Weight loss drug Wegovy arrives in Israel, ending off-label use of Ozempic

With the drug purchased privately and often requiring injections of increasing doses, users face high ongoing monthly prices

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Illustrative: Woman holds up a dosage of Wegovy, a drug used for weight loss, in Front Royal, Virginia, March 1, 2024. (AP Photo/Amanda Andrade-Rhoades)
Illustrative: Woman holds up a dosage of Wegovy, a drug used for weight loss, in Front Royal, Virginia, March 1, 2024. (AP Photo/Amanda Andrade-Rhoades)

Weight loss drug Wegovy has been approved for use in Israel by the Health Ministry.

The ministry’s announcement comes with the instruction that physicians must no longer prescribe Ozempic for off-label use for weight loss, a practice approved by the FDA in 2021.

Wegovy and Ozempic are both subcutaneous injectables containing semaglutide as their active ingredient. The difference between the two drugs manufactured by Novo Nordisk is their dosages and intended uses.

Ozempic is meant to manage blood sugar levels and reduce the risk of cardiovascular disease in adults with type 2 diabetes. The maximum dose for the drug is 1 milligram.

Wegovy is intended to help with weight loss in obese and overweight patients with complications like prediabetes, type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease. Approved for use in children 12 and older as well as adults, its maximum dose is 2.5 milligrams.

Reserving Ozempic for diabetics is aimed at maintaining a sufficient supply of the drug for these patients. Before the arrival of Wegovy in Israel, some doctors had to stop treating their diabetic patients with Ozempic because stocks were depleted by people using it off-label.

In a letter to the medical community dated April 10, the Health Ministry said that patients with a valid Form 29 for six months of off-label Ozempic use may continue to use the drug until the period expires. After that, they will need to switch to Wegovy.

Illustrative: The injectable drug Ozempic is shown in Houston on July 1, 2023. (AP Photo/David J. Phillip)

Wegovy is not included in Israel’s healthcare “basket,” meaning that it must be purchased privately at full cost, which varies from NIS 600 ($160) to NIS 1,300 ($350) per month, depending on the dosage. Ozempic was also not in the health basket for off-label use, but was some NIS 200 ($50) cheaper a month for the lower dose.

“Wegovy is more expensive than Ozempic, but less expensive than it would be if you were buying it in the US and some European countries,” noted Dr. Yael Sofer, head of the obesity clinic in the Department of Endocrinology, diabetes and hypertension at Tel Aviv-Sourasky Medical Center.

According to Sofer, people also need to be aware that unlike Ozempic, with Wegovy the weekly injection dose is often increased over time, which leads to an even higher cost.

“When using [it] in diabetics, we see more of a plateau with the glucose reduction and an improvement. But when using it for weight loss, if you increase the dose you see better reduction,” Sofer said.

Dr. Yael Sofer, head of the obesity clinic of the department of endocrinology, diabetes, and hypertension at
Tel Aviv-Sourasky Medical Center (Courtesy of Tel Aviv-Sourasky Medical Center)

Sofer said that in her experience, patients had sought Ozempic for weight loss from specialists, rather than their family doctors.

“But that may change now that Wegovy is available and physicians do not need to deal with filling in Form 29 for off-label drug use,” she suggested.

With Ozempic and Wegovy made available only in the last few years, there have yet to be any long-term studies published on them. However, Sofer said that one large study has been published showing that the use of semaglutide decreased complications and death for patients with a background of ischemic heart disease and cardiovascular disease.

In terms of semaglutide’s use for weight reduction, Sofer said she wouldn’t go so far as to call it a miracle drug, but she does see it as “a breakthrough” and “a game-changer.”

“When we talk about weight loss, there is the quantitative aspect and the qualitative aspect,” Sofer explained. “Quantitively, what we see is amazing.”

“However, qualitatively, we see in the clinic that along with people losing fat mass, they are also losing muscle and bone mass. There are also side effects to using the drugs, which are mainly gastrointestinal,” she said.

Sofer added that although there are no definitive studies yet on the psychological effects of semaglutide use, there have been clinical observations of some patients losing their vitality.

“It’s not full-blown depression, but for some people, there is a psychological effect,” she said.

Illustrative: A subject’s waist is measured during an obesity prevention study in Chicago in 2010. (AP Photo/M. Spencer Green)

Research by the National Institutes of Health in 2024 dispelled concerns raised a year earlier in Europe that Wegovy and Ozempic were related to suicidal ideation.

Like Ozempic, weight loss achieved through the use of Wegovy can only be maintained through continued use of the drug under medical supervision. Regular exercise is required to maintain muscle and bone mass, and a healthy diet prescribed by a registered dietician must be followed so that the body receives the proper nutrients despite a curtailing of the appetite.

There are some new drugs for weight loss in the pipeline, such as Eli Lilly’s Zepbound. Sofer said these may be even more effective and have fewer side effects. However, until these arrive in Israel, people who use Wegovy must commit to the ongoing injection regimen and financial cost.

Stopping Wegovy for personal reasons or because of a shortage can lead to problems when later going back on the drug.

“People don’t see the same effect when they try to restart it. We see this a lot and we don’t understand exactly why this happens,” Sofer said.

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