New weight-loss drugs work, but who pays?

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After decades of failure, weight-loss drugs finally seem poised to become Big Pharma’s new blockbuster category. According to Bloomberg Intelligence, the U.S. obesity drug market alone will be worth $12 billion in 2028. Morgan Stanley Research recently made a much more optimistic prediction, predicting that global obesity drug sales could hit $54 billion. billion dollars by 2030.

The enthusiasm is deserved. These new drugs offer deeper, more sustained weight loss than any drugs that have come before them, and many people could benefit from them: according to the US Government Accountability Office, between 2013 and 2016, only 3% of people eligible for a obesity medicine were taking one.

But these lofty sales goals will only be achieved if the medical field manages to overcome the structural barriers to their use.

The new drugs are usually weekly injections that mimic gut hormones that regulate feelings of fullness. The approach appears to solve the domain’s problems with safety and efficiency. Data on Novo Nordisk’s Wegovy, approved in June 2021, and Eli Lilly & Co.’s Mounjaro, which is expected to be approved next year, suggests that these drugs can help people lose, on average, up to 15 20% of their body weight. We only have a snippet of data on Amgen’s early-stage weight-loss drug AMG 133, but it’s already garnered strong investor interest in hopes it might offer similar or potentially greater weight loss than Mounjaro with single treatment. stroke of month. Amgen said this week that people taking a high dose of the drug lost an average of about 14.5% of their body weight around three months after the start of its Phase 1 trial. Full data from this study will be disclosed at a a conference early next month.

Such findings would make the new drugs 2-3 times more effective than the old diet drugs, which also carried a litany of side effects ranging from unpleasant (leaky stool) to downright dangerous (increased risk of heart attack or cancer).

People are eager to try new treatments. At an obesity conference last week, experts in the field swapped stories about the long waits for new patients seeking an appointment with weight loss specialists. The Massachusetts General Hospital Weight Center, for example, has more than 4,000 people on its waiting list, says Fatima Cody Stanford, a doctor who specializes in obesity medicine.

“Demand is overwhelming the workforce,” says Robert Kushner, obesity medicine specialist at Northwestern Medicine.

Pharmaceutical companies are also struggling to keep up with demand. Lilly has struggled to maintain its supply of Mounjaro, even though it is currently only approved for diabetes. When it receives expected Food and Drug Administration approval as an obesity treatment in the second half of 2023, at least one analyst believes it could quickly become one of the best-selling drugs in history. Of the industry. And although Novo Nordisk’s Wegovy has been on the market for over a year, it has been in a constant state of shortage, first due to surprisingly high demand and then due to manufacturing issues.

Novo expects this supply constraint to be resolved by the end of this year, a situation that could finally provide answers to key market questions. On the one hand, the magnitude of the demand could become clearer; currently, it’s complicated by people turning to diabetes treatments that use the same ingredients as weight-loss drugs. And once the supply is stable, it should be easier to gauge how long people stick to those once-a-week injections, a factor that will affect how big of a blockbuster drug they’ll get. become.

But all of this excitement implies that the field will overcome fundamental challenges that could hold back the widespread use of these weight-loss drugs.

A major problem ? Primary care physicians have been reluctant to prescribe the drugs. One of the problems is that doctors today are generally not trained to treat obesity, and some continue to believe that the disease is just a way of life rather than a medical problem. Until this group feels more comfortable with these treatments, “I’m afraid all of these advancements will sit on the shelf,” says Kushner, who consults for Novo Nordisk and led a Phase 3 study on Wegovy.

Affordability is also a huge issue. Wegovy launched with a monthly price of over $1,600 and insurance coverage has been spotty. A patchwork of laws dictates access to weight-loss drugs nationwide, making them more accessible in some states than others. In Massachusetts, for example, private insurers will pay for obesity drugs, but Stanford says it has remained difficult to get Medicaid to cover the drugs for its patients. In Pennsylvania, meanwhile, a bill that would allow treatments to be covered for state Medicaid recipients has moved closer to passage after languishing for years. And Medicare currently completely excludes coverage for obesity drugs.

Also to consider: The long-term safety story of this new generation of drugs is still being written. Past experience in the field of weight loss has shown that side effects can appear after the drugs have been marketed. This concern is compounded by the fact that the drugs are potentially used in situations where there is no evidence of their effectiveness or safety, namely in people who are not considered medically obese, but who want help to lose weight. (Elon Musk, for example, recently made headlines when he attributed his fitness to fasting and Wegovy, though it’s unclear if he would actually qualify for the treatment.)

The demand for treatments is unquestionable. But getting there — and therefore reaching the high end of all those high sales projections — will require structural changes in how these drugs are prescribed and covered by insurance.

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This column does not necessarily reflect the opinion of the Editorial Board or of Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, healthcare, and pharmaceuticals. Previously, she was the editor of Chemical & Engineering News.

More stories like this are available at bloomberg.com/opinion

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