A number of stories in the UK have emerged around Novo Nordisk’s blockbuster weight loss drug Wegovy in the last week. All of them highlight that the country is struggling with its relationship to the private medical sector, as well as Novo’s supply-chain woes.

On Saturday (18 November), The Observer reported that Novo executives had been in meetings with government officials over targeting welfare claimants who were “most likely to return to work” if they were given Wegovy. In these meetings it was also suggested that Wegovy be extended not only to patients with extremely high BMIs (over 35) or with a BMI of 30-34 and an existing comorbidity, but those with a high BMI and a “risk of developing comorbidities”.

This would overstep the current recommendation guidelines in the UK, though it is important to note the plan has so far not been taken further. In response to the revelations, Novo told The Observer that these talks were in fact initiated by the government, but did not deny that profiling benefit claimants was discussed.

The company is currently facing increased competition in the weight loss space, particularly from Eli Lilly’s drug Zepbound, which is also a GLP-1RA and was approved for use in the UK and US earlier this month. It is possible that the attempt to work with the government to expand usage of the drug is a strategy to ensure continued dominance in the field by becoming the standard of care for obesity in the UK.

Drug shortages

This strategy may not come to fruition no matter what Novo or the government want. Current Wegovy and Ozempic – Wegovy’s diabetes-treating cousin – are facing severe shortages in the UK, creating a black market of knock-off products, the BBC reported on 16 November.

Many of these products, available through sellers on social media apps such as TikTok and Instagram, do not contain semaglutide, the active ingredient in Ozempic and Wegovy. Others may contain it but in dosages other than those advertised or in an unmixed form that must then be blended at home. Both of these approaches are, of course, incredibly dangerous, and Novo told the BBC that it is working with a third party to “proactively identify and remove websites, ads or social media accounts” selling fake products.

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However, many of the adverse effects faced by those taking the drug in its unlicensed form are similar to the more extreme outcomes of legitimate semaglutide, including vomiting and headaches. The UK’s adverse effects reporting database, Yellow Card, shows that there have been over 560 adverse effects reported in 2023 so far, of which just under half are serious. Whilst these side effects are clearly marked on the packaging of licenced products, those taking unofficial versions may be unaware of the potential severity, preventing them from seeking adequate medical attention.

Who gets to access these drugs?

On the other side of the spectrum, Reuters reported on Saturday (18 November) that wealthy Britons are still able to buy Ozempic for weight loss through private pharmacies despite national shortages. This means that National Health Service (NHS) patients with type 2 diabetes are having to wait to access essential medication, which some have argued is creating a two-tiered system in a country known for its high-quality free healthcare.

This is part of a growing trend in the UK of patients moving towards private healthcare due to long wait times and uncertainty about when treatments will take place. While Novo Nordisk cannot be held responsible for these issues, it has pursued an aggressive expansion policy into new markets at the same time as acknowledging the likelihood of long-term shortages of its drugs due to off-label weight loss prescriptions. The current medical advice in the UK and many other countries is not to prescribe Ozempic off-label for weight loss, but this is reportedly not being followed in all cases.

The weakening of the almost total dominance of the NHS as the healthcare provider of the UK increasingly opens the door to US-style private pharmacies and drug companies to lobby the government, as well as emboldening scammers looking to profit from people’s insecurities and health concerns.

Meanwhile, Novo Nordisk continues to thrive, reporting obesity care sales of 244% in North America in Q3 of 2023 including a 467% increase in Wegovy sales in the US. Overall GLP-1RA sales were up 49%, which were behind the bulk of the 31% increase in operating profit measured in Danish Kroner. GlobalData analysis shows that not only is the company growing, but that it is in fact growing faster every year.

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