Semaglutide: From Weight Loss to Heart Health, a Game-Changer in Medicine
In 2019, Richard Neilson, a 68-year-old Toronto truck driver, survived a heart attack and underwent a double bypass surgery. Shortly after, his cardiac surgeon, Dr. subodh Verma, invited him to join a groundbreaking clinical trial for a medication that could reduce his risk of future heart attacks. The drug? Semaglutide, now widely recognized as Ozempic, a blockbuster treatment for Type 2 diabetes that has taken the world by storm for its weight-loss benefits.
Neilson, however, wasn’t in it for the weight loss. “If it was just a weight-loss thing,” he said,“I wouldn’t have even bothered.” Instead, he was drawn to the potential cardiovascular benefits of the drug. Over the course of a year, while taking Wegovy—a higher-dose version of semaglutide marketed for weight management—Neilson shed 45 pounds. But more importantly, he became part of a pivotal study that has reshaped how we think about this class of drugs.
The SELECT trial,in which Neilson participated,was a turning point. Its findings led Health Canada to approve Wegovy in November 2023 for reducing the risk of heart attacks—a first for a glucagon-like peptide-1 (GLP-1) receptor agonist in a condition beyond diabetes or obesity. This approval marks a significant milestone, as it opens the door for GLP-1 drugs to address a broader range of chronic conditions.
The Expanding Horizons of GLP-1 Drugs
GLP-1 drugs like semaglutide and tirzepatide (sold as Zepbound) are no longer confined to diabetes and weight management. The United States Food and Drug administration recently approved tirzepatide for obstructive sleep apnea, and researchers are exploring its potential for treating chronic kidney disease, non-alcoholic fatty liver disease, Alzheimer’s, and Parkinson’s.
“This would be a massive shift,” said Mina Tadrous, a University of Toronto professor specializing in pharmaceutical policy and drug safety. Traditionally, insurers have been reluctant to cover weight-loss medications, often categorizing them alongside cosmetic treatments like botox. Though,the success of GLP-1 drugs in addressing serious health conditions could force a reevaluation of thes policies.
A Challenge for Public Drug Plans
The growing list of potential uses for GLP-1 drugs presents a dilemma for Canada’s public drug plans, which have so far limited coverage of Ozempic to people with diabetes and excluded Wegovy due to its weight-management label. If these drugs gain approval for additional chronic conditions, the financial burden on public health systems could skyrocket.
For millions of overweight and obese Canadians, this could mean access to life-changing treatments. But it also raises questions about affordability and equity in healthcare.
key Takeaways: The Future of GLP-1 Drugs
| Aspect | Details |
|————————–|—————————————————————————–|
| Approved Uses | Type 2 diabetes, weight management, heart attack risk reduction |
| Potential Uses | Chronic kidney disease, Alzheimer’s, Parkinson’s, obstructive sleep apnea |
| Challenges | High costs, limited insurance coverage, strain on public drug plans |
| Impact | Improved cardiovascular outcomes, expanded treatment options for chronic diseases |
A New Era in Medicine
The story of semaglutide is far from over.As researchers continue to unlock its potential, this once niche diabetes drug is poised to revolutionize the treatment of multiple chronic conditions. For patients like Richard Neilson, it’s not just about losing weight—it’s about gaining a healthier, longer life.
As the medical community and policymakers grapple with the implications, one thing is clear: GLP-1 drugs are here to stay, and their impact will be felt far beyond the scale.
For more on the SELECT trial and its findings, visit The Lancet.
Ozempic and Wegovy Drive Record-Breaking Growth in Canadian Drug Sales
The meteoric rise of GLP-1 medications like Ozempic and Wegovy is reshaping Canada’s pharmaceutical landscape, with sales skyrocketing and public health programs grappling with the financial implications. According to data from IQVIA, a life-sciences analytics company, ozempic has become the top-selling drug in Canada, far outpacing its competitors.
In the first 11 months of 2023, nearly $2.3 billion worth of Ozempic was sold through Canadian retail pharmacies—more than double the sales of Stelara, the second-highest seller, which is used to treat Crohn’s disease and other autoimmune conditions. These figures include markups and dispensing fees, highlighting the drug’s dominance in the market.
The Off-Label Weight Loss Boom
While Ozempic is approved for managing type 2 diabetes, its off-label use for weight loss has significantly contributed to its sales surge. The IQVIA data accounts for all payers, including Canadians without diabetes who pay out of pocket to use the drug for weight management.
Wegovy,a higher-dose version of semaglutide specifically approved for weight loss,also made waves after its commercial debut in Canada last year.Between April and November 2023, Wegovy recorded nearly $147 million in sales.A 28-day supply of the weekly injectable costs $388.64 before pharmacy markups and dispensing fees, according to Novo Nordisk, the manufacturer of both Ozempic and Wegovy.
Unprecedented Growth in Drug Spending
the explosive growth of GLP-1 medications has had a profound impact on overall drug spending in Canada.A recent study led by Dr. Tadrous and his colleagues revealed that the dollar value of all drug purchases in Canada grew by 13.7% between 2022 and 2023. This increase was so significant that Dr. Tadrous initially suspected a calculation error.“This annual growth,” he said, “is all driven by semaglutide.”
