HEALTH AUTHORITIES’ GUIDANCE to pharmacists to prioritise patients with diabetes when dispensing Ozempic is causing “huge distress and anxiety” to people with obesity who have been prescribed it for weight loss, a doctor has warned.

The drug, which is effective in regulating blood sugar and insulin for people with type 2 diabetes and in suppressing appetite for people with obesity, is in very short supply in Ireland and internationally.

Professor Francis Finucane, who leads the obesity clinic at Galway University Hospital, told The Journal the problem was “worse than [he] envisioned in May”, when doctors and pharmacists were first instructed by regulators that using Ozempic for weight management was placing its availability for people with diabetes at risk.

Finucane said that it was not only obesity patients with new prescriptions who could not now access the drug but also some patients who have “done well” on it over a period of time.

“They are regaining weight and, more importantly, losing health as a result. It’s awful. We are inundated with emails about this,” he said.

Several community pharmacists The Journal spoke to this week confirmed they were following their regulator’s advice and prioritising diabetic patients when allocating limited and unpredictable supplies of Ozempic, or would do so if it came to it.

Some said they had so far been able to treat all existing patients equally and allocate supply based on waiting times.

Some pharmacists expressed disquiet at the guidance, with one saying: “Obesity is not being taken as seriously as diabetes or any other health issue”.

However another said she felt pharmacists had a “duty of care” to diabetic patients amid the current shortage.

All the pharmacists said they were unable to take on new Ozempic patients given current supply constraints.

In May, the Pharmaceutical Society of Ireland (PSI), the pharmacy regulator, told pharmacists to “consider….during their practice” manufacturer Novo Nordisk’s position that using Ozempic for weight loss represented “off label” use that was putting supply for diabetes patients at risk.

The Medical Council also circulated Novo Nordisk’s position to doctors in May, adding: “While your primary duty is to your patient, you must consider the needs of all patients and balance these duties where resources are limited.”

The Medical Council confirmed to The Journal this week that it subsequently issued further correspondence to “a number of doctors” acknowledging the “positive work being done for obesity patients” and confirming the importance of doctors following their “own clinical judgment”.

The initial correspondence issued by the PSI and Medical Council in May was also backed by the Department of Health, HSE and Health Products Regulatory Authority. These health authorities issued further advice on the matter last month stating that prescribing and dispensing for “the licensed indication”, diabetes, should be “prioritised”. 

However, in a statement, the Department of Health said ”incorrect” to say that the advice it has circulated to healthcare professionals – that using Ozempic for weight management will put supply for people with diabetes at risk – meant it had advised them to “prioritise patients with diabetes over those with obesity”.

“It is advised that where this shortage impacts ongoing treatment for a patient, prescribers and pharmacists, in conjunction with patients, should discuss the most appropriate course of action, based on suitable alternative treatment options available,” the Department of Health said. 

Finucane told the Medical Council in May that his specialist clinic at Galway University Hospital had prescribed Ozempic to over 3,000 patients with “severe and complicated obesity”.

Maura Murphy, secretary for the Irish Coalition for People Living with Obesity, said: “There should be no discrimination between diabetes and obesity – they are both diseases.”

She noted that Ozempic was currently in short supply, including from her own pharmacy, for both people with obesity and people with diabetes.

“These medications have helped a lot of people to stop the head hunger that we have. It takes away the overwhelmingness of food ruining your life,” Murphy said.

It’s not a desire for a thinner body, it’s treating [obesity] as an illness, as the science has proven it to be.”

She added that the shortage over the past year has meant she has had to wait for her prescription on occasion, and suffered adverse effects as a result. 

Bias and inequality

Writing in The Lancet medical journal this week, Finucane and colleagues from Australia and Brazil have claimed that the ongoing shortage of Ozempic internationally has “uncovered biases against the treatment of obesity”.

The doctors wrote that “however well intentioned”, prioritising diabetes patients “implies that regardless of its severity, complications, or effect on the individual, obesity is inherently less worthy of treatment than diabetes”.

They added that this is “negating widespread recognition of obesity as a disease, trivialising the substantial benefits of effective treatment on health and wellbeing, and perpetuating the discrimination faced by people with obesity in our health-care systems”.

They added that the advent of new obesity medications has also “revealed other objections to their use, such as the belief that obesity should be prevented rather than treated”, adding that these two approahces are not mutually exclusive and noting that no country has so far managed to reduce the prevalence of obesity.

They also noted emerging inequality in healthcare associated with the new generation of weight loss drugs, because of their high cost. The cost of the Ozempic is often self-funded by patients (including in Ireland), even though obesity disproportionately affects poorer people.

“Although they have regulatory approval for chronic weight management in people with a BMI [body mass index] of 30 or higher, or people with a BMI of 27 or higher and at least one weight-related health condition, at their current pricing, subsidisation or full coverage by public funding and insurers for everyone who meets these criteria is unfeasible,” the doctors wrote.

They said the health system, including pharmaceutical companies, regulators, health economists, researchers and doctors must find “sustainable and affordable ways to overcome inequities in access for people with the greatest need and likelihood of benefit”.

Another weight-loss drug, Saxenda, is also in short supply in Ireland.