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Business News/ Opinion / Columns/  New drugs for weight loss work but will insurers pick up bills?

New drugs for weight loss work but will insurers pick up bills?

Demand forecasts could run into doubts over their medical need

Weight-loss shots can achieve blockbuster sales but remain controversial ( istockphoto)Premium
Weight-loss shots can achieve blockbuster sales but remain controversial ( istockphoto)

After decades of failure, weight loss drugs seem finally poised to become big pharma’s newest blockbuster category. Bloomberg Intelligence sees the US obesity drug market alone as worth $12 billion in 2028. Morgan Stanley Research recently forecast their global sales at $54 billion by 2030. These new drugs offer more effective and sustained weight loss than any of the earlier pills. It’s estimated that between 2013 and 2016, only 3% of those eligible for an obesity medication in the US were taking any. But those lofty sales goals will only be reached if the medical field overcomes structural barriers to their use.

These drugs are typically once-a-week injections which mimic gut hormones that regulate the sense of satiety. Data on Novo Nordisk’s Wegovy, approved in June 2021, and Eli Lilly’s Mounjaro, expected to be approved next year, suggest these drugs can help people shed, on average, as much as 15-20% of their body weight. We have only a snippet on Amgen’s early-stage weight-loss drug, AMG 133, but it has generated interest from investors based on hopes that it could offer similar or potentially higher weight loss as Mounjaro with a once-a-month shot. Amgen said this week that people taking a high dose of the drug had lost on average about 14.5% of their body weight about three months into its phase 1 trial.

Results like those would make the new drugs 2-3 times more effective than older diet drugs, which had a litany of side effects ranging from the unpleasant (leaky stools) to downright dangerous (increased risk of heart attacks or cancer). People are eager to try new treatments. At an obesity conference last week, experts traded stories of long waits for appointments with weight-loss specialists. “Demand is overwhelming the workforce," says Robert Kushner, who specializes in obesity medicine at Northwestern Medicine.

Pharma companies are also struggling to keep up with demand. Lilly has had trouble keeping up its supply of Mounjaro, even though it’s currently only approved for diabetes. When it gets an expected nod from the US Food and Drug Administration as an obesity treatment, at least one analyst believes it could swiftly become one of the best-selling drugs in pharma history. And although Novo Nordisk’s Wegovy has been on the market for more than a year, it has been in a constant state of short supply.

Novo expects its supply constraints to ease by year-end, which could provide some answers to key questions. For one, the magnitude of demand could become clearer; currently, it’s complicated by people turning to diabetes treatments as a substitute. Once supply is steady, it should be easier to gauge how long people are sticking with weekly shots, a factor that will affect just how big of a blockbuster drug they become.

But all this enthusiasm assumes the field will work out some fundamental challenges that could hold back widespread use of these weight-loss drugs.

One major problem? Primary care physicians have been reluctant to prescribe them. Doctors aren’t typically trained to address obesity, and some still take the antiquated view that this disease is solely a lifestyle rather than a medical issue. Until that group gets more comfortable using these treatments, “I fear that all of these advances are going to remain on the shelf," says Kushner, who consults for Novo Nordisk and led a Phase 3 study of Wegovy.

Affordability is also a huge issue. Wegovy was launched with a monthly price of more than $1,600, and insurance coverage has been spotty. A patchwork of laws dictate access to weight-loss drugs around the US, making them more accessible in some states than others. In Massachusetts, for example, private insurers will pay for obesity drugs, but getting Medicaid to cover these has remained difficult elsewhere. In Pennsylvania, a bill that would allow the treatments to be covered for state Medicaid recipients has inched closer to passing after languishing for years. And Medicare currently excludes coverage of obesity drugs completely.

Also worth considering: The story about the long-term safety of this new generation of drugs is still being written. Past experience in the weight-loss arena has shown that side effects can emerge after the drugs hit the market. That worry is compounded by the drugs being potentially used in situations where there’s no evidence for their efficacy or safety—namely, in people who aren’t considered medically obese, but would like help shedding pounds.

Elon Musk, for example, recently made headlines when he credited his fitness to fasting and Wegovy, though it’s not clear he actually would qualify for the treatment.

Demand in the US for these treatments is indisputable. But meeting it, and thus hitting the high end of all those lofty sales forecasts, will require structural changes in how these drugs are prescribed and covered by insurance. 

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.

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Published: 10 Nov 2022, 10:48 PM IST
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