The study underscores the transformative role of GLP-1 drugs in the pharmaceutical market, but it also raises questions about their long-term financial impact on public health programs.
Public Drug Programs Under Pressure
The Canadian Institute for health Details (CIHI) reported that taxpayer spending on diabetes drugs, including GLP-1 medications, reached $868 million in 2022, accounting for 24% of the total growth in public drug program spending nationally. Ozempic alone contributed $434 million to this figure.however, the full impact of semaglutide’s growth on public drug programs remains unclear, as CIHI’s most recent report on prescribed drug spending only includes data up to the end of 2022.
beyond Weight Loss: Emerging Health benefits
GLP-1 drugs like Ozempic and Wegovy work by mimicking the GLP-1 hormone, which regulates blood sugar and reduces appetite. while their primary use has been for diabetes management and weight loss, emerging research suggests these medications may offer additional health benefits.
Recent analyses of clinical trial data indicate that GLP-1 drugs could have cardiovascular and kidney disease benefits independent of weight loss, potentially due to their ability to reduce inflammation throughout the body.“These are all brand-new conversations,” said Daniel Drucker, a clinician-scientist at Toronto’s Mount Sinai Hospital and one of the researchers who discovered the GLP-1 hormone. “We need to move our thinking from weight loss as the primary goal for everyone.It’s very important, but improving health is the primary goal for many people.”
A Paradigm Shift in Healthcare
The rapid adoption of GLP-1 medications is forcing healthcare systems to rethink their approaches. Dr. Tadrous emphasized that while the potential benefits are promising, more evidence is needed to fully understand their long-term impact.
“The thing that’s lagging behind is the true evidence. A lot of it is hypothetical,” he cautioned. “The cardiovascular benefit was the first time we saw a signal that it’s not just hypothetical anymore.”
Key Takeaways
| Metric | Details |
|———————————|—————————————————————————–|
| Ozempic Sales (2023) | $2.3 billion (Jan-Nov) |
| Wegovy Sales (2023) | $147 million (Apr-Nov) |
| public spending on Diabetes Drugs (2022) | $868 million (24% of total growth in public drug spending) |
| Ozempic Contribution to Public Spending (2022) | $434 million |
| Cost of Wegovy (28-day supply) | $388.64 (before markups and fees) |
Looking Ahead
As GLP-1 medications continue to dominate the pharmaceutical market, their impact on public health programs and patient outcomes will remain a critical area of focus. With ongoing research uncovering new potential benefits, these drugs are poised to play an even larger role in healthcare—but their rising costs and widespread use will require careful management to ensure sustainability.
For more insights into the latest trends in drug spending, explore the Canadian Institute for Health Information’s report on prescribed drug spending.
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Stay informed about the latest developments in healthcare and pharmaceuticals by subscribing to our newsletter.The Rising Cost of GLP-1 Drugs and the Struggle for access in Canada
In 2022,public spending on GLP-1 drugs surged to $300 million,a significant increase from $265 million the previous year. These medications, designed to treat diabetes, obesity, and heart disease, are proving to be life-changing for many patients. However, a recent Ontario study reveals a troubling gap: many individuals who could benefit from these drugs are not receiving them.
Take the case of Mr. Neilson, a trucker who participated in the SELECT trial for wegovy, a GLP-1 drug. When the trial ended a year and a half ago, he stopped taking the medication because he couldn’t afford it on his salary. Despite being a senior who qualifies for Ontario’s Drug benefit Program, the plan does not cover Wegovy.
Dr. Subodh Verma, a University of Toronto professor of surgery and pharmacology who performed Mr. Neilson’s double bypass surgery in 2019, believes the drug is crucial for his patient’s health.“There is an intrinsic value of the medication that is not necessarily related to weight, that is actually protecting his heart, and I need him to be back on it for that reason,” Dr.Verma emphasized.
Dr. Verma, who led the SELECT trial in Canada and is spearheading clinical trials of other GLP-1 drugs, highlights the broader issue. While some pharmaceutical companies offer trial extensions or bridging programs to cover medication costs post-trial, Novo Nordisk has not done so for SELECT, which enrolled over 17,000 participants. When asked by The Globe, the company declined to explain why.
Novo Nordisk’s canadian advocacy efforts include resubmitting Wegovy to an expert committee at Canada’s Drug Agency (CDA), which advises public drug plans on coverage. The CDA’s predecessor agency recommended against reimbursing Wegovy for weight management in 2022. However, with Health Canada’s recent approval for cardiovascular disease, the CDA is expected to issue a new advice later this year.
“The conversation that needs to happen is that this is for heart protection and not for cosmetic reasons,” Dr.Verma stated.
