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

Ozempic has been hard to get in the UK since mid-2022. The cause is very high global demand for semaglutide, the active ingredient.

Background to the shortage:

• Demand for semaglutide rose fast after wide media coverage of celebrity weight loss and social media posts
• Novo Nordisk could not make enough to keep up. This affected Ozempic, Wegovy, and Rybelsus
• The DHSC (Department of Health and Social Care) issued Serious Shortage Protocols (SSPs) for Ozempic more than once
• The shortage mainly hit certain pen types, not every dose at the same time

Impact on patients:

• People with type 2 diabetes who use Ozempic to control blood sugar were hit hardest
• Some had to switch to other GLP-1 agonists, or to other drug types, when stock ran out
• Community pharmacies struggled to stock all three dose pens (0.25/0.5 mg pen and 1 mg pen) at once
• Hospital pharmacies and diabetes specialist teams set up local plans to help affected patients

Novo Nordisk manufacturing response:

• The firm has invested over 40 billion DKK (about 4.5 billion GBP) in larger factories in Denmark, France, and the United States
• New lines now make the semaglutide active ingredient and assemble the devices
• Supply should improve in stages through 2025 and 2026. The firm has warned that meeting all demand may take longer

Check stock with your community pharmacy before you go in for a new prescription.

Ozempic is licensed on the NHS for type 2 diabetes in adults. It is used alongside diet and exercise.

NICE NG 28 sets out the rules for prescribing GLP-1 receptor agonists (medicines that lower blood sugar and curb appetite).

NICE NG 28 criteria for GLP-1 agonist prescribing:

• You have tried metformin and at least one other oral blood sugar drug, but your HbA1c (a measure of average blood sugar) is still above 58 mmol/mol (7.5%)
• Your BMI is 35 kg/m2 or more with weight-related health problems, or 30 kg/m2 or more and the prescriber judges the medicine is the right choice
• Triple oral therapy (metformin plus two others) does not suit you, does not work, or you cannot take it

Updated NICE position:

NICE has slowly eased the strict BMI limits. It now recognises that GLP-1 agonists help the heart and kidneys. Prescribers look more at each person's situation than at fixed BMI cut-offs.

Who cannot get Ozempic on the NHS:

• People without a type 2 diabetes diagnosis who want it just for weight loss. Wegovy (semaglutide 2.4 mg) is the licensed and NICE-approved product for weight management
• People with type 1 diabetes. Ozempic has no role in type 1 care
• People who have not tried first-line and second-line treatments when these are suitable

Prescribing route:

• A diabetes specialist or a GP with a special interest usually starts it
• The GP can then take over prescribing under a shared care agreement
• During shortages, some Integrated Care Boards have stopped new starts to protect people already on it

If your pharmacy cannot supply Ozempic, do not just stop your treatment. Contact your prescriber and ask what to do instead.

Immediate steps:

• Ask the pharmacy to check other wholesalers. A different supplier may have stock
• Try other local pharmacies. Stock can differ from branch to branch
• Phone your GP surgery or diabetes specialist nurse to talk about other options
• Do not buy Ozempic from unregulated online sellers. The MHRA has seized fake semaglutide with wrong doses or unknown substances

Alternative GLP-1 receptor agonists:

• Dulaglutide (Trulicity): 0.75 mg or 1.5 mg once a week. It works in a similar way. It lowers HbA1c and weight a little less than semaglutide 1 mg. Supply is good
• Liraglutide (Victoza): 0.6 mg, 1.2 mg, or 1.8 mg once a day. You inject it daily. It has a well-proven record for how well it works and how safe it is
• Exenatide (Bydureon/Byetta): weekly or twice-daily options. It works less well than semaglutide but is widely stocked
• Rybelsus (oral semaglutide): the same active ingredient as a tablet. It may be in stock when the injection is not

If switching to a different drug class:

• SGLT2 inhibitors (dapagliflozin, empagliflozin) give some weight loss and help the heart and kidneys
• DPP-4 inhibitors do not change your weight and are easy to tolerate, but they lower HbA1c less
• You may need insulin for a while if your blood sugar control drops a lot

Your prescriber should record the supply problem and the plan to switch back when Ozempic returns.

