Diabetes is expected to surge dramatically in young people over the next several decades in what experts say should be a wake-up call to prioritize health in America. Researchers estimate that in 2060, there could be as many as 220,000 people under age 20 with Type 2 diabetes, an increase of nearly 700%, according to a Centers for Disease Control and Prevention study. But Lilly’s new weight loss drug could be massive. According to an estimate from Bank of America analyst Geoff Meacham, annual sales of tirzepatide could hit a record $48 billion.
There’s gold in Obesity. A “fair” price for tirzepatide could be around $13,000 annually, or about $1,100 a month, said Dr. David Rind, the chief medical officer for the Institute for Clinical and Economic Review. This research group helps determine fair prices for drugs. The biggest hurdle is that insurers won’t cover the drug because they see it as a vanity drug.
There is another issue that too many journalists are ignoring. These “weight-loss” drugs need to be taken for life to maintain weight loss. $13,000 out-of-pocket is a lot of money for most people. However, the biggest issue may be the GI side effects that drug companies are minimizing. According to reports, some patients are experiencing moderate to severe side GI side effects, while some feel complete with tiny portions of food.
Insurance coverage of anti-obesity drugs may not improve until more people in the medical field change how they view Obesity. It’s not something that diet, exercise, or sheer willpower can fix — instead, it’s a dysregulation of fat cells in the body. But can insurers be persuaded?
Drug companies must convince payers that there are substantial cost savings in helping obese patients lose weight. It’s a tough nut to crack, and there’s going to be a lot of resistance, but it may be the only path to get them to cover these drugs.
My biggest worry is that too many people see these weight loss drugs as an easy way to lose weight rather than common sense interventions like exercise and diet. I understand that Obesity is a complex condition, but it also is more common among lower-income demographics who don’t have good health coverage. These people need these drugs the most, along with education on the dangers of Obesity.
Then drug companies are going to convince doctors. A review published last year in the research journal Obesity found that healthcare professionals hold implicit and explicit weight-biased attitudes toward people with Obesity.
In 2021, lawmakers in the House of Representatives introduced The Treat and Reduced Obesity Act, which would have allowed the federal government to expand Medicare Part D coverage to include anti-obesity medications. The legislation had 154 bipartisan co-sponsors, according to Congress.gov, but did not receive a vote on the House floor before the term ended.
With so much money at stake, Lilly is sure to use all their power to get the drug covered by insurers, but patients need to understand the risks of long-term use and potential side effects. As of yet, there is no magic drug that will lead to a decrease in Obesity. It goes back to HCP and the relationship they have with patients. They need to be able to convey the importance of exercise and diet and address psychological factors that lead to unhealthy lifestyles.