In a new analysis of national data, researchers at the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center (BIDMC) estimated that 137 million U.S. adults, more than half of all adults, are eligible for semagludtide for weight loss, diabetes management, or prevention of recurrent cardiovascular events. The findings, which were presented at the American Heart Association Scientific Sessions and simultaneously published in JAMA Cardiology, underscore the need to increase equitable access to this new class of pharmaceuticals.
"These staggering numbers mean that we are likely to see large increases in spending on semaglutide and related medications in years to come," said corresponding author Dhruv S. Kazi, MD, MS, associate director of the Smith Center and director of the cardiac critical care unit at BIDMC. "Ensuring equitable access to these effective but high-cost medications, as well as supporting individuals so that they can stay on the therapy long-term, should be a priority for our clinicians and policymakers."
Semaglutide, which belongs to a class of drugs known as GLP-1 receptor agonists, is currently approved for the management of diabetes, treatment of overweight or obesity, and prevention of recurrent cardiovascular disease (e.g., in patients who have already experienced a heart attack or stroke or are living with peripheral artery disease). About 15 million adults—just over ten percent of those who are medically eligible—currently take semaglutide, which was the top-selling drug in the United States in 2023 in terms of total pharmaceutical spending. But rapidly emerging data about its effectiveness for other health conditions is likely to further expand its use in future years. For instance, semaglutide improves symptoms in sleep apnea and in some types of heart failure and slows the progression of chronic kidney disease. Semaglutide and others in its class are currently being evaluated for the treatment of liver and kidney diseases, substance use disorders and dementia.
Ivy Shi, MD, who is a resident in internal medicine at BIDMC, worked with Kazi to produce the analysis. They used five years' worth of recent data from the National Health and Nutrition Examination Survey, a long-running survey of the U.S. population run by the U.S. Department of Health and Human Services, to identify U.S. adults aged 18 years or older who would be eligible for semaglutide treatment based on currently approved indications. They analyzed information about 25,531 survey participants gathered through in-person interviews, physical examinations, and laboratory testing.
They found that of the 136.8 million US adults eligible for semaglutide, 35.0 million adults would be eligible for the medication for diabetes management, 129.2 million adults for weight loss, and 8.9 million adults for secondary prevention of cardiovascular disease. The semaglutide-eligible population includes 26.8 million adults covered by Medicare, 13.8 million covered by Medicaid, and 61.1 million covered by commercial insurance.
"The large number of U.S. adults eligible for semaglutide highlights its potential transformative impact on population health," said Shi. "Prior studies have shown that more than half of the individuals who have taken these medications state the therapy was difficult to afford, interventions to reduce economic barriers to access are urgently needed."
Co-authors included: Ivy Shi, MD, MBA, Robert W. Yeh, MD, MSc, MBA, Jennifer E. Ho, MD, and Issa Dahabreh, MD, MS, ScD of BIDMC; and Sadiya S. Khan, MD, MSc, of Feinberg School of Medicine, Northwestern University.
