Novo Nordisk – the manufacturer of several GLP-1 receptor agonists such as liraglutide and semaglutide – has said that it envisages intermittent supply shortages over the next 18 months, despite running factories 24/7 to increase production.

Last week (27 June) the Department of Health and Social Care (DHSC) issued a Tier 3 (high impact) medicine supply notification for GLP-1 receptor agonists used in the management of type 2 diabetes.

It said that supply issues had been caused by an increase in demand for these products for licensed and off-label indications.

And it said that supply was not expected to return to normal until at least mid-2024.

But a spokesperson for Novo Nordisk has this week told The Pharmacist that while it has increased production, this will take time to take effect, and that it therefore envisaged intermittent supply shortages over the next 18 months.

The spokesperson said that Novo Nordisk was increasing the number of medicines it was making by running its factories 24 hours a day, seven days a week.

They said: ‘By the end of 2023, we will have dedicated more than $5 billion USD to open new production lines and facilities.

‘It will take time for the impact of our steps to take effect, therefore we envisage intermittent supply shortages over the next 18 months.

‘Novo Nordisk is acutely aware of the uncertainty and concern this is causing, and the disruption patients and healthcare professionals are experiencing.

‘We are speaking with health authorities to keep healthcare professionals informed and involved as we continue to address these challenges and meet the high demand for our medicines.’

Mike Dent, director of pharmacy funding at Community Pharmacy England, said that the shortage of GLP-1 receptor agonists was ‘just one issue in a long line of medicine supply problems’.

‘Whilst pharmacy teams are working immeasurably hard doing their best for patients in the face of all kinds of pressures, they are caught in the middle of an impossible situation,’ he said.

‘Patients are understandably frustrated, but the problems within the medicines market go far beyond the pharmacies trying to manage them.’

He pointed to CPE’s recent survey which found the majority of pharmacists were experiencing ‘extra workload’ and ‘additional stress’ due to supply issues.

‘The situation shows little sign of improving after years of turbulence and, with patient safety at risk, the government urgently needs to step in and help stabilise the medicines market,’ added Mr Dent.

Supply issues with Ozempic (semaglutide) have been reported since 2022.

On 30 September 2022, the Department of Health and Social Care (DHSC) issued Medicine Supply Notifications (MSNs) advising health professionals not to initiate new patients on Ozempic (semaglutide injection) and Trulicity (dulaglutide injection), to ensure that Ozempic is only used for licensed indications.

It also told health professionals to consider initiating patients on an alternative to Trulicity until the shortage was resolved.

And the most recent MSN addresses all glucagon-like peptide –1 receptor agonists including Victoza (liraglutide injection) and Rybelsus (semaglutide tablets).

The DHSC confirmed that it was working with diabetes specialists, wholesalers, and manufacturers of these medicines, as well as the relevant regulatory bodies and agencies, to address the shortages and maintain access to treatment for type 2 diabetic patients.

And several GLP-1 receptor agonists have been added to the list of medicines that are subject to export and hoarding restrictions.

A DHSC spokesperson said that the department was ‘working closely with partners to support the NHS in managing this issue’.

‘We have issued guidance to prescribers and pharmacists that medicines which are solely licensed to treat type 2 diabetes – such as Ozempic – should not be routinely prescribed for weight loss. It should only be prescribed for treatment of type 2 diabetes.

‘If any patient is concerned about their treatment, they should discuss this with their clinician.’

In March this year, NICE recommended a weekly injection of semaglutide, manufactured by Novo Nordisk under the brand name Wegovy, for adults who have at least one weight-related comorbidity and a body mass index (BMI) of at least 35kg/m2.

The DHSC confirmed that prescribers were expected to take account of appropriate national guidance, and would be accountable for their prescribing decisions, both professionally and to their service commissioners.

In June, DHSC announced a £40m two-year pilot to explore how approved drugs like Wegovy can be made safely available to more people, by expanding specialist weight management services outside of hospital settings.

Novo Nordisk said that it did not have a confirmed launch date for Wegovy (semaglutide 2.4mg) but was working to make it available in the UK as soon as possible.

And it said that the launch date for the government pilot scheme on obesity treatments announced in June 2023 would be set by the government.