Two years on from The Royal Gazette’s first report on a new wave of diabetes drugs with broader health benefits, the island’s growing demand for the high-cost medications is being watched closely by insurers, who report that their monthly use has “surged” since 2020.

The success shown by Ozempic and its higher-powered successor, Mounjaro, against type 2 diabetes has led to the original role of the drugs getting overshadowed by their popularity in combating obesity.

In the case of Ozempic, heart and kidney disease have also shown improvement — with the potential of the drug becoming a game-changer against chronic health conditions plaguing the island.

However, “growing demand for these medications poses a real challenge to Bermuda’s healthcare system due to their high cost”, said Peter Lozier, the group head of benefits for BF&M and Argus.

While the insurer provides 100 per cent coverage for the medication — when prescriptions conform with their defined on-label usage — a leading endocrinologist in Bermuda urged patients to shop around for the best deal on an effective but pricey drug.

Either way, experts in the field say the medications need to be used in a targeted, comprehensive regimen, rather than being taken in isolation.

“I think that fad phase has worn off a bit, which I’m pleased to see as a clinician,” said Sara Bosch de Noya, head of diabetes education at the Bermuda Diabetes Association.

“This isn’t a fad drug for weight loss. This is a powerful glycaemic medication which is going to help you lower your blood glucose levels.

“There was a perception of it as a weight-loss drug, that I had to reframe and bring back to the people coming in here to start with it as a diabetes medication.”

She added: “As an indication of how it works, that it helps people to lose weight, it became popular for that — but never lose sight of what it was traditionally intended for.”

Diabetes and obesity are rampant in Bermuda, and the reputation of the various drugs for helping people to lose weight attests to their efficacy at reining in type 2 diabetes, a disease largely driven by lifestyle factors.

Ms Bosch de Noya told The Royal Gazette: “Any effective diabetes medication, as any endocrinologist would tell you, has to have an outcome of weight loss.

“If a diabetes drug, which we had 20, 30 years ago, was good at lowering glucose levels but caused weight gain, at the end of the day it’s only going to increase insulin resistance and not make the diabetes outcome better.

“But when people realised that these new classes of drug cause weight loss, it activated everybody’s interest in using these drugs for weight loss.”

Drugs such as Ozempic can be far from perfect, as a 54-year-old Black man who struggled over decades to shed excess pounds attested.

“I lost five pounds over two, three years, but it was weird,” he said.

“It made chicken taste funny, so I couldn’t eat chicken.”

His interest in drinking alcohol also vanished — but in ways that felt “strange”.

“It was like that was removed as an option for me to have,” he said. “Towards the end, I started to have stomach pains, so I just quit it.”

Most patients get started with Ozempic, according to Ms Bosch de Noya.

Those who react badly could get switched up to Mounjaro, which she described as “a slightly ramped-up version — the main difference is that it activates two gut hormones that regulate blood sugars, whereas Ozempic is just one”.

She added: “We’re seeing a few that might get switched to Mounjaro, particularly people who don’t tolerate Ozempic, where they might have some nausea or gastrointestinal symptoms.

“There are anecdotal cases I’ve seen with patients where they’ve switched to Mounjaro and don’t have those same symptoms. It’s still a once-a-week drug.”

Bermuda’s health insurers vary, but Mr Lozier spelt out the Argus approach.

“Ozempic is approved to treat type 2 diabetes, reduce heart risks in people with diabetes and heart disease, and, starting in 2025, help slow kidney disease in those with diabetes,” he said.

Its active ingredient, semaglutide, is exactly the same as that contained in another drug, Wegovy — but only the latter, approved for weight loss, is covered by the insurer, which adheres to the book when it comes to deciding coverage.

In that regard, Mr Lozier said that Ozempic, if prescribed for weight loss without a medical diagnoses, would not be covered under the company’s plans.

Ms Bosch de Noya said she supported such vetting of payment by insurers.

“People who have diabetes, generally there isn’t an issue with it,” she said.

“Some of the insurance companies may require more of pre-authorisation, particularly with Mounjaro, because it’s more expensive. And rightly so — there should be some level of pre-authorisation with both of them.”

Regardless, Mr Lozier said, the island’s demand for the medications was increasing.

Monthly use of the drugs “surged by nearly 600 per cent between 2020 and 2023 for individuals under 25, and 300 per cent for those over 25”.

Mr Lozier said the monthly cost for Ozempic in Bermuda ranged from $936 to $1,300, “significantly higher than in regulated markets”.

The company estimated the annual cost per patient at about $10,00.

Mr Lozier said generic versions of the drugs stood to bring down costs “significantly”.

He added: “However, a generic version of Ozempic isn’t expected in the US until late 2031 or early 2032.

“In Canada, the semaglutide patent expires in January 2026, and several companies are expected to launch generics. Pending approval, these could lower the monthly costs by more than 50 per cent.”

Annabel Fountain, an endocrinologist with many years of experience with the medications, questioned Argus’s figures for cost, maintaining that she had seen substantially cheaper deals for the treatment described.

Her advice to patients was: “Call around and see how much it costs elsewhere.”

Dr Fountain said use of the drugs was best undertaken with education on nutrition and a study of individual body composition.

She said their results were “amazing” when properly deployed with attention to diet and fitness.

“Seventy-four per cent of us are overweight or obese,” Dr Fountain said. “The biggest health problem we have in Bermuda is diabetes and obesity.

“Oncologists and cardiologists will agree. If we could prevent people from becoming obese or developing diabetes, we would have significantly less cancer or heart disease.”

Dr Fountain said the weight loss triggered by the drugs could be a catalyst for the lifestyle changes required to eventually come off them.

“If your knees hurt when you’re 250 pounds, it’s hard to exercise,” she said. “But if you were to lose 50 pounds, it’s easier to exercise. It becomes a positive snowball effect.”

Dr Fountain agreed that the emergence of cheaper, generic versions of the drugs held some promise for cutting costs, but said pricing on the island needed to be regulated.

“If a wholesaler brings it in, and it only costs them $10, they can still charge people $100 for it — there’s no regulation at the moment.”

She said the development of a national drug formulary similar to Britain’s, now under way in Bermuda, would bring much needed precision to the prescription of drugs.

She added: “Potentially, there will be regulation in the future of the price of medications.”

Ms Bosch de Noya, whose focus is on diabetes, said she was optimistic that the medications could help to turn the tide on a host of chronic and debilitating diseases linked to the problem.

“Are we winning the war on it yet?” she said.

“That still remains an outcome for us to watch and wait for, but that’s our hope — that with the improved outcomes, we will certainly see less of the devastating complications that we used to see with diabetes.”