which version people get. It also depends on whether the drug is being prescribed for an approved use, and the person’s insurance coverage of the drug.

For someone without any insurance coverage of the drug, regardless of whether they’re receiving the drug for an FDA-approved use or off label, Ozempic costs about $1,000 and Wegovy costs about $1,600 for a 30-month supply.

Compared with Wegovy, Ozempic is more likely to be covered by insurance. Medicare and certain insurance plans may cover the drug only for someone who has type 2 diabetes — its FDA-approved use — while other plans may cover Ozempic in part or in full when prescribed off label.

Wegovy, like other obesity drugs, is less likely than Ozempic to be covered by insurance even among those people who meet the criteria for its FDA-approved use. (Medicare [PDF] does not cover weight loss drugs.) Specifically, this drug is approved for people who are overweight with a body mass index (BMI) of at least 27 and one weight-related health condition, like high blood pressure or high cholesterol, or people who are obese with a BMI of 30 or more, according to the FDA.

Practically speaking, this means even people who are a little bit overweight, with a BMI between 25 and 27, may not get insurance to pay for Wegovy. Suffice it to say, anyone taking Wegovy off label for weight loss is paying a steep price.

Dieters Appear to Be Driving Shortages of Semaglutide

Despite these high drug prices, people are clearly fighting for access to them for one reason or another.

In August 2022, drugmaker Novo Nordisk, which sells both Ozempic and Wegovy, said Wegovy was becoming hard to get as a result of “supply constraints following unprecedented product demand and short-term manufacturing issues.” At the time, the company said it had asked healthcare providers not to start new patients on Wegovy and halted shipments of the two lowest doses of the drug typically used as initial weight-loss treatments. These moves may have heightened off-label demand for Ozempic for weight loss, doctors say.

At the same time, many dieters left to pay the full retail price for semaglutide are seeking out Ozempic even though it’s not approved for weight loss, because it’s cheaper than Wegovy, doctors say. These off-label prescriptions of Ozempic to dieters are most likely playing a role in shortages, says Vivian Fonseca, MD, a professor of medicine and pharmacology and chair of endocrinology at Tulane University Health Sciences Center in New Orleans.

Other diabetes drugs used off-label for weight loss are still readily available, including the older generic pill metformin, Dr. Fonseca says. The FDA first approved Mounjaro to treat type 2 diabetes. Mounjaro retails for about $1,000 without insurance. Despite the high price tag, the medication has been in high demand and is experiencing intermittent shortages.

In November 2023, the agency approved tirzepatide for weight loss under the name Zepbound. In a study published in Nature Medicine of over 800 people weighing an average of 241 pounds, tirzepatide, in combination with rigorous lifestyle improvements over the course of three months, helped people lose more than 60 pounds. It’s not clear whether the newly approved drug for weight loss will help or hurt demand for similar medications.

For now, people taking Ozempic to manage type 2 diabetes have many good options that should help them weather the current shortage of this medicine, Fonseca says. For example, many people with type 2 diabetes who can’t get semaglutide due to current shortages can take another similar medicine such as Victoza or Trulicity, which like Ozempic are GLP-1 receptor agonists, says Robert Kushner, MD, a professor of endocrinology at the Northwestern University Feinberg School of Medicine in Chicago.

“GLP-1 receptor agonists are a wonderful medication for treatment of any patient with type 2 diabetes — and in particular for those who would also benefit from weight loss,” Kushner says. It’s a good thing this is true because the shortage might be here for a while. “I do not know when it will end,” Dr. Kushner adds.