This should be no surprise, just about all drugs are more expensive in the USA.
5 catalysts that Will Impact the Future of Weight Management Drugs
The weight management medication market is facing a crucial turning point. Learn about the five game-changing moments that will affect the use of GLP-1s for weight loss — from expanded indications to Medicare coverage — and find out what stakeholders should do now to prepare for the future.
Catalyst 1: FDA approval of new weight management drugs
Weight-management drug competition is ramping up. Though currently only one GLP-1 has been approved for weight management (Novo Nordisk’s semaglutide—also known as Wegovy), early reports from Eli Lilly’s tirzepatide show that the drug may outperform semaglutide in recipients’ percentage of weight loss and percentage of lean muscle mass retained. Furthermore, additional anti-obesity drugs are likely to hit the market in coming years that appeal even more to patients. If the FDA approves these drugs, they will likely have a positive impact on the perception of GLP-1s overall and ease some of the access and price concerns held today.
Ripple effects
Supply chain issues will lessen as more treatment options increase supply
Steeper rebates for health plans as pharmacy benefit managers gain the upper hand in negotiations with manufacturers
Net costs are likely to decrease, but patients may face cost-sharing barriers from persistently high list prices
Catalyst 2: SELECT trial results
Novo Nordisk’s SELECT trial for semaglutide seeks to demonstrate the drug’s efficacy in reducing major cardiovascular events for individuals with established cardiovascular disease. Researchers and clinicians seem confident that results will be positive, making it likely that the FDA will update the drug’s indicated use to include cardiovascular risk reduction in addition to chronic weight management for those above a designated BMI threshold.
Ripple effects
Increased pressure on commercial health plans and employers to cover semaglutide (and future competitors) given the demonstrated relation to cardiovascular health
A new mechanism for Medicare to provide coverage for semaglutide for patients with established cardiovascular disease
Force competitors with drugs in the pipeline to expand their trials to also focus on cardiovascular disease and/or other related health outcomes
Catalyst 3: New data on prescribing and utilization rates
Today, we have little real-world data on how GLP-1s are prescribed and used, limiting the ability of decision-makers to form long-term strategies. In the coming years as more data becomes available, payers and providers will be able to make more informed moves, influencing how these drugs are prescribed, managed, and reimbursed.
Ripple effects
Providers will have a better sense of the overall patient population and more insight into how to manage follow-up care to improve outcomes
Payers will develop more informed coverage policies to limit low-value use of the drugs
Patient medication use and adherence patterns will reveal the scale and clinical impact of drug-related weight cycling (patients take the medication, lose weight, go off the treatment and regain weight, and then get on the medication again)
Catalyst 4: Patient outcomes from wrap-around services for weight management drugs
Some payers are responding to the demand for GLP-1s and weight loss services by directing members to obesity centers of excellence to ensure the right patients are receiving weight management medications as part of holistic obesity care. At the same time, wellness companies like WeightWatchers and Noom are expanding into prescribing with new telehealth offerings that increase subscriber access to GLP-1s in combination with behavioral interventions. The success (or failure) of these wrap-around service models will likely shape how patients access these drugs and obesity management services in the future.
Ripple effects
If wrap-around service models improve patient outcomes and experience long-term, more payers and wellness companies are likely to employ these models, solidifying this as a new model for obesity care that will come with its own risks and rewards
If these early wrap-around models aren’t successful, healthcare leaders will likely experiment with different ways to facilitate the use of weight management medications as part of holistic obesity care to improve long-term outcomes. Whether via wrap-around services or some alternative model, weight management drugs are unlikely to have a positive impact unless healthcare leaders find a way to integrate them into holistic obesity care
Catalyst 5: Medicare weight loss coverage reversal
Right now, Medicare cannot legally cover weight-management medications. Advocates have been lobbying to reverse this restriction for years and lawmakers are likely to reintroduce a bill that would do so later this year. The bill had bipartisan support in the past; however, its passage is uncertain given Medicare cost implications. If lobbyists are successful, the change will increase access to these medications—not to mention costs to Medicare and patients, increasing fears about the financial impact of GLP-1s.
Ripple effects
A large group of patients would gain access to medications covered by their Medicare Part D plans, reducing access disparities
Increase in Medicare Part D plan premiums to accommodate for high cost and projected high utilization of weight management drugs
11 years after FDA approves each weight-management drug, Medicare could negotiate its price as long as generics are not developed
So what should stakeholders be doing now as we wait to see how these catalytic moments transpire?
Providers, especially those unused to providing obesity care, can brush up on clinical guidelines and ensure that patients seeking out weight management drugs receive holistic care. Purchasers can start collecting claims data on prescribing and utilization practices, and surveying members and employees about how likely they are to seek access to these medications.
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