Dismay at being unable to access semaglutide despite apparently being eligible

[clare56]

I am diabetic (diagnosed 8 years ago) and I although I tried to keep off medication through diet and exercise I had to start taking metformin 2 years ago. Like many others, I've found it increasingly difficult to lose the weight I believe has been a major factor in controlling my diabetes. I've repeatedly asked my GP if I can try the semaglutide injections and been repeatedly refused. My GP seemed sympathetic, but said it was up to the local health authority's diabetes centre. They have again said no. (Brighton and Hove)
Last week I was involved in some research for a well known pharmacy who sell weight loss drugs on line, including Wegovy and Mounjaro. I had to explore the websites of various online clinics - famous names such as Superdrug and LLoyds - and see what I liked and disliked about each offering.
All of them asked me to fill in a form about my medical history and they then all told me I couldn't get these drugs because I was diabetic.
So, it would appear that despite these drugs being for diabetes, I can't access them. I think the criteria in Brighton and Hove to access semaglutide is extremely high, and I feel really upset and frustrated with this system, particularly when I hear that they may be rolled out for people who are jobless and obese. (I have nothing against that happening, but it seems crazy that I'm not eligible.)
I'd be interested to hear if other people have had similar experiences.

 

[Rachox]

I’m type 2 and put on weight after family bereavements. At my diabetes review in 2023 I asked if I could start on a GLP1 med of which semaglutide is an example. My BMI was 34.8 just short of the NICE guideline of 35, I joked with my diabetes nurse that I could eat a few more high calorie meals to achieve 35! She then agreed after consulting one of the GPs, that I could start in Victoza injections, another GLP1 med. This became impossible to get by the end of ‘23 (due to all the skinny jab hype) and long story short I was switched to Rybelsus, the tablet version of semaglutide which is only licensed for use in diabetes. I continue on these tablets and along with a low carb diet I keep my diabetes under control and have lost 3 stone.
If I was in your position I’d ask for a second opinion. Can you book an appt with a different GP? See if they are prepared to prescribe it for you?

 

[clare56]

I’m type 2 and put on weight after family bereavements. At my diabetes review in 2023 I asked if I could start on a GLP1 med of which semaglutide is an example. My BMI was 34.8 just short of the NICE guideline of 35, I joked with my diabetes nurse that I could eat a few more high calorie meals to achieve 35! She then agreed after consulting one of the GPs, that I could start in Victoza injections, another GLP1 med. This became impossible to get by the end of ‘23 (due to all the skinny jab hype) and long story short I was switched to Rybelsus, the tablet version of semaglutide which is only licensed for use in diabetes. I continue on these tablets and along with a low carb diet I keep my diabetes under control and have lost 3 stone.
If I was in your position I’d ask for a second opinion. Can you book an appt with a different GP? See if they are prepared to prescribe it for you?

Your story is very interesting and I will definitely try for another opinion. I have been given dapagliflozin, following my last failed attempt. My GP suggested this could help with weight loss, but so far it hasn’t helped, although my blood sugar is less spiky now. I read that if 3 drug regimes have failed to control the diabetes successfully, my health authority will consider the semaglutide injections. I hadn’t heard about Rybelsus, and will follow that up. Thank you!

 

[Sally66]

I am diabetic (diagnosed 8 years ago) and I although I tried to keep off medication through diet and exercise I had to start taking metformin 2 years ago. Like many others, I've found it increasingly difficult to lose the weight I believe has been a major factor in controlling my diabetes. I've repeatedly asked my GP if I can try the semaglutide injections and been repeatedly refused. My GP seemed sympathetic, but said it was up to the local health authority's diabetes centre. They have again said no. (Brighton and Hove)
Last week I was involved in some research for a well known pharmacy who sell weight loss drugs on line, including Wegovy and Mounjaro. I had to explore the websites of various online clinics - famous names such as Superdrug and LLoyds - and see what I liked and disliked about each offering.
All of them asked me to fill in a form about my medical history and they then all told me I couldn't get these drugs because I was diabetic.
So, it would appear that despite these drugs being for diabetes, I can't access them. I think the criteria in Brighton and Hove to access semaglutide is extremely high, and I feel really upset and frustrated with this system, particularly when I hear that they may be rolled out for people who are jobless and obese. (I have nothing against that happening, but it seems crazy that I'm not eligible.)
I'd be interested to hear if other people have had similar experiences.

I’ve just had the same rejection here in Cheshire. I’ve done well controlling my bs and cholesterol. I eat low carb, a sustainable natural diet based on real food and I swim 1 km a day (equivalent to a 4 km run). Despite this I’ve gained weight since my initial 11 kg loss after being diagnosed.

I’ve been offered a 800 calorie “Soup and Shakes” NHS diet that actually costs the NHS £1100 per patient. Over the counter Mounjaro costs about the same for 6 months. It is simply not true that this diabetes treatment costs so much that it has to reserved only for those who are morbidly obese and have badly controlled blood sugar. My bmi is 31. I am obese by their bmi table but I don’t qualify.

I am going down the formal complaint route and taking this up with my MP. I am requesting that he brings this unfair loophole to the attention of Wes Streeting. This has to change.


