Ozempic in the UK: Supply Status, Prescribing Criteria, and Alternatives During Shortages

Ozempic has experienced significant supply disruptions in the UK since mid-2022, driven by unprecedented global demand for semaglutide products.

Background to the shortage:

• Global semaglutide demand surged following widespread media coverage of celebrity weight loss and social media promotion
• Novo Nordisk's manufacturing capacity could not keep pace with demand across Ozempic, Wegovy, and Rybelsus
• The DHSC (Department of Health and Social Care) issued Serious Shortage Protocols (SSPs) for Ozempic on multiple occasions
• The shortage primarily affected specific pen presentations rather than all doses simultaneously

Impact on patients:

• Patients with type 2 diabetes who rely on Ozempic for glycaemic control have been the most affected group
• Some patients were forced to switch to alternative GLP-1 agonists or other drug classes during supply gaps
• Community pharmacies reported difficulty sourcing all three dose presentations (0.25/0.5 mg pen and 1 mg pen) at the same time
• Hospital pharmacy departments and diabetes specialist teams developed local protocols for managing affected patients

Novo Nordisk manufacturing response:

• Investment of over 40 billion DKK (approximately 4.5 billion GBP) in expanded manufacturing facilities in Denmark, France, and the United States
• New production lines for semaglutide active pharmaceutical ingredient and device assembly
• Phased supply improvement expected through 2025 and 2026, though the company has cautioned that full demand satisfaction may take longer

Patients should check with their community pharmacy before attending for a new prescription to confirm stock availability.

Ozempic is licensed and available on NHS prescription for type 2 diabetes in adults as an adjunct to diet and exercise. NICE NG 28 provides the framework for prescribing GLP-1 receptor agonists.

NICE NG 28 criteria for GLP-1 agonist prescribing:

• Metformin and at least one other oral glucose-lowering drug have been tried and HbA1c remains above 58 mmol/mol (7.5%)
• BMI of 35 kg/m2 or greater and specific weight-related comorbidities, or BMI of 30 kg/m2 or greater with the prescriber's clinical judgement supporting the choice
• Triple oral therapy (metformin plus two others) is not tolerated, not effective, or contraindicated

Updated NICE position:

NICE has progressively relaxed strict BMI thresholds, acknowledging the cardiovascular and renal benefits of GLP-1 agonists.

Prescribing decisions increasingly reflect individual clinical circumstances rather than rigid BMI cut-offs.

Who cannot get Ozempic on the NHS:

• Patients without a type 2 diabetes diagnosis requesting it solely for weight loss. Wegovy (semaglutide 2.4 mg) is the licensed and NICE-approved product for weight management
• Patients with type 1 diabetes. Ozempic has no role in type 1 management
• Patients who have not tried first-line and second-line therapies where these are appropriate

Prescribing route:

• Initiation is typically by a diabetes specialist or GP with specialist interest
• Ongoing prescribing can be transferred to the GP under a shared care agreement
• Some Integrated Care Boards have restricted new initiations during shortage periods to protect existing patients

If your pharmacy cannot supply Ozempic, do not simply stop treatment. Contact your prescriber for guidance on alternative arrangements.

Immediate steps:

• Ask the pharmacy to check alternative wholesalers. Stock may be available from a different supplier
• Contact other local pharmacies. Supply distribution can vary between branches
• Phone your GP surgery or diabetes specialist nurse to discuss alternatives
• Do not purchase Ozempic from unregulated online sources. The MHRA has seized counterfeit semaglutide products containing incorrect doses or unidentified substances

Alternative GLP-1 receptor agonists:

• Dulaglutide (Trulicity): 0.75 mg or 1.5 mg once weekly. Similar mechanism, slightly less HbA1c reduction and weight loss than semaglutide 1 mg. Good supply record
• Liraglutide (Victoza): 0.6 mg, 1.2 mg, or 1.8 mg once daily. Daily injection required. Well-established efficacy and safety profile
• Exenatide (Bydureon/Byetta): weekly or twice-daily options. Less effective than semaglutide but widely available
• Rybelsus (oral semaglutide): same active ingredient in tablet form. May be available when the injection is not

If switching to a different drug class:

• SGLT2 inhibitors (dapagliflozin, empagliflozin) offer some weight loss and cardiovascular/renal benefit
• DPP-4 inhibitors are weight-neutral and well tolerated but provide less HbA1c reduction
• Insulin may be required temporarily if glycaemic control deteriorates significantly

Your prescriber should document the supply issue and planned re-switch when Ozempic becomes available again.