Some people get Ozempic through a private prescription. This may come from a face-to-face private clinic or from a regulated online service.

Legitimate private prescribing:

• Registered private clinics can prescribe Ozempic for type 2 diabetes. They follow the same clinical rules as the NHS
• Some online clinics prescribe Ozempic off-label for weight loss. This is legal in the UK. Prescribers may prescribe off-label using their own judgement. But it brings extra things to think about
• Private prescriptions are dispensed at community pharmacies from the same stock as NHS ones. So private demand during shortages leaves less for NHS diabetes patients

Costs of private Ozempic prescriptions:

• Consultation fees usually run from 30 to 100 GBP
• A private Ozempic pen costs about 150 to 230 GBP, depending on the dose and the pharmacy
• Monthly costs at the maintenance dose can reach 200 to 300 GBP

Red flags for unsafe online services:

• No need to speak with a registered prescriber
• No request for your medical history, current medicines, or recent blood tests
• They supply semaglutide without a prescription (this is illegal in the UK)
• Prices well below the market rate (the product may be fake)
• No registered UK pharmacy dispenses the medicine

MHRA warnings:

The MHRA has put out many alerts about fake semaglutide pens sold online. Some fakes held the wrong amount of semaglutide. Others had no active ingredient. Some held unknown substances.

Only get semaglutide from a registered UK pharmacy with a valid prescription.

A large part of UK demand for Ozempic comes from off-label use for weight loss in people without type 2 diabetes. This raises clinical, ethical, and supply issues.

Scale of off-label use:

• OpenPrescribing data show semaglutide prescribing in England rose by over 200% between 2021 and 2023
• Much of this rise is linked to weight loss prescribing, though it is hard to pin down exact figures from NHS data
• Private online clinics have driven a lot of the off-label demand

Clinical considerations for off-label use:

• Ozempic 1 mg gives less weight loss than Wegovy 2.4 mg (about 5 to 7% vs 15% of body weight)
• So people who use Ozempic for weight loss get a dose of semaglutide that is too low for that goal
• Wegovy is made for weight loss. It uses a longer dose build-up and a higher maintenance dose
• Off-label prescribers should still do a proper check, including cardiovascular risk, mental health screening, and monitoring

Supply impact:

• NHS England and the BMA warn that off-label weight loss prescribing has made Ozempic shortages worse. This hurts diabetes patients who need it to control blood sugar
• In 2023 the DHSC told prescribers to put diabetes patients first during shortages
• Some Integrated Care Boards have issued local advice against off-label semaglutide while supply is tight

The regulatory position is clear. Ozempic is licensed for diabetes. Wegovy is licensed for weight loss. Use the right product for the right reason.

That gives the right dose and keeps supply going for everyone.

The supply picture for semaglutide should change a lot in the next few years. Novo Nordisk is expanding its factories. New rival products are coming to market too.

Novo Nordisk supply expansion:

• Large investment in plants in Kalundborg (Denmark), Chartres (France), and Clayton (North Carolina, USA)
• The main bottleneck is fill-finish capacity for pre-filled pens, and that is being fixed
• The firm expects better supply through 2026, but not fully back to normal

New semaglutide formulations in development:

• CagriSema: semaglutide plus cagrilintide (an amylin analogue) in one weekly injection. Phase 3 trials show more weight loss than semaglutide alone
• Higher-dose oral semaglutide (25 mg and 50 mg): being studied for weight loss. It could replace or add to injectable Wegovy
• Once-monthly semaglutide: in early development to cut how often you inject

Competitor GLP-1 and dual agonist products:

• Tirzepatide (Mounjaro): a GIP/GLP-1 dual agonist from Eli Lilly. It is now licensed in the UK for type 2 diabetes. In head-to-head trials (SURMOUNT programme) it gives more weight loss than semaglutide
• 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. It could give a once-daily pill that absorbs normally. You would not need to fast

What this means for patients:

• More treatment choices will arrive, so people rely less on one maker
• Competition may make supply steadier and, in time, bring costs down
• If you take Ozempic now, talk about new options with your prescriber at your annual review
• The core advice stays the same. Get semaglutide only through proper prescriptions from registered healthcare providers