Mod edit to conform with forum rules

 

[))Denise((]

I took part in the Ascend Plus trial, which is Semaglutide tablets - brand name Reybelsus, and did really well (weight loss and great HbA1c) but I was randomised into the placebo after 3 months of the real tablets.

I had been taking metformin for 16 years, but I had always had bad gastric problems with it (I know where the loo is in every town I visit!), but I was off on the holiday of a lifetime, so I stopped taking metformin.

HbA1c went up, and I put the weight back on that I had lost on the trial.

I wanted to be prescribed the semaglutide tablets again, even though I didn't meet the weight criteria. I used my surgery online submission to argue my case for being prescribed it (a sheet of A4), I knew I wouldn't be able to get all this across in an appointment, and they were forewarned about what I wanted. I think what went in my favour were 'quality of life' arguments that unpredictable diarrhoea is no fun and not acceptable.

I now have on my medical record that I am intolerant to metformin.

I was prescribed the semaglutide tablets in January 2025 and my HbA1c is in the non-diabetic range and my weight is the lowest it has been in 45 years.



Mod edit
To conform with forum rules

 

[Sally66]

Great to hear you succeeded in your argument. I am appealing the decision against me and involving my MP. I can only hope the tide turns in our favour. Fascinated to hear how you did in the trial, this was my experience also. You have given me hope.

 

[Melgar]

A call to order. There are many reasons people struggle to loose, or maintain a healthy weight ratio. Raised/high HbA1c numbers may or may not be associated with weight. Simply assigning weight, or an inability to lose weight to high HAbA1c numbers is a complete oversimplification. Issues with hormone regulation, insulin resistance, medications, and genetic predispositions, to name but a few, can impact metabolism and weight control. Please be mindful when making over arching simplifications, they are both hurtful and incorrect.

 

[Sally66]

A call to order. There are many reasons people struggle to loose, or maintain a healthy weight ratio. Raised/high HbA1c numbers may or may not be associated with weight. Simply assigning weight, or an inability to lose weight to high HAbA1c numbers is a complete oversimplification. Issues with hormone regulation, insulin resistance, medications, and genetic predispositions, to name but a few, can impact metabolism and weight control. Please be mindful when making over arching simplifications, they are both hurtful and incorrect.

I completely agree but I think what you outline here is exactly what is being overlooked by the NHS criteria for the prescription of weight loss drugs in the UK. To limit that criteria to those with a BMI of 40+ or uncontrolled HbA1C numbers is indeed wrong and fails to take into account the serious struggles people have with weight loss for the many reasons you outline. I could not agree more about how such an "over simplification" impacts on those of us desperately seeking support. As if managing diabetes alone wasn't a big enough burden on our mental health. Here in the UK, decisions are being made (which immediately impact the health and well being of diabetes patients) that are based on out of date and erroneous data and are discriminatory in nature. This is why I have raised this with my MP who I hope will take this up with the Secretary of State for Health, Wes Streeting. Something needs to change and fast.

 

[))Denise((]

@Sally66 I hope you are successful with your appeal. As I have stated, I didn't ask for the injections but a prescription of the semaglutide tablets, which may have also gone in my favour (with the evidence that they had worked). Additionally, I outlined my arguments before my GP appointment, so they could consider them before they saw me. I had also consulted the NICE guidelines and the diabetes medication pathway for my health trust area.

 

[Sally66]

Yes, I too asked for oral Semaglutide as an alternative to Metformin even though I took both on the trial. I also pointed out how well I responded on the trial but the Physician Associate just rejected this after consulting her “team”. It’s all in my complaint/appeal.

Now I have assumed that my practice are working on NICE guidelines. What I’m less certain of whether there is any guidance that allows discretion. I suspect there is but they are not sharing it with me. I’ll see what I can find on the Cheshire Health Trust website.

 

[TreboroughLiz]

Yes, I too asked for oral Semaglutide as an alternative to Metformin even though I took both on the trial. I also pointed out how well I responded on the trial but the Physician Associate just rejected this after consulting her “team”. It’s all in my complaint/appeal.

Now I have assumed that my practice are working on NICE guidelines. What I’m less certain of whether there is any guidance that allows discretion. I suspect there is but they are not sharing it with me. I’ll see what I can find on the Cheshire Health Trust website.

I had Rybelsus added to my combination of metformin (30 years) and dapaglaflozin (15 years) in September 2024. This has supported some additional weight loss taking my bmi down to 19 and my hba1c down to 44. New GP had a look at my stats and pulled my prescription for Rybelsus without consultation so I filled in an e-consult quoting NICE guidance (including the fact that I had bad experience on Glicklizide and my HBa1 c kept rising to 60 plus) and research about personal fat thresholds. I have now been prescribed a low does maintenance dose and have an appointment to discuss coming off medications. I only want to come off dapaglaflozin once my Hba1c is under 40 as I want to aim for 'healthy' not 'satisfactory for a type 2 diabetic. I imagine I will have a fight on my hands but Rybelsus has been the most effective medication I have ever been on and I have had fewer digestive issues than I have had with metformin - Referencing improvements to quality life does also appear to carry some influence but there does appear to be a post code lottery.