Patients in Scotland are experiencing a postcode lottery when it comes to accessing Ozempic-style medications, with prescribing rates varying significantly across different health boards. A report analyzing the prescribing patterns of drugs approved for NHS use has found a tenfold difference between the highest and lowest prescribing areas.
The study, conducted by the Association of the British Pharmaceutical Industry (ABPI), identified substantial geographical variation in the prescription of these medications, despite their overall growth in NHS use. The Western Isles demonstrated a prescribing rate ten times higher than Shetland, the lowest prescribing area identified in the analysis.
Across all studied medications, the research highlighted "substantial variation in the pace and scale of recorded prescribing between NHS boards." To address this, the ABPI recommended a more coordinated approach to implementation across NHS Scotland, proposing seven priority areas for action that should be led by health board bosses and the Scottish Government.
Ozempic and similar drugs, such as Wegovy and Mounjaro, are a new generation of medications that help curb appetite and promote weight loss. While they have been approved for NHS use in eligible patients for weight loss and to treat inadequately controlled type 2 diabetes, the report noted that the majority of NHS prescriptions are for the latter condition. The use of these drugs for obesity management remains significantly more limited, with 71 percent of Scottish patients obtaining such medication privately in the last 12 months.
The report cautioned that the findings likely reflect prescribing primarily for type 2 diabetes rather than widespread NHS adoption for obesity. It further pointed out anomalies, such as the two areas with the highest prescribing rates, the Western Isles and NHS Greater Glasgow and Clyde, having different recorded population needs. Greater Glasgow and Clyde had a lower prevalence of overweight and obesity compared to the Western Isles, which had the second-highest prevalence. Meanwhile, Shetland recorded the lowest per capita prescribing despite a relatively high prevalence of overweight and obesity.
Victoria Jordan, ABPI executive director of patient access, stated that while Scotland has a robust system for assessing new medicines, the report indicates that the utilization of some accepted medicines can vary widely between NHS boards, and these differences are not fully explained by patient needs. She emphasized the need for closer examination of the issue, suggesting that avoidable barriers can delay patient access to effective and value-for-money medicines. Jordan called for collaborative planning among government, the NHS, clinicians, patients, academia, and industry to ensure national decisions benefit patients regardless of their location.
Doctors have also raised concerns about a "two-tier system" for weight loss treatment, noting that only around 700 patients in Scotland have received these weight-loss injections through the NHS over the past three years, making them unavailable to the majority who could benefit.
Professor Mark Strachan, President of the Royal College of Physicians of Edinburgh, described the advent of weight loss medicines as a "monumental development" for managing obesity, type 2 diabetes, and associated conditions. He highlighted research indicating a significant reduction in cardiovascular events for eligible patients. However, he observed that many individuals who would benefit from these medicines for weight management cannot access them through the NHS in Scotland. Strachan noted that public health data suggests that people in the most deprived communities disproportionately bear the burden of obesity and type 2 diabetes, while financially better-off individuals can often afford private prescriptions, potentially creating a two-tier system.
The Simple Online Pharmacy estimates that approximately 300,000 Scottish individuals pay for private prescriptions for these drugs, which can cost upwards of £4,000 annually.
The Scottish Government has stated it is working to reduce regional healthcare disparities and will carefully consider the report's findings. A government spokesperson indicated that reforms to NHS boards are intended to improve equitable access to services and mitigate unwarranted variation and bureaucratic obstacles.