A new generation of weight-loss drugs offers promise—but at a price


Excitement is growing about a new generation of drugs that offer the ability to help overweight adults lose more pounds than older drugs on the market.

Some patients, obesity experts say, are experiencing lower blood pressure, better diabetes control, less joint pain and better sleep from these newfound treatments.

The newer drugs, which are repurposed diabetes drugs, “are showing weight loss unlike other drugs we’ve had in the past,” he said David Creelpsychologist and registered dietitian at the Bariatric & Metabolic Institute at the Cleveland Clinic.

Still, for him and other experts, the excitement is mild.

This is because no single drug is a panacea on its own and many patients may need to take it drugs long term to maintain results. In addition, the latest treatments are often very expensive and often not covered by insurance.

The five-figure annual cost of new drugs also raises concerns about patient access and what widespread use could mean for the country’s overall health care bill.

Evaluating the trade-offs—weighing the value of better health and perhaps fewer obesity complications against the upfront costs of drugs—will increasingly come into play as insurance companies, employers, government programs and others who pay health care bills consider which treatments to cover.

“If you pay too much for the drug, everyone’s health insurance goes up. Then people drop their health insurance because they can’t afford it,” so providing the drug could do more harm to the system than not. said Dr. David Rindchief medical officer of the Institute for Clinical and Economic Evaluation, or ICER, a nonprofit group that reviews medical evidence to evaluate the effectiveness and cost of treatments.

Many commercial insurers currently limit coverage to only certain drugs that are currently available or require patients to meet certain thresholds for coverage—often bundling them with controversial measure called “body mass index”, the ratio of height to weight. Medicare specifically provides coverage for obesity drugs or drugs for “anorexia, weight loss, or weight gain,” even though it pays for bariatric surgery. Coverage in other government programs varies. Legislation that would allow Medicare to cover drugs — the Obesity Treatment and Reduction Act — has made no progress despite being reintroduced in every session of Congress since 2012.

As insurance companies view treatment costs with concern, manufacturers see a potential financial bonanza. Morgan Stanley analysts recently said that “obesity is the new hypertension” and projected revenue from US obesity drug sales could grow from the current $1.6 billion to $31.5 billion by 2030.

It’s easy to see how they could predict this surprising number simply based on potential demand. In the US, 42% of adults are considered obese, up from 33% a decade earlier. Health problems sometimes associated with weight, such as diabetes and joint problemsare also on the rise.

Even losing 5% of your body weight can provide health benefits, experts say. Some of the new drugs that can help curb hunger are helping some patients overcome this indicator.

The Wegs, a higher dose of the self-injectable diabetes drug Ozempic, helped patients lose an average of 15% of their body weight over 68 weeks during the clinical trial that led to its FDA approval last year. After discontinuing the drug, many patients continued to extend the study and gained weight, which is not unusual for almost any diet medication. Wegovy spent a large part of the year in insufficient supply due to production problems. It can cost around $1,300 per month.

Wego's injection pens
Wegovy, an injectable prescription drug, can help overweight or obese adults with weight-related health problems lose weight.

Novo Nordisk

Another injectable drug, still in final clinical trials, but expedited for approval according to the FDA, it could induce even greater weight loss in the range of 20%, according to Eli Lilly, its manufacturer. Both drugs mimic a hormone called glucagon-like peptide 1, which can signal to the brain in ways they create people feel fuller.

However, the average weight loss from both puts the drugs at a considerable distance from the results seen after surgical procedures, offering another option for patients and doctors.

But will a slew of old and new prescription medical products — with even more in development — be the answer to America’s weight problem?

Maybe a big one, experts say. First, drugs and devices do not work for everyone and vary in effectiveness.

Fullness is a prime example. With a price tag of $98 per month, it is considered a device by the FDA and requires a prescription. During clinical trials, about 40% of people who tried it failed to lose weight. But among the other 60%, the average weight loss was 6.4% of body weight over 24 weeks when combined with diet and exercise.

