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June 2, 2022

Why are weight-loss drugs so hard to get?

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    Weight-loss drugs can help adults with obesity lose a significant amount of weight, often improving related medical conditions—but many health insurers do not cover the drugs, making it difficult for patients to access treatments for "the biggest chronic disease of our time," Gina Kolata writes for the New York Times.

    Why is it so difficult to get weight-loss drugs?

    More than 40% of adults in the United States have obesity, and most have tried and failed to lose the weight that contributes to related medical conditions, including diabetes, joint pain, and heart disease.

    Still, accessing weight-loss drugs is difficult for patients for a variety of reasons—a problem Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School, calls "dismal in this country."

    According to Stanford, the medical system shoulders much of the blame in this situation. Notably, only 1% of U.S. doctors have been trained in obesity medicine. "It's the biggest chronic disease of our time, and no one is learning anything about it," she said.

    Most providers will not suggest weight-loss drugs, and most patients will not request them, largely because they do not recognize that they are good treatment options, according to Scott Kahan, an obesity medicine specialist in Washington, D.C. In addition, even if doctors and patients are aware of FDA-approved weight-loss drugs, many believe that they are "unsafe or not well studied and that everyone regains their weight."

    Data on weight-loss drug use by patients predate the newer, safer, and more effective drugs made by Novo Nordisk and Eli Lilly. "Still, obesity medicine doctors say, they doubt that the number has changed much from the earlier studies that found that less than 1 percent who are eligible obtained one of these drugs. That is about the same percentage as those who get bariatric surgery, which most insurers, including Medicare, pay for," Kolata writes.

    In addition, insurers often deny coverage of weight-loss drugs. When Maya Cohen, a 55-year-old woman being treated for obesity, was prescribed Saxenda, a recently approved weight-loss drug, her insurer classified it as a "vanity drug" and would not cover it.

    "The perception is, 'If you are heavy, pull yourself up from your bootstraps and try harder,'" Kahan said.

    Because of that perception, which many patients and doctors share, many are reluctant to seek medical help or ask for prescription medications, Kahan added.

    But "[t]he evidence is now overwhelming that there are physical changes in weight regulating pathways that make it difficult for people to lose weight and maintain their weight loss," said Louis Aronne, an obesity medicine specialist who directs the comprehensive weight control center at Weill Cornell Medicine. "It's not that they don't have willpower. Something physical is holding them back."

    Efforts to increase obesity drug access

    Currently, drug makers like Novo Nordisk—the maker of the medicine Cohen was prescribed—and patient advocacy groups have been working to lobby insurers to pay for weight-loss drugs. In addition, they have been lobbying Congress to pass a bill that would require Medicare to pay for weight-loss drugs.

    According to Kolata, some obesity specialists have uncovered a "workaround" to help patients access Novo Nordisk's "effective but expensive" weight-loss drug when their insurance companies refuse to pay.

    "The workaround exploits quirks in the way Novo Nordisk markets its drugs. The company sells a drug, semaglutide, for both diabetes and obesity. As a diabetes drug, it is marketed as Ozempic, with a list price of $892 for four weeks. Under this name, the drug is easily to get at pharmacies, and insurance companies will cover it for people with diabetes," Kolata writes.

    For weight loss, Novo Nordisk sells two drugs from the same class in two different doses. They sell liraglutide as Saxenda, and semaglutide, which is sold at a higher and more effective dose as Wegovy. The suggested retail price for both drugs is around $1,350 a month, which means the same drug costs 51% more if it is prescribed to treat obesity than if it is used to treat diabetes.

    According to Douglas Langa, an EVP at Novo Nordisk, diabetes and obesity fall into "separate categories, separate marketplaces"—a distinction he said explains the price difference between the companies' two drugs that were based on the same medicine. Wegovy's price "reflects efficacy and clinical value in this area of unmet need," he added.

    Still, Stanford said it is "unbelievable," calling it a gross inequity to charge people more for the same exact drug because they are being treated for obesity. Stanford said she finds herself in a tough situation when she gets excited when her patients with obesity also have diabetes, which means their insurers will likely pay for the drug.

    Aronne and other obesity specialists emphasize that obesity is a chronic condition that should be treated with the same intensity as other diseases like diabetes, heart disease, or any other chronic illness. However, Kolata notes, "that rarely happens." (Kolata, New York Times, 6/1)

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