Hollywood's connection to a shortage of critical type 2 diabetes drug

Until recently the only thing I associated with Ozempic — an injectable medication made by pharmaceutical company Novo Nordisk designed to help those with type 2 diabetes lower their blood sugar — was the earworm of a jingle in its TV ads.

Once you hear those “Oh ... oh ... oh ... Ozempic” lyrics — set to the music of the 1974 hit song “Magic” by Scottish pop rock band Pilot — good luck getting them out of your head for the rest of the day.

So leave it to comedienne Chelsea Handler to put Ozempic — one of the brand names for semaglutide (others include Wegovy and Rybelsus) — under a spotlight for how it’s often being (mis)used and (over)prescribed in Hollywood.

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Last month, while appearing on the “Call Her Daddy” podcast with host Alex Cooper, she revealed that she’d been unknowingly taking the drug for awhile. 

"My anti-aging doctor just hands it out to anybody. I didn't even know I was on it. She said, 'If you ever want to drop 5 pounds, this is good.'

"I came back from a vacation and I injected myself with it. I went to lunch with a girlfriend a few days later, and she was like, 'I'm not really eating anything. I'm so nauseous, I'm on Ozempic.' And I was like, 'I'm kind of nauseous too.' But I had just come back from Spain and was jet-lagged.

"I'm not on it anymore. That's too irresponsible. I'm an irresponsible drug user, but I'm not going to take a diabetic drug.”

With so many people using Ozempic off-label (meaning to treat a condition for which the drug was not originally approved), Handler said she believed “it's going to backfire, something bad is going to happen."

Why a diabetes drug is in demand for weight loss

Semaglutide was approved by the FDA in 2017 to treat type 2 diabetes. In the aforementioned Ozempic TV ads, the voiceover notes that, by taking the drug, in addition to lowering your A1C (your blood sugar level for the previous three months) “you may also lose some weight.”

But in recent years the number of people taking Ozempic — whether they’ve been diagnosed with type 2 diabetes or not — has risen to the point that there are now reports of a shortage of the drug.

Actress Jameela Jamil — a longtime advocate for body positivity — posted her concerns about the rise in off-label Ozempic use on Instagram: “I have said what I have said about the potential harm of people using the diabetes medication for weight loss only. I fear for everyone in the next few years. Rich people are buying this stuff off prescription for upwards of 1,000 dollars. Actual diabetics are seeing shortages. It's a now mainstream craze in Hollywood. HOPE this doesn't end the same way we were told opioids were safe. There is little to no discussion of the side effects in any advertising online. I'm deeply concerned but I can't change any of your minds because fat phobia has our generation in a chokehold.”

Dr. Vineeth Mohan, chairman of the Department of Endocrinology and Metabolism at Cleveland Clinic Weston, explained how semaglutide is believed to work: “Semaglutide mimics a naturally-occurring gut-derived hormone called GLP-1.  GLP-1 is released while eating and has multiple effects. GLP-1 has an important role in blood sugar regulation in response to meals. It also was found to directly inhibit the brain's appetite center as well as to slow down stomach emptying. As a consequence, this hormone is one of the signals telling us that we are full after a meal.”

Ozempic, Wegovy and the 'insurance angle'

What’s notable about the rise in semaglutide use is that in 2021 the FDA approved another version of semaglutide — Wegovy — specifically for weight loss for those who are either obese or overweight (a combined 70% of American adults, with an estimated 42% being the former).

The primary difference in the two medications is dosage amounts: Ozempic’s maximum weekly dosage is 2 milligrams while Wegovy’s is 2.4 milligrams.

But as a Buzzfeed report noted about the Ozempic shortage, “You can’t really explain the Ozempic shortage without discussing the insurance angle. Many health plans don’t cover weight-loss medications, but they do tend to cover diabetes medications, and Ozempic, unlike Wegovy, falls into this category. Doctors can prescribe Ozempic for obesity off label allowing people to get coverage for a medication they otherwise couldn’t. When companies do require evidence someone needs diabetes treatment, doctors can usually provide blood tests that show someone has poorly regulated blood glucose levels or prediabetes.”

Sans health insurance coverage, the monthly out-of-pocket cost for Wegovy (or another Novo Nordisk FDA-approved weight-loss drug called Saxenda — the brand name for liraglutide) users can be anywhere from $1,350 to $1,500.

Another weight-loss drug coming, but stigma remains

A new weight-loss drug — Eli Lilly’s diabetes medication tirzepatide — is expected to be approved for weight loss this year.

NBC News predicts that when this happens, tirzepatide “could become the best-selling drug of all time.”

But again — whether it will be covered by insurance is anybody’s guess.

And that’s a shame according to experts who lament the unaffordability of medications that have proven effective.

Dr. Fatima Cody Stanford, an obesity medicine specialist and the equity director of the endocrine division at Massachusetts General Hospital in Boston, appeared on the "PBS NewsHour" earlier this month and explained that, while obesity is now considered a chronic illness, there’s still a societal and healthcare stigma associated with treating the condition as such.

“Shame and stigma are very, very pervasive,” she said. “The two most common forms of bias in the U.S. are race bias [and] weight bias. We judge, we devalue, we dehumanize individuals that struggle with this disease, and we don't feel like they deserve any forms of therapy. We believe that they have done this to themselves. After treating over 10,000 patients with obesity, I can tell you, that is not the case. They have tried. They have struggled. And we have not been able to offer them any benefits from other things that we would do for chronic diseases.”

This article originally appeared on Palm Beach Post: Why Ozembic? Run on diabetes drug for off-label use has insurance angle