More than 18 weight loss drugs are in development because drug companies know that the market is worth billions of dollars even though insurance companies are still debating their coverage for weight loss. It’s going to be a knockout, drag-down battle.
Bloomberg says, “at least $100 billion annually is potentially riding on new weight loss drugs. In the US alone, about 130 million adults are eligible for GLP-1s because of their weight and other health conditions. If just a third of Americans with severe obesity took them, US sales of weight loss drugs would swell more than 30 times, into an $80 billion industry, according to data analytics company Airfinity Ltd. Analysts at Jefferies Financial Group Inc. predict that GLP-1s for diabetes and obesity could become the biggest blockbusters of all time, bringing in as much as $150 billion a year globally.”
Private and public insurers aren’t convinced they’re worth covering. Medicare, the federal health insurance program for the elderly and some people on long-term disability, put weight loss in the same category as balding and erectile dysfunction. Three-quarters of private insurers don’t cover weight loss drugs, either. Most state Medicaid programs for low-income and disabled Americans restrict coverage, too, with just 10 offering broad coverage, according to a Bloomberg Businessweek survey of programs in all 50 states and DC. Coverage is also spotty in much of Europe and Canada. When insurers do pay, patients can face restrictions for how long they can take it or have to prove that they tried other weight loss methods first.
One recent review of medical studies found that up to a third of people with obesity are “metabolically healthy,” meaning they don’t have conditions such as diabetes and hypertension. Who qualifies as obese is up for debate: The widely used body-mass index calculation doesn’t accurately measure fat. “We need to be clear about which patients benefit from these medicines,” Andrew Witty, UnitedHealth Group Inc.’s chief executive officer, said in April on a call with investors.
The drug companies, it turned out, didn’t need the promise of insurance coverage to create a market for these treatments. Americans spend about $50 billion a year trying to shed pounds. (We didn’t evolve to sit in offices and eat highly processed carbs all day, but here we are.) Drugs that seem to offer quick, straightforward results are particularly appealing. Four million people took fen-phen in the few years the drug combination was popular. Novo, which sold nearly $900 million worth of Wegovy last year, has roughly doubled its market value since launching the drug in mid-2021—making it more valuable than Pfizer Inc.
Even if only 10% of Medicare beneficiaries with obesity take Wegovy, it could cost around $27 billion a year, or about 18.5% of Medicare’s net drug spending, according to an analysis recently published in the New England Journal of Medicine.
What do I think? I think the drugs should be covered for diabetes patients and patients who are morbidly obese and have health problems because of their weight, but not for patients show seem healthy and want to lose weight.
There are other issues we need to know such as:
1ne: What are the side effects of long term use?
2wo: What percentage of patients who use these drugs regain weight when they stop?
Insurers could require, for example, that patients who want these drugs for weight loss also consult with a registered dietician.
There are already new drugs in development that leapfrog the current weightloss drugs. There’s a lot of money to be made because we’re an obese nation looking for a quick fix.