In a new analysis of national data, an estimated 137 million U.S. adults, more than half of the adult population, would qualify for the anti-obesity drug semagludtide.

“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, associate director of the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center. “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.”

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.

Semaglutide belongs to a class of drugs known as GLP-1 receptor agonists. It is currently approved to manage diabetes, treat overweight or obesity, and of recurrent cardiovascular disease. About 15 million adults take semaglutide, which stimulates the pancreas to produce insulin and reduces the hunger hormone ghrelin, decreasing the appetite and slowing down the rate of stomach emptying. As a result, semaglutide helps lower blood sugar levels and promotes weight loss.

Semaglutide is found to improve symptoms in sleep apnea and in some types of heart failure, and slows the progression of chronic kidney disease.

In 2023, it was the top-selling drug in the U.S. 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 is found to improve 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 treatment of liver and kidney diseases, substance use disorders, and dementia.

Ivy Shi, 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 U.S. adults who qualified for semaglutide, 35 million would administer it for diabetes management, 129.2 million for weight loss, and 8.9 million 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: Ivy Shi, Robert W. Yeh, Jennifer E. Ho, and Issa Dahabreh of BIDMC; and Sadiya S. Khan of Feinberg School of Medicine, Northwestern University.

Disclosures: Sadiya S. Khan reported grants from the National Heart, Lung, and Blood Institute outside the submitted work. Jennifer E. Ho reported grants from the National Institutes of Health during the conduct of the study. Issa Dahabreh reported a contract with the Patient-Centered Outcomes Research Institute and grants from the National Institutes of Health during the conduct of the study. Kazi reported grants from the National Heart, Lung, and Blood Institute, American Heart Institute, Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, and Institute for Clinical and Economic Research outside the submitted work. No other disclosures were reported.

Funding/support: Dahabreh is supported by grants from the National Library of Medicine (R01 LM013616), the National Heart, Lung, and Blood Institute (R01 HL136708), and the Patient-Centered Outcomes Research Institute (ME-2021C2-22365).