Abstract
This cross-sectional study evaluates the use of direct-to-consumer advertising for a glucagon-like peptide-1 receptor agonist (GLP-1RA).
Introduction
Direct-to-consumer advertising (DTCA) of prescription drugs remains commonplace in the US, accounting for billions of dollars of expenses each year and influencing patients’ and physicians’ perceptions of health issues and treatments.1 DTCA has made broad use of pay-per-click (PPC) advertising, in which advertisers target users based on their search queries and online behavior.2 With PPC, companies bid on keywords related to their products and pay when someone clicks their advertisements.
Prescription drug promotion is regulated by the Food and Drug Administration (FDA), and manufacturers must follow certain rules, including that advertising be truthful, balanced, and accurate, while disclosing key information.3 This study explores how PPC advertising is used in the pharmaceutical context by analyzing a large dataset of keyword ads linked to Ozempic.com to identify key components of digital promotion.
Methods
To explore the phenomenon of PPC DTCA, we evaluated the case of semaglutide (Ozempic), a GLP-1RA FDA approved for diabetes.4 Our cross-sectional study analyzed publicly available data on paid search advertisements for the drug’s website in the US from April 2022 to March 2024 using Semrush, a tool for keyword and PPC analysis.5 Semrush offers a reliable tool for examining strategies,6 providing estimated data on traffic, identifying paid Google ads, estimating costs, and understanding the keywords advertisers use to reach users.
Our study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. Our publicly available data were exempt from ethics review per the Common Rule, and we relied on descriptive analyses conducted in Excel version 16 (Microsoft) and Semrush Guru.
Results
In the case of Ozempic, an estimated $7.5 million was spent on more than 15 000 paid keywords over 2 years, generating 2.4 million paid visits to the drug’s website. More than 3500 of the keywords (23%) contained no mention of the drug (Table 1), including misspellings of the brand name. Substantial spending covered weight-loss-related terms, including Ozempic for weight loss ($302 757) and Ozempic weight loss ($188 626), as well as keywords linked to competitors’ drugs such as Trulicity ($203 578) and Mounjaro ($113 668). More than 600 keywords included Mounjaro and more than 1000 keywords included Trulicity, including Trulicity side effects, side effects of Trulicity, and Trulicity complaints.
Table 1. Top 20 Keywords That Do Not Contain the Brand Name Ozempic, by Traffic Cost, April 2022 to March 2024.
| Keyword | Total traffic cost, US $ |
|---|---|
| Trulicity | 203 578 |
| Mounjaro | 113 668 |
| Trulicity side effects | 67 820 |
| Tirzepatide | 52 042 |
| Foods to avoid with Trulicity | 43 274 |
| Mounjaro side effects | 26 429 |
| Trulicity dosage | 25 180 |
| Semiglutide | 24 511 |
| Trulicity complaints | 18 852 |
| Side effects of Trulicity | 17 352 |
| Trulicity coupon | 16 765 |
| Munjaro | 16 051 |
| Trulicity dosing | 13 849 |
| Semaglutide near me | 13 601 |
| Mounjaro cost | 10 641 |
| Byetta | 10 445 |
| Manjaro drug | 10 393 |
| Mounjaro dosage | 10 023 |
| Bydureon | 9765 |
In the cohort, 1729 keywords (11%) contained the term weight (Table 2). These keywords led to more than 358 000 website visits via advertisements, constituting 14% of paid keyword visits.
Table 2. Top Weight-Related Keywords by Traffic, April 2022 to March 2024.
| Keyword | Paid traffic |
|---|---|
| Ozempic for weight loss | 113 811 |
| Ozempic weight loss | 77 218 |
| 6 week plan Ozempic weight loss results | 14 703 |
| How to get Ozempic for weight loss | 13 452 |
| Ozempic weight loss before and after pictures | 9608 |
| Trulicity weight loss | 8345 |
| Weight loss drug Ozempic | 7426 |
| Ozempic and weight loss | 6762 |
| Ozempic weight loss side effects | 6503 |
| Mounjaro weight loss | 5429 |
| Trulicity for weight loss | 4413 |
| 6 week belly Ozempic weight loss before and after | 4177 |
| Mounjaro for weight loss | 4066 |
| How does Ozempic work for weight loss | 3960 |
| Ozempic dosing for weight loss | 3868 |
| Weight loss Ozempic | 3415 |
| Weight watchers Ozempic | 2654 |
| How to get prescribed Ozempic for weight loss | 2594 |
| Ozempic for weight loss side effects | 2521 |
Discussion
PPC advertising prioritizes company websites over other sources, an outcome that may not be apparent to users expecting search results to reflect informational relevance or objectivity. Manufacturers’ websites inevitably emphasize medications’ benefits, risks, and alternatives in ways designed to drive prescriptions.
Ozempic’s website has been promoted in response to a diverse set of search keywords that include other prescription drugs. PPC advertising may allow companies to promote their drugs for non–FDA-approved uses; for example, individuals searching weight keywords may be targeted with an Ozempic paid advertisement. While Ozempic has been shown to help them lose weight, it is not FDA approved for weight loss. This approach may influence consumer behavior by increasing the likelihood that individuals, including those for whom the drug may not be FDA approved or clinically indicated, initiate conversations with their clinicians that lead to a prescription. This single-case analysis limits generalizability, and the relatively modest spending observed may reflect regulatory caution, strategic targeting, or reliance on other digital channels.
Future research should assess whether similar PPC strategies are used across other products or manufacturers. While the FDA provides guidance for manufacturers’ use of social media, this does not cover search engines. In response, the FDA could issue guidelines about or seek to review PPC content to prevent patients from being misled.
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
Data Sharing Statement
