Weight loss drugs did not reduce health costs within two years
Oct 24 (Reuters) – Drugs like Wegovi may trim your waistline but not medical costs, according to an analysis of U.S. health insurance claims shared with Reuters.
A similar control group of patients who did not receive the drug for the same period had a 14% increase in costs.
Among GLP-1 patients, prescription drug costs drove most of the costs, but medical costs also increased over the two-year period.
Over a two-year period, the analysis found “no reduction in obesity-related medical events,” such as heart attacks, strokes and diagnoses of type 2 diabetes, or the use of prescription drugs for high blood pressure and high cholesterol, compared to the control group.
They say the use of their drug will save society by eliminating many of the health problems associated with being overweight.
Yet many US employers and government health officials are wary of adding coverage for these highly effective, but expensive drugs because of the significant upfront investment and uncertainty about any future savings.
“The budget implications here are dire for many governments and private organizations,” said Ben Ippolito, an economist at the American Enterprise Institute. “What makes these drugs different is the sheer size of the potential demand.”
Some analysts say the weight loss drug market could reach $150 billion a year in the next decade.
“We know obesity treatment is associated with better medical outcomes, even if bureaucrats can't account for these savings,” Novo Nordisk said in a statement. Lilly did not respond to requests for comment.
Not 'absolutely final'
Prime Therapeutics reviewed pharmacy and medical claims data for 3,046 people with commercial health plans that cover GLP-1 drugs. They all received new GLP-1 prescriptions between January and December 2021 and were diagnosed with obesity or a body mass index of 30 or more.
In the analysis, 46% of patients were taking Novore Ozempic or Wegovi, both injectable versions of semaglutide. Others were taking the older Novo drugs Sexenda or Victoza, which are both liraglutide, Ribelsus, 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 introduced after the study began.
Prime excludes from its medical claims patients diagnosed with diabetes or those using a medication for type 2 diabetes, for which these medications were originally developed. The mean age of patients analyzed was 46 and 81% were female.
Patrick Gleason, assistant vice president of health outcomes at Prime and co-author of the analysis, said employers and insurers should be prepared to spend an additional $11,200 for each patient who takes a GLP-1 drug for obesity during the first two years of therapy. Due to lack of reduction in price and associated medical costs.
The estimate reflects drugmakers' rebates for these drugs, but not all rebates, he said.
David Lassen, the PBM's vice president for pharmacy clinical services, said replicating the health benefits demonstrated in clinical trials can be challenging because so few patients stick to their prescriptions.
“I don't think it's completely conclusive at this point,” Lassen told Reuters, adding that three years of data may be needed to measure the cost impact.
“We want to do everything possible to help individuals achieve positive outcomes from being on this drug,” Lassen said. “But if we determine that we don't have a positive outcome with the data and a return on investment, then that will be a turning point that we have to consider.”
Prime is owned by 19 US Blue Cross and Blue Shield health insurance plans and operates pharmacy facilities for approximately 38 million people.
The company estimates that less than 20% of members have weight loss drug coverage. Prime said it supports clients' decisions to cover these GLP-1 drugs with lifestyle modification programs.
Valerie Smith, an associate professor of population health sciences at Duke University, says in her research on bariatric surgery, years of weight loss have not reduced medical costs.
However, he said this analysis may mask potential savings in certain groups of patients, such as those with severe obesity or multiple chronic conditions.
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Editing by Bill Berkrot Reporting by Chad Terhune
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