Key Points on GLP-1 Drug access in Canada
| Aspect | Details |
| Public Spending on GLP-1 Drugs | $300 million in 2022, up from $265 million in 2021 |
| SELECT Trial Participants | Over 17,000 enrolled; no bridging program offered by Novo nordisk |
| ontario Drug Benefit Program | Does not cover Wegovy |
| CDA Recommendation | Expected later this year; previous recommendation against reimbursement for weight management |
The struggle for access to GLP-1 drugs like Wegovy underscores a critical need for policy changes. As Dr. verma and others advocate, these medications are not merely for weight management but are vital for protecting heart health.
For more insights on the evolving landscape of GLP-1 drugs and their impact on public health, explore the Ontario study and stay updated on the CDA’s forthcoming recommendations.
The meteoric rise of GLP-1 medications like Ozempic and Wegovy is reshaping Canada’s pharmaceutical landscape, with sales skyrocketing and public health programs grappling with the financial implications. According to data from IQVIA, a life-sciences analytics company, Ozempic has become the top-selling drug in Canada, far outpacing its competitors.
In the frist 11 months of 2023, nearly $2.3 billion worth of Ozempic was sold through Canadian retail pharmacies—more than double the sales of Stelara, the second-highest seller, which is used to treat Crohn’s disease and other autoimmune conditions. These figures include markups and dispensing fees, highlighting the drug’s dominance in the market.
The Off-Label Weight Loss Boom ###
while Ozempic is approved for managing type 2 diabetes, its off-label use for weight loss has significantly contributed to its sales surge. The IQVIA data accounts for all payers, including Canadians without diabetes who pay out of pocket to use the drug for weight management.
Wegovy, a higher-dose version of semaglutide specifically approved for weight loss, also made waves after its commercial debut in Canada last year.between April and November 2023, Wegovy recorded nearly $147 million in sales. A 28-day supply of the weekly injectable costs $388.64 before pharmacy markups and dispensing fees, according to Novo Nordisk, the manufacturer of both Ozempic and Wegovy.
Unprecedented growth in drug Spending ###
The explosive growth of GLP-1 medications has had a profound impact on overall drug spending in Canada. A recent study led by dr. Tadrous and his colleagues revealed that the dollar value of all drug purchases in Canada grew by 13.7% between 2022 and 2023. This increase was so important that Dr. Tadrous initially suspected a calculation error. “This annual growth,” he said, “is all driven by semaglutide.”
The study underscores the transformative role of GLP-1 drugs in the pharmaceutical market, but it also raises questions about their long-term financial impact on public health programs.
Public Drug Programs Under Pressure ###
The Canadian Institute for Health Details (CIHI) reported that taxpayer spending on diabetes drugs, including GLP-1 medications, reached $868 million in 2022, accounting for 24% of the total growth in public drug program spending nationally. Ozempic alone contributed $434 million to this figure. However, the full impact of semaglutide’s growth on public drug programs remains unclear, as CIHI’s most recent report on prescribed drug spending only includes data up to the end of 2022.
Beyond Weight Loss: Emerging Health Benefits ###
GLP-1 drugs like Ozempic and Wegovy work by mimicking the GLP-1 hormone,which regulates blood sugar and reduces appetite. While their primary use has been for diabetes management and weight loss,emerging research suggests these medications may offer additional health benefits.
Recent analyses of clinical trial data indicate that GLP-1 drugs could have cardiovascular and kidney disease benefits independent of weight loss, potentially due to their ability to reduce inflammation throughout the body. “These are all brand-new conversations,” said Daniel Drucker, a clinician-scientist at Toronto’s Mount Sinai Hospital and one of the researchers who discovered the GLP-1 hormone. “We need to move our thinking from weight loss as the primary goal for everyone. It’s very critically important,but improving health is the primary goal for many people.”
A Paradigm Shift in Healthcare ###
The rapid adoption of GLP-1 medications is forcing healthcare systems to rethink their approaches. Dr.Tadrous emphasized that while the potential benefits are promising, more evidence is needed to fully understand their long-term impact.
“The thing that’s lagging behind is the true evidence. A lot of it is hypothetical,” he cautioned.“the cardiovascular benefit was the first time we saw a signal that it’s not just hypothetical anymore.”
Key Takeaways ###
| Metric | Details |
|———————————|—————————————————————————–|
| Ozempic Sales (2023) | $2.3 billion (Jan-Nov) |
| Wegovy Sales (2023) | $147 million (Apr-Nov) |
| Public Spending on Diabetes drugs (2022) | $868 million (24% of total growth in public drug spending) |
| Ozempic Contribution to Public Spending (2022) | $434 million |
| Cost of Wegovy (28-day supply) | $388.64 (before markups and fees) |
Looking Ahead ###
As GLP-1 medications continue to dominate the pharmaceutical market, their impact on public health programs and patient outcomes will remain a critical area of focus. With ongoing research uncovering new potential benefits, these drugs are poised to play an even larger role in healthcare—but their rising costs and widespread use will require careful management to ensure sustainability.
For more insights into the latest trends in drug spending,explore the Canadian Institute for Health Data’s report on prescribed drug spending.
Stay informed about the latest developments in healthcare and pharmaceuticals by subscribing to our newsletter. The Rising Cost of GLP-1 Drugs and the Struggle for Access in Canada
In 2022, public spending on GLP-1 drugs…
