December 4, 2023

Almost half (45%) of U.S. adults recently polled by KFF express interest in taking a prescription drug to lose weight if it’s known to be safe and effective. But many lose interest after given additional information regarding route of administration, side effects, cost, lack of insurance coverage, or the need to take the medications indefinitely.

Interest drops by more than 20% when adults are told they must administer it themselves as a weekly injection (23%). And interest declines to 16% if the drug is not covered by insurance. Further, respondents’ interest in taking a medication for weight loss decreases to 14% when told they may gain weight back after stopping use.

The new classes of obesity medications—GLP-1 and GIP/GLP-1 receptor agonists—have been grabbing the media’s attention for quite some time. And recently posted topline data from the SELECT trial suggest Wegovy (semaglutide) can reduce the risk of a major cardiovascular event such as a stroke by 20% in overweight or obese people with a history of heart attacks, stroke and heart failure. This is an impressive finding, despite it applying to a fairly narrowly defined population of patients who are at severe risk of (recurring) cardiovascular disease.

Thus far, there’s been considerable demand from early adopters, who tend to be of means and therefore able to afford the expensive products. At between $900 and $1,300 per month, however, the price is unaffordable for most of the 100 million American adults who are considered obese, especially given that these products must be taken indefinitely to avoid weight gain rebound.

Notably, semaglutide-based drugs such as Ozempic and Wegovy have much higher list prices in the U.S. than in other high-income countries, according to a new KFF analysis released this week. In fact, the drugs are at least seven times as expensive in the U.S. as in, for example, the U.K.

In order to reach a broader population of obese people either the prices would have to come down substantially or insurers would need to cover a much greater proportion of the population than they currently do.

For insurers that do cover weight loss products, in the short term the drugs may be adding costs to the healthcare system. Last month, an analysis was released which showed that total healthcare costs for those on the drugs increased sharply. The average annual cost of overall healthcare for patients prior to taking Wegovy or a comparable therapeutic was $12,371, according to the analysis. The average one-year cost of aggregate healthcare for each patient after starting the medication jumped by 59% to $19,657. Conspicuously, the average costs for a control group of patients not taking weight loss drugs decreased by 4% over the same period.

What is also striking in the analysis is that fewer than one-third of patients given Wegovy or a similar drug at some point in 2021 were still on them a year later. It’s not known what caused these patients to drop out and no longer take the medications.

And so, some insurers have been reversing course with respect to covering the new classes of weight loss drugs.

Lack of insurance coverage can mean outright reimbursement denials. But even if a person has coverage there can be subtle ways that insurers restrict access, including high patient cost-sharing; quantity limits, often expressed as the length of time a patient is covered for a product; use of step edits to discourage doctors from prescribing the more expensive drugs first; pre-authorization requirements, usually in the form of a specific diagnosis and data on the patient such as their body mass index and existence of co-morbidities before dispensing and reimbursing a product.

In the healthcare space, doctors with younger and wealthier patients who aren’t reliant on health insurance are more inclined to prescribe new pharmaceuticals and medical procedures sooner. According to an article in Health Affairs, resource-rich communities tend to therefore be early adopters of innovations, such as new weight loss drugs. In some cases, rich and famous celebrities become influencers by posting their experiences with products such as Ozempic on social media.

The diffusion of innovation theory, developed by Everett Rogers more than six decades ago, helps explain the adoption of new products. The S-shaped diffusion curve depicts the typical lifecycle of a new product, with an initial slow rate of adoption giving way to a rapidly accelerating rate and then a deceleration as fewer non-adopters remain.

While the market for new weight loss agents has potential to attain rapid growth toward peak sales, mimicking the S-curve, ultimately broad adoption of weight loss agents will require much more comprehensive health insurance coverage along with resolutions of questions regarding the route of administration, possible adverse events and the need for indefinite use of such products.


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