The Policy Consequences of Support for Regulating Off-Label Ozempic Prescription

• In Event: Medicaid and Drug Policy

Abstract

Obesity is a pressing health policy challenge. Obesity rates have doubled in over 70 countries since 1980 and almost a third of the global population is overweight or obese. Obesity is particularly problematic in the United States, where the obesity rate increased from 30.5% in 1999-2000 to 41.9% twenty years later. Considerable effort has therefore been put towards promoting health policy strategies to increase the proportion of individuals at a healthy weight. Many policy interventions have focused on improving the quality of individuals’ diets. For example, efforts have emphasized teaching children about healthy eating, encouraging healthier school lunches, taxing sugar sweetened beverages, and providing caloric content on menus, among other policy interventions. Additional attempts have called attention to creating environments for learning healthy preferences, overcoming barriers to acting on healthy preferences, and encouraging individuals to reassess their food choices at the point of purchase. As obesity rates continue to rise, however, alternatives to help individuals achieve a healthy weight are needed.

Increasingly, Americans are turning to a class of pharmaceuticals known as glucagon-like-peptide-1 (GLP-1) receptor agonists as an alternative. GLP-1 receptor agonists like Ozempic are a class of drugs used to treat Type 2 diabetes and lower cardiovascular risk. Critically, these drugs – and the drug Ozempic in particular – are being used as a weight management drug off label. While some have made an effort to study the prevalence of Ozempic’s "off label" use (i.e., as a weight management treatment), less is known about how Americans feel about the regulation of physicians' abilities to prescribe Ozempic and related drugs off label. In a large (N = 3,549) and demographically representative survey, we unpack both the prevalence of public support for off-label Ozempic use, as well as its social, political, and psychological correlates. We also test, in a randomized controlled trial, whether emphasizing concerns related to supply shortages (i.e., for people with diabetes) and/or concerns about the safety of off-label use are associated with policy attitudes. Observational analyses suggest that nearly half (48%) of respondents -- on both sides of the partisan aisle -- support off-label prescribing. Experimental analyses further suggest that highlighting concerns about safety of Ozempic use as a weight management drug, but not supply shortages for diabetic subpopulations, are associated with preferences for subjecting off-label prescribing to increased regulation. We conclude by discussing how results from this research can help inform policy-relevant debates about off-label prescribing and the growing use of medications for weight loss.

Authors

• Timothy Herbert Callaghan, Boston University

• Matt Motta, Boston University School of Public Health

• Robert Kirby Goidel, Texas A&M