Tom Albers and Jeff Stewart created a recent podcast analyzing the access and reimbursement for GLP-1 agonists being approved for weight loss. Tom and Jeff discussed the challenges these weight loss drugs are having with payer reimbursement and how economic data may help with access in the future. Tom mentioned, at the time, that Eli Lilly and Company had a follow up to their diabetes drug, Mounjaro, in a phase II trial that was showing excellent results. Well, that drug, Zepbound, has been approved by the FDA for the treatment of obesity.1 Zepbound will compete with Novo Nordisk’s drug, Wegovy which is extremely popular.2
Many in the field say that Zepbound will be life-changing for some patients. In an interview with Forbes Health, Dr. Amanda Velsquez, assistant professor of surgery and medicine and director of obesity medicine at Cedars-Sinai in Los Angeles stated, “This medication is the most efficacious of all the anti-obesity medications that we have in our toolbox.”3 Usually, when multiple drugs are approved for use in a certain condition, that provides more proof to doctors and patients have that these treatments are effective so the approval of Zepbound will likely accelerate the use of GLP-1s agonists for weight loss.
Now there are two GLP-1 agonists that are approved for both diabetes and obesity. As you can imagine, the size of the market for both indications is very large. The market size and the cost of these drugs have influenced payers to restrict coverage or in the case of Medicare, deny reimbursement of these treatments for obesity. Roughly 40% to 50% of payers cover these obesity treatments to some extent, but many of them have restrictions that are more stringent than the indication.4
What can pharmaceutical manufacturers do to ensure broader coverage of these antiobesity drugs? Economic data and reduction in risk results may be the answer. Many payers still don’t consider obesity to be a disease that warrants an expensive therapy.5 But if manufacturers can prove that a weight loss drug can save payers money in the long run or reduce the risk of expensive comorbidities, then these decision makers could be swayed to change their restrictive policy. Novo Nordisk recently published results from a Wegovy clinical trial that showed this drug could reduce the risk of heart attack, stroke or heart-related death by 20%.6 This type of data could be impactful to some payers. The studies that Novo Nordisk has conducted show that Wegovy can not only reduce patients' weight, but also improve the risk of other harmful conditions.6
The weight loss market is in its infancy, and there are many variables still left to be determined. There are many treatments in the weight loss pipeline, so there will be many more trials to analyze, and many more access decisions payers will need to make.7 In this market, efficacy alone will not ensure reimbursement, so manufacturers should continue to prove the economic and safety benefit of these drugs.
Link to the podcast:
Syneos Health Podcast | Market Access for Weight Loss Drugs | Syneos Health
Footnote:
1. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management
2. https://www.nytimes.com/2023/11/08/health/fda-tirzepatide-obesity-zepbound-wegovy.html
3. https://www.forbes.com/health/weight-loss/zepbound-fda-approved-what-to-know/
4. https://www.syneoshealth.com/insights-hub/syneos-health-podcast-market-access-weight-loss-drugs
5. https://thehill.com/policy/healthcare/4309838-american-medical-association-coverage-weight-loss-drugs-wegovyozempic/#:~:text=Federal%20law%20bars%20Medicare%20from,cosmetic%20medicine%20and%20not%20essential.
6. https://www.nbcnews.com/health/health-news/wegovy-heart-disease-stroke-heart-attack-obesity-study-rcna123836
7. https://www.pharmavoice.com/news/weight-loss-drugs-Wegovy-tirzepatide-Novo-Nordisk/641451/
