A new weight loss drug could become the best-selling drug of all time. Who can afford it?
Experts believe the drug, called tirzepatide, will be approved by the Food and Drug Administration within the next year. If so, he’ll join two other popular (and expensive) weight-loss drugs, Wegovy and Saxenda (both from pharmaceutical company Novo Nordisk), which have recently been approved on the market.
Bank of America analyst Jeff Meacham estimates that annual sales of tirzepatide could reach a record $48 billion. Another Wall Street analyst, Colin Bristow of UBS, estimates that the drug’s annual sales will reach $25 billion. The figure still tops his $20.7 billion record set for AbbVie’s rheumatoid arthritis drug Humira in 2021.
Lilly spokeswoman Kelly Smith declined to comment on the cost of tilzepatide. It said it could be priced similarly to Saxenda, which costs about $1,350 a month in supply.
If the FDA confirms the drug’s efficacy, a “fair” price for tirzepatide could be about $13,000 a year, or about $1,100 a month, said the chief medical officer of the Institute for Clinical and Economic Review. One Dr. David Rind said: Help determine fair prices for medicines.
These drugs have been shown to be very effective in weight loss in clinical trials. All three drugs given by injection work similarly. These are a class of drugs called GLP-1 agonists, which mimic hormones that help control food intake and appetite.
However, Eli Lilly’s tirzepatide mimics a second hormone called GIP and may reduce appetite as well as improve how the body breaks down sugar and fat.
A Phase 3 clinical trial found that high-dose tirzepatide helped patients lose an average of 22.5% of their weight, about 52 pounds, better than any drug currently on the market. Most patients in the study had a body mass index (BMI) of 30 or higher. In trials, Wegovy and Saxenda reduced body weight by approximately 15% and approximately 5%, respectively.
Are weight loss pills covered by insurance?
At low doses, all three drugs are already approved for diabetes.
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Tirzepatide is marketed under the name Munjaro for diabetes.
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Semaglutide, when marketed for weight loss, is sold in higher doses and is called Wegovy. In lower doses, it is marketed for diabetes and marketed as Ozempic.
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Similarly, a higher dose of liraglutide is marketed under the name Saxenda for weight loss, and a lower dose is marketed as Victoza for diabetes.
With the exception of Munjaro, which was approved earlier this year, most insurance policies cover the version of the drug used to treat diabetes.
Not necessarily if it is prescribed for obesity.
Obesity has its own stigma, says W. Scott Bucci, M.D., chief of obesity medicine at the Cleveland Clinic’s Institute of Obesity and Metabolism. Many doctors still view it as a behavioral problem rather than a medical problem.
That belief, he said, has made insurance companies reluctant to cover many new treatments, in addition to older anti-obesity drugs being less effective.
“You’re biased,” Butch said, adding that insurance companies want more evidence of the benefits of anti-obesity drugs than other types of drugs.
Some insurers may choose to offer coverage for one of their weight loss medications, but often restrict access only to patients who meet certain thresholds, such as a BMI greater than 30. .
What’s more, not everyone responds to a particular weight-loss drug the same way, says Butch. He said there were no left.
Dr. Holly Lofton, director of the weight management program at NYU Langone Health, who regularly prescribes new drugs to patients, says many patients are denied coverage. “Patients tell me they seem to want to wait until their insurance companies are sick and need more medicine,” she said.
Lofton says some of her patients end up spending thousands of dollars on medication for months as they negotiate with insurance companies to get coverage. She added that her insurance plan hasn’t reimbursed her for the money she spent on the drug.
Dr. Fatima Stanford, an expert in obesity medicine and equity director of the Endocrinology Division at Massachusetts General Hospital in Boston, said private insurance coverage for anti-obesity drugs is spotty, limiting treatment to the most expensive plans. says there are many things.
Medicare doesn’t cover them. Anti-obesity drugs aren’t mandatory Medicaid benefits, but some states are choosing to include them, she said.
Obesity is considered a chronic disease, Also, as with other chronic diseases, most patients are expected to take medication for the rest of their lives, which would be a significant financial burden if forced to pay out-of-pocket, Stanford said.
Only the “millionaires” are likely to be able to afford drugs like tirzepatide on their own, she said.
Despite barriers to access, UBS analyst Bristow said he still expects tirzepatide to be a blockbuster drug against obesity, and the US has already seen a shortage of the drug as a diabetes injection. I pointed out that
“It’s clear how strong the demand is,” he said.
what do i need to change?
Lofton of NYU Langone Health said anti-obesity drug coverage may not improve until more people in the medical field change their views on obesity. It’s not something that diet, exercise, or sheer willpower can fix, it’s a dysregulation of fat cells in the body.
Stigma and stigma surrounding obesity are pervasive throughout the medical community.
“It’s obvious to all health professionals, including doctors, nurses, nutritionists, and others,” says Lisa Howley, an educational psychologist and senior director of strategic initiatives and partnerships at the Association of American Medical Colleges.
A review published last year in the research journal Obesity found that health professionals have an implicit and/or explicit weight bias toward obese people.
But changing the opinion of the medical community, and insurance companies, is very difficult. Legislation may be needed to require insurance coverage for anti-obesity drugs, Stanford said.
In 2021, Congressmen introduced the Obesity Treatment and Reduction Act, which allows the federal government to expand Medicare Part D coverage to include anti-obesity drugs. According to Congress.gov, the bill had 154 bipartisan co-sponsors, but it was not put to a vote in the House before the end of its term.
The American Health Insurance Program (AHIP), a trade group representing insurers, said it would support coverage for tirzepatide if it gets FDA approval next year, as well as for other anti-obesity drugs. I refrained from mentioning what.
AHIP spokesman David Allen said, “Health insurers regularly review the evidence for medication and surgical treatments for obesity, and offer options ranging from lifestyle changes and nutritional counseling to surgical interventions and prescription medications. It offers patients many options.
Dr Butch, of the Cleveland Clinic, said he hopes insurance companies will cover tilzepatide.
“This is the first time we’ve actually seen a highly effective anti-obesity drug,” he said. “The benefits are real.”
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