Billions’ worth of weight loss and diabetes medications reached SA shelves and patients in 2024

The staggering cost of prescription medications distributed in South Africa has shed light on the nation’s physical and mental well-being.  

Data shows that USD2.28 billion worth of prescription medications – R41.3 billion based on this week’s exchange rate –  were distributed in South Africa in 2024. 

Physical health is tied to mental health, with a previous government study stating that 16% of the population was suffering from mental health issues.

Ozempic and diabetes

The list of the top 20 medications distributed in the country accounted for R5.7 billion of the total, with the remaining pharmaceutical treatments amounting to R35.6 billion.

The figures were shared with The Citizen by IQVIA, a leading international healthcare data and analytics firm. 

Medications for diabetes and weight loss made up roughly 30% of the top 20 medications, with HIV-related medications accounting for a further 20%.

At least R3.4 billion worth of diabetic or weight loss medications reached shelves and patients, with top-seller Ozempic accounting for R636 million of that figure.

The remaining leaders of prescription medications were for cancer treatments, antibiotics, renal care and arthritis.

The Human Sciences Research Council (HSRC) stated in 2024 that over 50% of South Africans were overweight or obese.

“Carrying excess weight poses a number of health risks. It increases the dangers of high blood pressure, high triglyceride levels, coronary heart disease, stroke, type 2 diabetes, osteoarthritis, sleep apnoea, and respiratory problems,” stated the HSRC.

Counselling before meds

Psychologists have illustrated the link between physical and mental well-being, stressing that alternatives to medications exist.

“We do know that Ozempic works on that addictive part of the brain, and we do have a big eating issue in South Africa,” said counselling psychologist Ereen Mitchell.

“We have a lack of understanding of what is good for us in terms of food and people get frustrated at the lack of information, which leads to a reliance on medications,” Mitchell told The Citizen.

The Florida-based psychologist said she takes a holistic, multidisciplinary approach with her patients, working with their doctors to ensure the patients are honest about their intake.

“We see how the patient can set out a better eating plan and a better lifestyle and what can be achieved in steps,” Mitchell said, adding that it was one part of a larger treatment method.

When considering medication, Mitchell said it was dependent on the individual and is designed to be a short-term approach, but adds that patients are prone to not sticking to their prescriptions.

Only when symptoms severe

Like Mitchell, Dr. Donny Fick from Meldene Medicross said medication for mental health conditions is typically considered when symptoms are moderate to severe, or when the patient’s safety is at risk.

“For mild cases, counselling, therapy and lifestyle changes are usually tried first. In the acute phase of managing stress and anxiety, we use anxiolytics like benzodiazepine,” Dr Fick told The Citizen.

“Note that these are for short-term use and should be prescribed with caution as they are habit-forming,” he added.

“If they need further medical intervention after the acute phase, or longer-term treatment, we will then use antidepressants. Some of those could cause weight gain and a loss of libido,” he explained.

Stats ‘underestimated’

Fedhealth Principal Officer Jeremy Yatt stated that 3991 of their members had a chronic registration for depression and depression with no psychosis.

This accounted for 4% of their clients, while a further 2% were registered to receive prescriptions for bipolar mood disorder and generalised anxiety disorder.

The scheme also serves a portion of members with other mental health conditions, such as schizophrenia and post-traumatic stress disorder.

“These figures are underestimated, as not all plan options cover out-of-hospital medication for depression, which is not considered a chronic disease list,” Yatt told The Citizen.

“Not all patients seek assistance either and stats show that woman are more likely to register for support for mental health,” he added.

Fedhealth paid out R5.8 million for depression medication, with the top three medications being Lexamil, Cilift and Nuzak.

Fedhealth showed that admission to wellness facilities costs roughly R28 000 on average, and the average stay for mental health support lasts 10 days.

Mental health figures

While the rate of admission had dropped between 2023 and 2024, the National Planning Commission stated in 2024 that nearly 16% of the population suffered some sort of mental health issues.

Additionally, Discovery Health had previously stated that payouts for mental health-related issues had increased by 224% over a ten-year period.

Discovery told The Citizen that 58% of their clients claiming for mental health issues do so for antidepressants, while 22% are on anxiolytics, and 20% take antipsychotics.

Of those being treated for depression, 50% take selective serotonin reuptake inhibitors, while 88% of those being treated for anxiety take benzodiazepine derivatives.

Alternatives

The psychologists suggested counselling, mindfulness practices, yoga or in severe cases psychotherapy, as alternatives to medication.

Mitchell suggested sleep, exercise, cognitive behavioural therapies (CBTs), interpersonal therapies and even exposure to hallucinogenic treatments in extreme cases.

“CBTs involve integrating your emotions and your thoughts and evaluating how that alters your behaviour by replacing negative thoughts with more adaptive thoughts,” Mitchell said.

On how to avoid prescription medication abuse by a patient, Dr Fick said it was important to closely monitor the situation.

“This is in the hands of the prescribing doctor, not to overprescribe. It is vital to council appropriately and to do regular follow-ups and check-ups,” he concluded.

NOW READ: More than half of SA employees diagnosed with mental health issues linked to work