Make obesity drugs affordable


Manufacturers appear to have chosen a pricing strategy of limited access at high cost — roughly $1,300 a month — rather than broader access at reasonable cost.

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Opinion

November 2, 2023 - 10:13 PM

Photo by Diana Polekhina/UNSPLASH

The new obesity drugs are so much in demand that the food industry has grown concerned that they might threaten future profits. The entertainment industry is speculating about which celebrities might be taking them. Amid the noise, it can be easy to miss a much more fundamental question: Will these new medications improve the health of the country?

The fact that Wegovy, Ozempic, Saxenda and other injectable medications in this class seem to truly help people lose weight certainly looks like great news for the more than 100 million American adults with obesity. Never before has there been a way, short of surgery, to make so significant a difference for this condition, which is linked to Type 2 diabetes, cardiovascular disease, certain cancers and severe covid-19. Counseling and self-motivated dietary changes work, but with these, weight loss doesn’t come easily, and it is notoriously difficult to maintain. Previous drugs such as fen-phen and Meridia had serious side effects, were not terribly effective and had to be removed from the market.

In some studies of the new medications, in contrast, most subjects lost at least 15 percent of their weight — and kept it off as long as they continued taking the medications. For example, in a clinical trial of a similar drug that has not yet been approved by the Food and Drug Administration, 75 percent of patients with obesity who were given a middle dose lost 15 percent of their body weight over 48 weeks, compared with just 2 percent of those given placebo.

The injections might provide other benefits, too. In a one-year trial in patients with heart failure and obesity, Wegovy reduced symptoms of heart failure and improved quality of life. In another trial, whose results have not been published in a scientific journal and have so far been described only in a company press release, Wegovy use among adults with cardiovascular disease who were overweight or obese reportedly reduced serious cardiovascular outcomes — including heart attacks, strokes and death — by 20 percent for up to five years.

These studies are not adequate, however, to fully establish the drugs’ value. More research is needed to evaluate and confirm the full range of potential benefits, including reductions in mortality. Given that there appears to be a significant rebound effect when treatment is stopped, patients might have to take the injections over extended periods. So studies are needed to gauge the safety of long-term use and learn how the drugs affect patients’ dietary patterns and nutrient levels over time.

This research will probably need to be supported by the government. With sales already reaching billions of dollars, the companies that make the drugs have less incentive to fund studies that might raise questions about their value. But the National Institutes of Health and the nonprofit Patient-Centered Outcomes Research Institute can make this a priority. What’s more, data from all research on the medications can be archived and released to qualified researchers for additional review.

No matter how useful the medications prove to be, their impact will be limited if they aren’t made available to all who need them. Right now, Medicare and most state Medicaid programs do not cover them for obesity, and their high cost is discouraging employers from covering them broadly. (No doubt, these policies are influenced by the perception that obesity stems from a failure of self-control.) Manufacturers, for their part, appear to have chosen a pricing strategy of limited access at high cost, rather than broader access at reasonable cost.

Few patients can afford to pay the roughly $1,300 monthly retail price out of their own pockets. Ironically, many might have to wait until they develop Type 2 diabetes, a complication of obesity that is also treated by the medications and for which they are typically covered by health insurance. People without insurance might have no way to obtain the drugs. Thus, the medications threaten to worsen health-care gaps across economic, regional, racial and ethnic groups. But manufacturers could provide wider access by selling the medications to federal and state governments and insurance companies in bulk at affordable prices. Insurance companies could then reciprocate by expanding coverage and reducing out-of-pocket costs for patients.

And there is another concern: that by driving attention to individual body transformation, the treatments might distract from broader efforts to improve American diet and exercise habits.

Front-of-package nutrition labeling; reformulation of foods to reduce sodium, added sugars and unhealthy fats; and taxation of sugary drinks to nudge consumers to healthier options could advance the health of many Americans. Community-level policies could expand access to locally grown fruits and vegetables, while supporting local businesses. Higher-quality school breakfasts and lunches could help children set healthy eating habits. Enhanced sidewalks, bike lanes and parks could promote exercise and community safety.

Together, such policies stand to improve the health of millions, including people who are obese and cannot or don’t want to take medications. If the urgency of these efforts were to be overshadowed by the excitement over Wegovy and related medications, the drugs’ overall health impact might be negative.

The public health approach to obesity should be “all of the above”: policies to improve diet and exercise, more research on the new medications and greater access to effective care for people who already have obesity. A major step forward for American health might be at hand, but success will require a lot more than chatter about stock futures or gossip about celebrities.

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