Excitement is building for a new generation of drugs that tout the ability to help overweight adults lose more weight than older drugs on the market.
Some patients, obesity experts say, are experiencing reductions in blood pressure, better-managed diabetes, less joint pain and better sleep from these new treatments.
The newer drugs, which are repurposed diabetes drugs, “show weight loss unlike any other drugs we’ve had in the past,” said David Creel, a psychologist and registered dietitian at the Cleveland Clinic’s Bariatric & Metabolic Institute.
However, for him and other experts, the thrill is tempered.
This is because no drug is a magic bullet on its own, and it is likely that many patients will need to take the drugs long-term to maintain the results. In addition, newer treatments are often very expensive and often not covered by insurance.
The new drugs’ five-figure annual cost also raises concern about patient access and what widespread use could mean for the country’s overall health care tab.
Evaluating the trade-offs—weighing the value of better health and possibly fewer complications of obesity down the road against the upfront cost of drugs—will increasingly come into play as insurers, employers, government programs and others who pay health care bills consider which treatments to cover.
“If you pay too much for a drug, everyone’s health insurance goes up. Then people drop health insurance because they can’t afford it,” so providing the drug may do more harm to the system than not , said Dr. David Rind, chief medical officer for the Institute for Clinical and Economic Review, or ICER, a nonprofit group that reviews medical evidence to evaluate treatments for effectiveness and cost.
Many commercial insurance companies currently limit coverage to only some of the drugs currently available or require patients to meet certain thresholds for coverage — often by tying it to controversial measure called “body mass index,” a ratio of height to weight. Medicare specifically prohibits coverage for obesity drugs or drugs for “anorexia, weight loss, or weight gain,” although it does pay for bariatric surgery. Coverage in other government programs varies. Legislation that would have allowed drug coverage in Medicare — the Obesity Treatment and Reduction Act — has made no progress despite being reintroduced every session of Congress since 2012.
As insurers view the cost of treatments with concern, manufacturers see a potential financial boon. Morgan Stanley analysts recently said “obesity is the new hypertension” and predicted industry revenue from US obesity drug sales could rise from $1.6 billion today to $31.5 billion by in 2030.
It’s easy to see how they could predict this staggering number based simply on potential demand. In the US, 42% of adults are considered obese, up from 33% a decade earlier. Health problems sometimes linked to weight, such as diabetes and joint problems, are also on the rise.
Even losing 5% of body weight can provide health benefits, experts say. Some of the new drugs, which can help curb hunger, help some patients overcome this index.
Wegovy, which is a higher dose of the self-injectable diabetes drug Ozempic, helped patients lose an average of 15% of their body weight over 68 weeks during the clinical trial that led to its FDA approval last year. After stopping the drug, many patients who followed through on an extension of the trial gained weight back, which is not unusual with almost any diet drug. Wegovy spent much of the year in short supply due to manufacturing issues. It can cost around $1,300 per month.
Another injectable drug, still in final clinical trials but fast-tracked for FDA approval, could induce even greater weight loss, in the 20% range, according to Eli Lilly, its maker. Both drugs mimic a hormone called glucagon-like peptide 1, which can signal the brain in ways that make people feel fuller.
The average weight loss from both, however, puts the drugs within striking distance of the results seen after surgery, offering another option for patients and doctors.
But will the array of old and new prescription drugs — with more in development — be the answer to America’s weight problem?
A big maybe, experts say. First, drugs and devices do not work for everyone and vary in effectiveness.
Abundance is a prime example. Priced at $98 per month, it is considered a device by the FDA and requires a prescription. During clinical trials, about 40% of people who tried it failed to lose weight. But among the other 60%, the average weight loss was 6.4% of body weight over 24 weeks when combined with diet and exercise.
This average puts it in line with other, older, prescription weight loss drugs, which often show 5% to 10% weight loss when taken over a year.
While it’s true that weight loss drugs — both old and new generation — don’t work for everyone, there’s enough variation among people that “even the older drugs work really well for some people,” Rind told ICER .
But it’s too early — especially for newer drugs — to know how long the effects might last and which patients will be weighing five or 10 years, he said.
But advocates argue that insurers should cover treatments for weight issues, just as they cover those for cancer or chronic conditions such as high blood pressure. Paying for such treatment could be good for both the patient and insurers, they argue. Over time, insurers may pay less for people who lose weight and then avoid other health complications, but such financial benefits to the health system may take years or even decades to accrue.
The financial benefits for pharmacists have been mixed so far. Novo Nordisk, the maker of Wegovy and Ozempic, saw obesity care sales rise 110% in the first half of the year due to Wegovy, but its share price remained flat and even fell in September. But Lilly, which won approval for a new diabetes drug, Mounjaro, which may soon get the green light for weight loss, saw September share prices 34% higher than last September.
Some employers and insurers who pay health care bills also ask whether drugs are fairly priced.
ICER recently took a look, comparing four weight loss drugs. The two, Wegovy and Saxenda, are next-generation treatments, both made by Novo based on an existing injectable diabetes drug. The other two — phentermine/topiramate, sold by Vivus as Qsymia, and bupropion/naltrexone, sold as Contrave by Currax Pharmaceuticals — are older treatments based on pill combinations.
The results were mixed, according to a report released in August, which will soon be finalized after public comments are evaluated and incorporated.
Wegovy showed greater weight loss compared to other treatments. But Qsymia also helped patients lose a significant amount of weight, Rind said. This older drug combination has a net cost, after manufacturer rebates, of about $1,465 per year in the second year of use, compared with Wegovy, which had a net cost of $13,618 in the second year, the report said. Many patients may be prescribed weight loss medications for years.
With such numbers, Wegovy did not meet the group’s cost-effectiveness threshold.
“It’s a great drug, but it’s about twice as expensive as it should be” when the health benefits are weighed against the cost and its potential to increase overall medical spending and health insurance premiums, Rind said.
However, don’t expect the cost to come down anytime soon, even though other new drugs are about to hit the market.
Lilly, for example, has yet to disclose how much Mounjaro will cost if it cancels clinical trials for use as a weight-loss drug. But one clue comes from its $974-a-month price tag as a diabetes treatment — a figure similar to that of rival diabetes drug Ozempic, Wegovy’s precursor.
Novo charges more for Wegovy than Ozempic, although the weight loss version contains more of the active ingredient. It is possible that Lilly will take a page out of this book and also charge more for their weight loss version of Mounjaro.
Dr. W. Timothy Garvey, a professor in the department of nutritional sciences at the University of Alabama-Birmingham, predicts that insurance coverage will improve over time.
“It’s now indisputable that you can achieve significant weight loss if you stay on medication — and reduce the complications of obesity,” Garvey said. “It’s going to be hard for health insurers and payers to say no to that.”
One thing the new focus on drug therapy can promote, most experts said, is to ease the bias and stigma that has long attached to patients who are overweight or obese.
“The group with the highest level of weight bias is physicians,” said Dr. Fatima Stanford, an obesity specialist and director of endocrinology at Massachusetts General Hospital. “Imagine how you feel if you have a doctor who tells you your worth is based on your weight.”
Rind sees new, more effective treatments as another way to help dispel the idea that patients “aren’t trying hard enough.”
“It’s become increasingly apparent over the years that obesity is a medical issue, not a lifestyle choice,” Reid said. “We’ve been waiting for drugs like this for a long time.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with Political Analysis and Polling, KHN is one of the three main operating programs in the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides health information to the nation.