This average is in line with other older prescription weight loss drugs that often show up 5% to 10% weight loss when taken over a year.

A large number of capsules
Plenity, Gelesis’ weight loss treatment, is designed to help people feel satisfied with smaller portions.

Business Wire via AP

While it’s true that weight loss drugs — both old and new generations — don’t work for everyone, there is enough variation between individuals that “even the older drugs work really well for some people,” ICER’s Rind said.

But it’s too soon — especially with newer drugs — to know how long the results might last and how patients will weigh in five or 10 years, he said.

Still, advocates argue that insurance companies should cover treatment for weight problems, as well as treatment for cancer or chronic conditions such as high blood pressure. Paying for such treatment could be good for both the patient and the insurers’ bottom line, they argue. Over time, insurers may pay less for people who lose weight and then avoid further health complications, but such financial gains for the health system may last for years or even decades.

The financial benefits for drugmakers are so far mixed. Novo Nordisk, the maker of Wego and Ozempic, saw obesity care sales rise 110% in the first half of the year, driven by Wego, but its share price remained flat and even fell in September. But Lilly, who won approval for a new diabetes drug, Mounjarowhich may soon also get the green light for weight loss, saw September share prices 34% higher than last September.

Some employers and insurance companies that pay health care bills also question whether drugs are priced fairly.

ICER recently he looked, comparing four weight loss drugs. Two, Wego and Saxenda, are new-generation treatments, both made by Novo based on an existing injectable diabetes drug. The other two — phentermine/topiramate, sold by Vivus as Qsymia, and bupropion/naltrexone, sold as Contrave by Currax Pharmaceuticals — are older therapies based on pill combinations.

The results were mixed, according to a report released in August that will be finalized soon after public comments are evaluated and incorporated.

Wegovy has shown greater weight loss compared to other treatments. But Qsymia also helped patients lose a substantial amount of weight, Rind said. This older drug combination has a net cost, after manufacturer rebates, of about $1,465 a year in the second year of use, compared with Wego’s, which had a net cost of $13,618 in the second year, the report said. Many patients may be prescribed weight loss medications for years.

With such numbers, Wegovy failed to meet the group’s cost-effectiveness threshold.

“It’s a great drug, but it’s about twice as expensive as it should be” when its health benefits are weighed against its cost and the potential to increase overall medical spending and health premiums, Rind said.

But don’t expect costs to come down anytime soon, even as more new drugs come to market.

For example, Lilly has not yet disclosed how much Mounjaro will cost if it clears clinical trials for use as a weight-loss drug. But a hint comes from its $974-a-month price tag for diabetes treatment — an amount similar to that of rival diabetes drug Ozempic, Wego’s predecessor.

Novo charges more for Wegos than Ozempic, although the weight loss version contains more active ingredients. It is possible that Lilly will take a page out of this playbook and charge more for their weight loss version of Mounjaro as well.

Dr. W. Timothy Garveyprofessor in the Department of Nutritional Sciences at the University of Alabama-Birmingham, predicts that insurance coverage will improve over time.

“It’s now undeniable that you can achieve substantial weight loss if you stay on medication — and reduce the complications of obesity,” Garvey said. “It’s going to be hard for health insurers and payers to deny that.”

One thing the new focus on drug treatment can help, most experts said, is to ease the bias and stigma that has long dogged overweight or obese patients.

“The group with the highest level of weight bias is physicians,” he said Dr. Fatima Stanford, obesity medicine specialist and chief endocrinologist at Massachusetts General Hospital. “Imagine how you feel when you have a doctor who tells you that your worth is based on your weight.”

Rind sees new, more effective therapies as another way to help dispel the notion that patients are “not enough.”

“Over the years, it has become increasingly clear that obesity is a medical problem, not a lifestyle problem,” Rind said. “We have waited a very long time for drugs like this.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and public opinion polling, KHN is one of the company’s three main operational programs KFF (Kaiser Family Foundation). KFF is a subsidized non-profit organization providing information on the nation’s health issues.


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