WASHINGTON—Drugs like Wegoby may trim your waistline, but they won’t pay for your medical bills, according to an analysis of U.S. health insurance claims shared with Reuters.
The average annual cost of treatment for obese patients in the United States was $18,507 two years after starting Novo Nordisk’s Wegovy or a similar GLP-1 drug. That’s 46% more than the average annual medical cost of $12,695 before taking the drug, according to data provided by pharmacy benefits manager Prime Therapeutics.
Costs for patients in a similar control group not taking the drug increased by 14% over the same period.
For GLP-1 patients, medical costs also increased over the two-year period, although most of the increase in spending was for prescription drugs.
The analysis found that over a two-year period, there was “no reduction in obesity-related medical events,” including heart attacks, strokes, type 2 diabetes diagnoses, and prescription drug use for high blood pressure and high cholesterol, compared to a control group. It turned out that.
Novo and rival Eli Lilly, which makes the GLP-1 weight loss drug Zepbound, have made billions of dollars in profits since the new drug hit the U.S. market, but out of an estimated 100 million obese patients, , only a small number of people used the new drug.
They claim that the use of their medicines will reduce many health problems associated with excess weight, resulting in savings for society.
However, many U.S. employers and government health officials remain wary of adding coverage for highly effective but expensive drugs due to the large upfront investment and uncertainty of future savings. It is.
“The budget hit here is scary for many governments and private entities,” said Ben Ippolito, an economist at the American Enterprise Institute. “What makes these drugs different is the huge potential demand.”
Some analysts say the weight loss drug market could reach $150 billion annually over the next decade.
“We know that treating obesity leads to improved health outcomes, even if bureaucrats don’t know how to account for these savings,” Novo Nordisk said in a statement. Lilly did not respond to a request for comment.
Not “fully definitive”
Prime Therapeutics examined pharmacy and medical claims data for 3,046 people with commercial health insurance coverage for GLP-1 drugs. They all received a new GLP-1 prescription between January and December 2021 and were diagnosed as obese or with a BMI of 30 or higher.
In the analysis, 46% of patients were taking Novo’s Ozempic or Wigovy, both injectable versions of semaglutide. Others were taking older Novo drugs Saxenda or Victoza, both of which are liraglutide, Libersus, an oral version of semaglutide, or Lilly’s Trulicity (dulaglutide).
The researchers did not track long-term use of Lilly’s new GLP-1 drugs Mounjaro and Zepbound (both tirzepatide), which were launched after the study began.
Prime excluded patients who had a diagnosis of diabetes on their medical claims or who were using the type 2 diabetes drug originally developed. The mean age of patients included in the analysis was 46 years, and 81% were female.
Patrick Gleason, assistant vice president for health outcomes at Prime and a co-author of the analysis, said employers and insurers are increasing the number of people taking GLP-1 drugs to treat obesity during the first two years of treatment. He said hospitals should be prepared to spend an additional $11,200 per patient. This is because the price is high and the associated medical costs are not reduced.
He said the estimates reflect discounts on these drugs by drug companies, but not all rebates.
The analysis found that only one in four patients prescribed Wegovy or Ozempic for weight loss were still taking the drug two years later, Reuters reported in July.
David Lassen, vice president of pharmacy clinical services at Prime Therapeutics, said it may be difficult to replicate the health benefits proven in clinical trials because few patients stick to their prescriptions. .
“I don’t think it’s completely conclusive at this point,” Lassen told Reuters, adding that three years’ worth of data could be needed to assess the cost impact.
“We want to do everything we can to help individuals achieve positive outcomes by taking this drug,” Lassen said. “But if we determine that the data is not positive and there is no return on investment, that will be an inflection point that we will have to consider moving forward.”
Prime is owned by 19 Blue Cross and Blue Shield health plans in the United States and manages pharmacy benefits for approximately 38 million people.
The company estimates that less than 20% of its members have insurance for weight loss drugs. Prime said it supports customers’ decisions to cover these GLP-1 drugs in combination with lifestyle improvement programs.
Valerie Smith, associate professor of population health sciences at Duke University, said her research on bariatric surgery also found that health care costs were not reduced even when weight loss was maintained over many years.
However, he said this analysis could mask potential savings among certain patient groups, such as those with severe obesity or multiple chronic conditions.
