Novo Nordisk’s obesity drug, Wegovy, has shown promising results in a large clinical trial, cutting the risk of serious heart problems by 20%. This groundbreaking finding could increase pressure on U.S. insurers to cover the medication and similar weight loss treatments. However, insurers are cautious, stating that the data is still preliminary and concerns about the high costs of the drugs remain.
Shares of Novo Nordisk, Eli Lilly, and Weight Watchers International soared following the release of the data. These companies are all invested in the growing weight loss drug market, which analysts estimate could be worth up to $200 billion by 2030. Despite the positive results, insurance coverage for obesity drugs in the United States is inconsistent. Medicare, most state Medicaid programs, and some commercial insurance plans do not cover these treatments.
Organizations representing insurers point out that the costs of covering the medications are high, with patients paying nearly $1,350 per month for a single prescription. Additionally, concerns about the long-term efficacy and effectiveness of the drugs persist. Insurers are skeptical about covering these medications solely based on a drug manufacturer’s press release.
The trial data challenges the perception that obesity drugs are merely lifestyle products with cosmetic benefits. The study followed over 17,600 individuals with established cardiovascular disease who were overweight or obese but did not have a history of diabetes. It showed that a weekly injection of Wegovy reduced the risk of cardiovascular events, such as heart attacks and strokes, by 20% compared to a placebo.
While insurers acknowledge the potential health benefits of obesity drugs, they are wary of the high costs involved. They are concerned about the impact on their profitability if widespread coverage were to be implemented. The University of Texas System, for instance, decided to significantly reduce coverage for these drugs due to the steep costs.
Experts suggest that the entry of new drugs into the obesity market could increase competition and potentially lower prices. Eli Lilly’s diabetes drug, Mounjaro, may be approved for weight management in the near future. However, more data demonstrating the heart health benefits and cost-effectiveness of obesity drugs may be needed before insurers are willing to expand coverage.
Overall, while the new data on Wegovy’s effectiveness in reducing heart problems is a significant development, insurers remain cautious due to the high costs and preliminary nature of the findings. The potential impact on insurance coverage for obesity drugs in the U.S. still has a long way to go.