The cost of a full year’s treatment for obese US patients two years after starting Novo Nordisk’s Wegovy or a similar GLP-1 drug was $18,507, on average. That represents a 46% jump from the average annual medical cost of $12,695 before taking the drug, data provided by pharmacy benefit manager Prime Therapeutics shows.
The costs for the same control group for patients who did not take the drug increased by 14% for the same period.
Among GLP-1 patients, prescription drug costs led to an increase in spending, but medical costs also increased over the two years.
Over two years, the analysis found “no reduction in obesity-related medical events,” such as heart attack, stroke and diagnosis of type 2 diabetes, or use of prescription drugs for hypertension and high cholesterol, compared to the control group. .
Novo and rival Eli Lilly, which makes the GLP-1 weight loss drug Zepbound, have made billions of dollars in profits since the new drugs hit the US market, with only a small fraction of the estimated 100 million obese patients already using them. He said that the use of drugs would result in savings for society by reducing many of the health problems associated with excess weight. But many U.S. employers and government health officials remain wary of expanding coverage for drugs that are highly effective but expensive because of the significant initial investment and uncertainty about future savings.
“The budget that’s being passed here scares a lot of governments and private entities,” said Ben Ippolito, an economist at the American Enterprise Institute. “What makes these drugs different is the potential size they want.”
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, although bureaucrats don’t yet know how to account for those savings,” Novo Nordisk said in a statement. Lilly did not respond to a request for comment.
Not ‘FULLY CONCLUSIVE’
Prime Therapeutics reviewed pharmaceutical and medical claims data for 3,046 people with commercial health plans that covered GLP-1 drugs. They all had received a new GLP-1 prescription between January and December 2021, and had a diagnosis of obesity or a body mass index of 30 or more.
In the analysis, 46% of patients took Novo’s Ozempic or Wegovy, both injectable versions of semaglutide. Others take the older Novo drugs Saxenda or Victoza, which are both liraglutide, Rybelsus, an oral version of semaglutide, or Lilly’s Trulicity (dulaglutide).
The researchers did not track the use of Lilly’s newer GLP-1 drugs, Mounjaro and Zepbound (both tirzepatides), which were released after the study.
Prime does not include patients diagnosed with diabetes in medical claims or those using drugs for type 2 diabetes, which were initially developed. The average age of the patients in the analysis was 46 and 81% were women.
Patrick Gleason, assistant vice president for 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. because of the price and less reduction in related medical costs.
The estimate reflects the drugmaker’s discount on the drug but not all rebates, he said. In this analysis, only one-in-four patients prescribed Wegovy or Ozempic for weight loss are still taking the drug two years later, which Reuters reported in July.
David Lassen, PBM’s vice president for pharmaceutical clinical services, said it may be difficult to replicate the health benefits shown in clinical trials because few patients stick to their prescriptions. “I don’t think it’s over yet,” Lassen told Reuters, adding that three years of data may be needed to gauge the cost impact.
“We want to do everything we can to help individuals get positive results from this drug,” Lassen said. “But if we determine that there are no positive results with our data and no return on investment, that will be an inflection point that we have to think about.”
Prime is owned by 19 U.S. Blue Cross and Blue Shield health insurance plans and manages pharmacy benefits for about 38 million people.
The company estimates that less than 20% of members have coverage for weight loss drugs. Prime says it supports clients’ decisions to cover these GLP-1 drugs in combination with a lifestyle modification program.
Valerie Smith, an associate professor of population health sciences at Duke University, said research on bariatric surgery also found no reduction in medical costs even when weight was maintained for years.
However, they say this analysis may mask potential savings among certain patient groups, such as those with severe obesity or various chronic conditions.