Some patients obtain Ozempic through private prescriptions, either from face-to-face private clinics or regulated online prescribing services.

Legitimate private prescribing:

• Registered private clinics can prescribe Ozempic for type 2 diabetes under the same clinical criteria as the NHS
• Some online clinics prescribe Ozempic off-label for weight management. This is legal under UK law (prescribers can prescribe off-label at their clinical discretion) but carries additional considerations
• Private prescriptions are dispensed at community pharmacies against the same supply as NHS prescriptions. Private demand during shortages reduces availability for NHS diabetes patients

Costs of private Ozempic prescriptions:

• Consultation fees typically range from 30 to 100 GBP
• Ozempic pen costs (private) range from approximately 150 to 230 GBP per pen depending on dose and pharmacy
• Monthly costs at maintenance dose can reach 200 to 300 GBP

Red flags for unsafe online services:

• No requirement for a consultation with a registered prescriber
• No request for medical history, current medications, or recent blood tests
• Supplying semaglutide without a prescription (illegal in the UK)
• Prices significantly below market rate (possible counterfeit product)
• No registered UK pharmacy dispensing the medication

MHRA warnings:

The MHRA has issued multiple alerts about counterfeit semaglutide pens sold online.

Identified counterfeit products have contained incorrect semaglutide concentrations, no active ingredient, or unidentified substances.

Only obtain semaglutide from a registered UK pharmacy against a valid prescription.

A significant proportion of Ozempic demand in the UK comes from off-label prescribing for weight management in patients without type 2 diabetes. This has clinical, ethical, and supply implications.

Scale of off-label use:

• OpenPrescribing data show that semaglutide prescribing in England increased by over 200% between 2021 and 2023
• A substantial portion of this increase is attributed to weight management prescribing, though exact figures are difficult to isolate from NHS data
• Private online clinics have driven much of the off-label demand

Clinical considerations for off-label use:

• Ozempic 1 mg produces less weight loss than Wegovy 2.4 mg (approximately 5 to 7% vs 15% of body weight)
• Patients using Ozempic for weight loss are receiving a suboptimal dose of semaglutide for that purpose
• Wegovy is specifically designed for weight management with a longer titration schedule and higher maintenance dose
• Off-label prescribers should still conduct appropriate clinical assessment, including cardiovascular risk, mental health screening, and monitoring

Supply impact:

• NHS England and the BMA have raised concerns that off-label weight loss prescribing has worsened Ozempic shortages for diabetes patients who depend on it for glycaemic control
• The DHSC issued guidance in 2023 asking prescribers to prioritise diabetes patients during supply shortages
• Some Integrated Care Boards have issued local guidance discouraging off-label semaglutide prescribing while supply remains constrained

The regulatory position is clear: Ozempic is licensed for diabetes. Wegovy is licensed for weight management.

Using the correct product for the correct indication ensures appropriate dosing and supports supply for all patient groups.

The semaglutide supply landscape is expected to evolve significantly over the coming years as Novo Nordisk expands manufacturing and new competitor products enter the market.

Novo Nordisk supply expansion:

• Major capital investment in manufacturing sites in Kalundborg (Denmark), Chartres (France), and Clayton (North Carolina, USA)
• Fill-finish capacity for pre-filled pens is the primary bottleneck being addressed
• Company forecasts suggest improved but not fully normalised supply through 2026

New semaglutide formulations in development:

• CagriSema: a combination of semaglutide and cagrilintide (amylin analogue) in a single weekly injection. Phase 3 trials show greater weight loss than semaglutide alone
• Higher-dose oral semaglutide (25 mg and 50 mg): under investigation for weight management, potentially replacing or supplementing injectable Wegovy
• Once-monthly semaglutide: early-stage development to reduce injection frequency further

Competitor GLP-1 and dual agonist products:

• Tirzepatide (Mounjaro): a GIP/GLP-1 dual agonist from Eli Lilly, now licensed in the UK for type 2 diabetes. Produces greater weight loss than semaglutide in head-to-head trials (SURMOUNT programme)
• Survodutide: a glucagon/GLP-1 dual agonist from Boehringer Ingelheim, in Phase 3 development
• Orforglipron: an oral non-peptide GLP-1 agonist from Eli Lilly. Could offer a once-daily pill with conventional absorption (no fasting requirement)

What this means for patients:

• More treatment options will become available, reducing dependence on a single manufacturer
• Competition may improve supply reliability and eventually reduce costs
• Patients currently on Ozempic should discuss emerging options with their prescriber at annual reviews
• The fundamental guidance remains unchanged: obtain semaglutide only through legitimate prescriptions from registered healthcare providers