Given Shortages, Who ‘Deserves’ Ozempic and GLP-1 Drugs?

Drugmakers are struggling to keep up with the demand for weight loss drugs semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). The limited supply is forcing doctors, public health experts, and insurers to confront an unpleasant question: Who “deserves” these life-changing therapies the most?

“Right now, it’s first come, first served,” says Neda Rasouli, MD, an endocrinologist and professor at the University of Colorado in Aurora. “But it should be based on maximizing the benefit and prioritizing people who do worse without this intervention.”

GLP-1 drugs were originally developed to treat type 2 diabetes and are still considered a game-changing therapy in the field. In recent years, they’ve been widely recognized as the most effective weight loss drugs ever developed, and researchers keep discovering new benefits, too. GLP-1s also appear to prevent or treat kidney disease, sleep apnea, and cardiovascular disease.

Doctors wish these drugs were universally accessible and affordable, but shortages continue as demand rises. Instead, health practitioners are debating how these drugs would ideally be distributed so that a limited supply can have the biggest possible health impact.

GLP-1 Drugs Are Not Distributed Equitably

“In our system, Americans can buy whatever they can afford,” says William Herman, MD, professor of epidemiology at the University of Michigan in Ann Arbor.

“We really need to think about health equity,” says Dr. Herman. “Allowing wealthy individuals to purchase GLP-1s that are in short supply denies access to individuals who are more likely to benefit.”

Dr. Rasouli believes that the situation ought to be reversed: “I want to prioritize ... underrepresented minorities, because they are not getting medication and they’re at even higher risk of comorbidities.” Several nonwhite communities have higher rates of obesity and diabetes complications, such as cardiovascular and kidney disease, and might therefore reap even greater benefits from GLP-1 drugs.

Timothy Garvey, MD, professor of medicine at the University of Alabama in Birmingham, calls the situation, with sky-high prices causing American insurers to revoke coverage, “untenable.”

"These are life-saving medications,” says Dr. Garvey. “To deny them to patients who would benefit is unacceptable."

Who Benefits the Most From GLP-1 Drugs?

In order to maximize the public health benefits, it’s necessary to understand who responds best to these drugs. That is a difficult question to answer, because different people take GLP-1 drugs for different reasons. While one adult may choose Ozempic for type 2 diabetes to help control their blood sugar, another might choose Wegovy, essentially the same medication, to lose weight and manage heart disease risks. There’s no easy way to compare the importance and cost-effectiveness of the benefits across conditions.

Revoking GLP-1 Access

Deborah Horn, DO, medical director at the University of Texas’ Center of Obesity Medicine and Metabolic Performance in Bellaire, is especially concerned with the plight of people who lose access to their drugs. In 2023, the University of Texas announced that it would stop covering weight loss drugs for its several hundred thousand employees, many of them Dr. Horn’s patients: “I’m helping manage all those patients who had great success, but then had to figure out another way to manage their disease.” She has plenty of experience seeing what happens when patients stop taking Ozempic — the weight usually comes back while the other metabolic benefits disappear.

“We would never do this with diabetes medications!” says Horn.

Pam Taub, MD, a cardiologist at UC San Diego Health, agrees: “No payer would ever tell you to stop a statin after your LDL [cholesterol] met your goal.”

Prioritizing Heart Disease

Dr. Taub has a different perspective. She believes that clinicians can’t be guided by an academic concept of maximum public health benefit. Instead, they need to engage with the reality of the insurance industry that largely decides which Americans get to use which drugs. And she believes that it could be the GLP-1 family’s effect on cardiovascular health that allows them to become widely accessible.

Taub believes these cardiovascular benefits are the key to persuading insurers, employers, and governments to pay for these notoriously expensive drugs. “The harsh reality of our clinical practice is that it is dictated by what payers will cover and what we can get our patients access to,” she says. Emphasizing the cardiovascular benefits of GLP-1 drugs could be the best way of increasing access — and of allowing patients to enjoy the full range of cardiometabolic benefits, including weight loss, blood sugar reduction, and kidney protection.

Prioritizing Overall Cardiometabolic Health

“All of our organs are intricately linked,” says Taub. “The dysfunction of one leads to the dysfunction of another.”

“Let’s focus on overall cardiometabolic health,” Taub says. “We need to be selling these as more than just weight loss drugs. ... By just focusing on obesity, we’re doing this field a disservice.”

Herman suggests that the people who will benefit the most from GLP-1 drugs are those who have been diagnosed with multiple cardiometabolic conditions: “I think the value is probably greatest in people with type 2 diabetes, obesity, and cardiovascular disease ... and for people with type 2 diabetes and complications.”

Is Hollywood Really Hogging GLP-1s?

Many people, both doctors and patients alike, assume that the intense demand for GLP-1 drugs has been substantially driven by people who want to slim down but who do not have a serious medical need to lose weight.

Rasouli says, “When we have scarce resources, and if Hollywood people or people who don’t really need it get it first, it means that we’re denying access to people who might need it more.”

“I think the least cost-effective approach is in the treatment of ... people who are overweight or have mild obesity who want to fit into that fabulous gown by losing a few pounds,” says Herman. “This is what we’re really seeing in Hollywood, and unfortunately this is what we’re seeing fairly widely.”

Nikhil Dhurandhar, PhD, a professor of nutritional sciences at Texas Tech University in Lubbock, says that he “wants to put in a good word for those who want to lose weight to fit into a dress.” Dr. Dhurandhar says that as long as users are medically indicated to use a GLP-1 drug, “motivation should not matter ... your benefits are going to be the same regardless of what made you lose weight.”

Dr. Wigham worries that vilifying some GLP-1 users only contributes to the disapproval and discrimination experienced by people who are overweight.

“These kinds of comments about the dress just perpetuate this stigma that people don’t deserve the medication unless they’re trying really hard to lose weight on their own,” says Wigham. “We don’t do that for other diseases and we need to stop using that language for obesity.”

Shortages May Persist

Many different businesses are trying to meet the demand. Major drugmakers are racing to expand their manufacturing capacity and to develop additional GLP-1 therapies. Generics may soon be approved in India and China, and in the United States, compounding pharmacies operating in a legal gray area offer less expensive unbranded equivalents.

In a perfect world, everyone who stands to benefit from these blockbuster drugs would be able to access them. At the moment, that possibility seems very far away.

The Takeaway

Demand for GLP-1 drugs like Ozempic has outstripped supply, sparking debates over fair access. Some health experts suggest prioritizing these medications for those who might benefit most, especially patients with multiple cardiometabolic conditions, including type 2 diabetes and severe obesity.