December 1, 2022
Novo Nordisk’s products Ozempic and Wegovy both contain the same active ingredient semaglutide, which is a glucagon-like peptide-1 (GLP-1) agonist. These two drugs have different indications. Ozempic is FDA-approved for the treatment of type 2 diabetes (T2D) and Wegovy for chronic weight management.1 Patients with T2D may need to seek alternative treatments due to the increased off-label use of Ozempic.1
Social media posts about Ozempic for weight loss is causing individuals to use Ozempic off-label. This is leading to further shortages for both Wegovy and Ozempic. Novo Nordisk has experienced unprecedented demand for both products since December. Novo Nordisk expects all strengths of Wegovy to be available in the United States by the end of 2022. They’re also making plans for additional production going into 2023. Ozempic has been placed on intermittent back order and Novo Nordisk is releasing supply as it becomes available.
It's more important than ever to ensure appropriate prescribing of semaglutide and other GLP-1 agonists to deter off-label use of these products.
Costs for Medicare Patients
Medicare drug benefit coverage is different than commercial. Members pay different cost shares during four benefit phases: deductible, co-payment, gap phase, and catastrophic phase. Many diabetic brand name medications are very expensive for Medicare members. During the gap phase, members pay a portion of the total cost of the medication. Many members can’t afford the medication once they hit the gap phase and will discontinue taking the medication for the rest of the year. This can negatively affect the member’s adherence rate and can lead to poor outcomes. The table below shows the costs during the gap phase for common brand medications that providers use for diabetics and non-diabetics (non-FDA indications).
For Medicare members, the American Diabetes Association still recommends metformin extended release (ER) and glipizide ER as the first line of affordable medications for elderly patients.
| 30 days |
Class of drug |
Member Copay |
Member hits Gap (cost share) |
Premera Cost |
| Metformin ER |
Biguanide |
$2 |
NA - don’t get into gap |
$2 |
| Glipizide ER |
Sulfonylurea |
$2 |
NA - don’t get into gap |
$2 |
| Ozempic |
GLP-1 |
$40 |
$245 |
$850 |
| Wegovy |
GLP-1 |
CMS not covered |
CMS not covered |
NA |
| Mounjaro |
GLP-1 |
Not covered |
Not covered |
Not covered |
| Jaridance |
SGLT2 |
$40 |
$134 |
$575 |
A Reminder
Currently, Medicare Part D Star measures don’t define a diabetic by a diagnosis code but from a diabetic medication prescription. If you’re prescribing these medications for non-diabetic patients’ weight loss this year, your patients ‘diabetic adherence measure’ will be severely impacted. Using samples will also impact your adherence measure.
1IPD Analytics Payer and Provider Update: Novo Nordisk’s Ozempic and Wegovy Experience Shortage Due to High Demand. 2022 IPD Analytics, LLC. October 20, 2022