Medsafe has approved an application for Ozempic to be used in New Zealand to treat diabetes. How does this new drug work and why is everyone talking about it?
What just happened?
Last Thursday, New Zealand’s medical regulatory body Medsafe gave consent for Ozempic to be prescribed in New Zealand. The approval is for injectable forms of the drug, sold as Ozempic by Danish drug company Novo Nordisk Pharmaceuticals, to be used to treat unmanaged type 2 diabetes.
Wait, what is Ozempic?
Ozempic was initially developed in 2012; after a phase of clinical trials, it was approved for use as a type 2 diabetes treatment in the US in 2017. In 2021, it was approved for use in the US and the UK as a treatment for weight management, under the brand name Wegovy; it’s also available with a prescription in the EU, Australia, and Canada.
Semaglutide, the active ingredient sold under Novo Nordisk’s brands Wegovy and Ozempic, has become exceptionally popular over the past few months, at least online; the tags “Wegovy” “Ozempic” and “semaglutide” have more than 1.1 billion combined views on TikTok. In the US, the drug has been heavily marketed on television. Celebrities have spoken about their use of the drug; Elon Musk has tweeted about it, and Chelsea Handler said that she’d used the prescription before stopping, while others have denied use of or discredited the drug.
How does it work?
Liraglutide and dulaglutide, described as “cousins” of semaglutide, are already being used to treat diabetes and obesity in Aotearoa. Taken in synthetic form, Semaglutide, dulaglutide, and liraglutide make your stomach slower to empty after eating, encourage the pancreas to produce more insulin, and prevent the liver from producing too much blood sugar. It also acts on the central nervous system, meaning you feel less hungry. The combined effect is that you feel full faster and have less appetite, causing you to eat less.
Liraglutide and dulaglutide have proven very effective, says John Baker, an endocrinologist and chairman of the Diabetes Foundation Aotearoa. “The world has been starved – so to speak – of good weight loss medicine. Once the usefulness of [these drugs] became known, the demand has impacted the availability of supply.”
So now Ozempic will be available in NZ?
Almost. After permission for a drug to be prescribed has been granted, the company that has applied to MedSafe can choose when to start supplying the medication. The approval is only for use of the drug for diabetes, not weight loss – the reason it’s recently gone viral. If Novo Nordisk chooses to import Ozempic into New Zealand, it will be as a private prescription, not covered by the Pharmac subsidy. It won’t be cheap; based on prices in Australia and the US, a private prescription could cost between $130 to $1000 a month, depending on the dose prescribed.
“Novo Nordisk welcomes Medsafe’s approval of Ozempic (semaglutide) in New Zealand [and] is exploring options to provide access to Ozempic semaglutide for people living with type 2 diabetes in New Zealand,” a company spokesperson said, in reply to The Spinoff’s request for comment.
What about people who really need these drugs for their diabetes?
Media attention has had a direct impact on use of the drug, causing a temporary shortage, which is difficult for people who use the drug to treat their diabetes. However, Baker says that supply issues are temporary. “These are manufactured drugs – the companies will adjust.”
Pharmac, which has funded dulaglutide since 2021, has also started to fund liraglutide due to supply issues, with the product available in pharmacies this month.
Liraglutide is sold as Saxenda (for obesity) and Victoza (for diabetes) and is also manufactured by Novo Nordisk; these medications were approved for use in New Zealand in 2016 and 2017 respectively. Victoza is now funded by Pharmac. Even if semaglutide, which studies show is more effective at creating weight loss than liraglutide, becomes available in New Zealand, it’s unlikely that Pharmac will fund it, as the drug subsidisation agency tends to only fund one or two medications in a drug class.
What is taking these drugs like?
Semaglutide, dulaglutide, and liraglutide are usually delivered in EpiPen-like injectable containers that can be self-administered, once a day or once a week. A form of semaglutide in oral pills is available overseas; however, Novo Nordisk have not applied for this medication to be approved by Medsafe.
The drugs have a number of side effects, including nausea, diarrhoea, constipation, fatigue and heart palpitations. The weight loss isn’t always permanent, too; patients say that they have regained some of the weight they lost after stopping taking the drug. Doctors who prescribe semaglutide expect their patients to also be making shifts in their diet and exercise, which has to be constantly maintained – but often doesn’t work at all.
How do weight loss drugs fit into wider ideas about weight and dieting?
Critics of diet culture have pointed out that semaglutide is far from the first “miracle cure” for weight loss; many of the same claims were made of bariatric surgery, which can help people manage weight, but doesn’t provide instantaneous or straightforward results.
GLP-1 treatments for weight loss also use much higher doses of the drug than when they are used for diabetes treatments, so side effects can be stronger – and many of those side effects contribute to making eating actively unpleasant, increasing users’ avoidance of food. People using these drugs can forget to eat, which can make them lightheaded, dizzy and bad at focusing.
Dieting and exercise alone are not helpful for many people – medical interventions can be more effective than sheer willpower. Losing weight can make it easier to exercise and lower the risk of heart disease and diabetes. Weight and health are linked – but they’re also extraordinarily complex, with ever-evolving science, and corporations prepared to profit from individual shame, guilt, and ill-health.
So what happens now that Medsafe has given consent?
It’s still not clear when, or if, Novo Nordisk will make semaglutide available in New Zealand; if it does, it will be for insufficiently managed type 2 diabetes, with prescription for other symptoms granted if an authorised prescriber thinks the patient requires it. Consent from Medsafe means that the ball is in the pharmaceutical company’s court, and in the meantime the drug won’t be available at pharmacies. Doctors and pharmacists will probably direct eligible patients to the Pharmac-funded liraglutide and dulaglutide in the meantime.
It’s also worth remembering that New Zealand and the US are the only two high-income countries that allow prescription drugs to be marketed directly to consumers. Perhaps we’ll all be humming Oh-oh-oh-Ozempic soon.