How to make obesity drugs available to all
The medical sensation of the decade is a set of drugs that help people slim down. With weekly injections, people can drop 15% to more than 22% of their body weight on average, often 40, 50 pounds or more. No safe medicine or any other weight-loss strategy except surgery has been so effective. Given that nearly 42% of Americans are obese, and thus vulnerable to diabetes, heart disease, stroke and various kinds of cancer, Wegovy, Zepbound and other so-called GLP-1 agonists come as a breakthrough. They offer a way to vastly improve public health — not to mention quality of life among people who struggle to lose weight.
Surely health insurers, including employers and Medicare, can find a way to pay for these extraordinary drugs. If they don’t, only wealthy people will benefit — while poorer Americans are more prone to obesity. And the opportunity to bring a large share of the population back to good health will largely be lost.
Doing this without drastically inflating the price of U.S. health care and straining public budgets will be hard. The monthly cost for the drugs is upward of $1,000. (Zepbound is $1,060 and Wegovy $1,350.) If Medicare’s drug-coverage program, Part D, were to cover Wegovy at the list price for all obese beneficiaries, it would cost more than the entire Part D budget — and more than the total amount of excess health care spending on obese Americans of all ages (estimated to be $260 billion in 2016), according to an analysis in the New England Journal of Medicine.
The drugs stand to be alarmingly expensive for private insurers, too. If more than a tiny fraction of the people they cover use the drugs, the cost will drive up premiums for everyone. The injections are meant to be taken in perpetuity — people who quit see much of the weight return — which could translate into an enormous addition to America’s already world-beating health care costs, yet more and more employers are covering them, as most Americans want them to do.
Limiting demand would be a daunting challenge because almost half of the U.S. population meets the Food and Drug Administration criteria for taking them: They have either a body mass index of at least 30 (obesity) or a BMI of 27 (overweight) and at least one weight-related ailment (diabetes, high blood pressure or high cholesterol, for example). Not everyone who qualifies will want the drugs, of course, and many who start taking them will quit. A recent study found that 68% of patients stop within a year of starting. Presumably, this is at least in part because of unpleasant gastrointestinal side effects. But demand is already so high that the drugmakers are having trouble keeping up.