Next-generation weight-loss drugs show promise, but at a price

ByDonald L. Leech

Oct 13, 2022

Excitement is mounting over a new generation of drugs that tout the ability to help overweight adults lose more weight than older drugs on the market.

According to obesity medicine specialists, some patients are experiencing lower blood pressure, better managed diabetes, less joint pain and better sleep thanks to these new treatments.

The new drugs, which are repurposed diabetes drugs, “show weight loss unlike any other drugs we’ve had in the past,” said David Creel, a psychologist and dietitian at Cleveland’s Bariatric & Metabolic Institute. Clinic.

Still, for him and other experts, the thrill is tempered.

This is because no drug is a magic bullet on its own, and many patients may need to take the drugs long term to maintain results. On top of that, newer treatments are often very expensive and often not covered by insurance.

The five-figure annual costs of new drugs also raise concerns about access for patients and what their widespread use could mean for all of health care in the country.

Weighing the trade-offs – weighing the value of better health and possibly fewer obesity complications down the road against upfront drug costs – will increasingly come into play as insurers, employers, government programs and others who pay health care bills consider which treatments to cover.

“If you pay too much for a drug, everyone’s health insurance goes up. Then people drop out of health insurance because they can’t afford it,” so providing the drug could cause more harm to the system than otherwise, said Dr David Rind, the institute’s chief medical officer. for Clinical and Economic Review, or ICER, a nonprofit group that reviews medical evidence to assess the effectiveness and cost of treatments.

Many commercial insurers currently limit coverage to only some of the drugs currently available, or require patients to meet certain coverage thresholds — often tying it to a controversial measure called “body mass index,” a height-to-weight ratio. Medicare specifically prohibits coverage for obesity drugs or drugs for “anorexia, weight loss, or weight gain,” although it does pay for bariatric surgery. Coverage of other government programs varies. Legislation that would allow drug coverage in Medicare — the Obesity Treatment and Reduction Act — has not progressed despite being reintroduced in every session of Congress since 2012.

As insurers view the cost of treatments with concern, manufacturers see a potential financial windfall. Morgan Stanley analysts recently said “obesity is the new hypertension” and predicted that industry revenue from sales of obesity drugs in the United States could rise by $1.6 billion. to $31.5 billion by 2030.

It’s easy to see how they could predict this startling number just based on potential demand. In the United States, 42% of adults are considered obese, up from 33% ten years earlier. Health problems sometimes related to weight, such as diabetes and joint problems, are also on the rise.

According to experts, even losing 5% of your body weight can have health benefits. Some of the newer drugs, which can help reduce hunger, are helping some patients pass this marker.

Wegovy, which is 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 l ‘last year. After stopping the drug, many patients followed in an extension of the trial regained weight, which is not uncommon with almost all diet drugs. Wegovy spent much of the year in short supply due to manufacturing issues. It can cost around $1,300 per month.

Another injectable drug, still in final stages of clinical trials but whose FDA approval is fast-tracked, could lead to even greater weight loss, in the order of 20%, according to Eli Lilly, its manufacturer. Both drugs mimic a hormone called glucagon-like peptide 1, which can send signals to the brain in ways that make people feel fuller.

The average weight loss of the two, however, puts the drugs at a striking distance from the results seen after surgeries, providing another option for patients and doctors.

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

A big maybe, say the experts. For one thing, medications and devices don’t work for everyone and their effectiveness varies.

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

This average puts it in line with other older weight loss drugs, which often show 5% to 10% weight loss when taken over a year.

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

But it’s too early – especially for new drugs – to know how long the results may last and how much weight patients will be in five or 10 years, he said.

Still, advocates argue that insurers should cover treatments for weight problems the way they cover those for cancer or chronic conditions like high blood pressure. Paying for such treatment could be good for both the patient and insurers’ bottom line, they argue. Over time, insurers may pay less for people who lose weight and then avoid other health complications, but such financial gains for the healthcare system could take years or even decades to accrue. .

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

Some employers and insurers who pay health care bills also ask if drug prices are fair.

ICER recently took a look comparing four weight loss drugs. Two, Wegovy and Saxenda, are next-generation treatments, both made by Novo from an existing injectable diabetes medicine. The other two – phentermine/topiramate, sold by Vivus as Qsymia, and bupropion/naltrexone, sold as Contrave by Currax Pharmaceuticals – are older therapies based on combination pills.

The results were mixed, according to a report published in August, which will be finalized shortly after the evaluation and incorporation of public comments.

Wegovy showed greater weight loss compared to the 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 approximately $1,465 per year in the second year of use, compared to Wegovy, which had a net cost of $13,618 during of this second year, according to the report. Many patients may be prescribed weight-loss drugs for years.

With such figures, Wegovy did not reach the group’s break-even point.

“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 its potential to increase overall medical expenses and health costs. health premiums, Rind said.

Don’t expect costs to come down anytime soon, even though other new drugs are about to hit the market.

Lilly, for example, has yet to reveal what Mounjaro will cost if it allows clinical trials for use as a weight-loss drug. But one clue comes from its price of $974 a month as a diabetes treatment — a similar amount to rival diabetes drug Ozempic, the precursor to Wegovy.

Novo charges more for Wegovy than for Ozempic, although the weight loss version includes more of the active ingredient. It’s possible that Lilly will take a page out of this playbook and charge more for its weight loss version of Mounjaro as well.

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

“It’s undeniable now that you can achieve substantial weight loss if you continue to take medication and reduce the complications of obesity,” Garvey said. “It will be difficult for health insurers and payers to deny.”

According to most experts, one thing the new focus on drug treatment could help with is tempering the prejudices and stigma that have long plagued overweight or obese patients.

“The group with the highest level of weight bias is physicians,” said Dr. Fatima Stanford, an obesity medicine specialist and equity director for Massachusetts General Hospital’s endocrine division. “Imagine how you feel if you have a doctor telling you that your worth is based on your weight.”

Rind sees newer, more effective therapies as another way to help dispel the idea that patients are “not trying hard enough.”

“It’s become increasingly clear over the years that obesity is a medical condition, not a lifestyle choice,” Rind said. “We’ve been waiting for drugs like this for a very long time.”

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