The Buzz Around Weight Loss Drugs – What’s Driving It?
Posted on May 18, 2023
Who would have imagined one of the hottest online trends would be pharmaceuticals for weight loss? Social media and commercials are flooded with advertisements for drugs, such as Ozempic®, Wegovy®, and Mounjaro™. Headlines and celebrities confirming their effectiveness further fuel the hype. Rx Savings Solutions has found that 8 of the top 10 drug searches by volume are for diabetes and weight loss drugs. In fact, there have been nearly as many searches for Ozempic year-to-date as compared to all of 2022. The lay public’s awareness has exploded, and the pressure for plans to cover these medications is strong. People know these drugs by name, know someone taking them, or hope to try one themselves.
So why all the buzz? It is likely because these drugs work. Unlike prior weight loss therapies, these newer drugs help individuals shed substantial weight over sustained periods, resulting in meaningful health benefits. The weight loss effect is completely tied to the use of the drugs, as they work in part by slowing down how fast food moves through the digestive tract, and users feel full longer with less desire to eat. Based on studies, Wegovy and Mounjaro (currently not FDA-approved for weight loss) have demonstrated average losses of 15-20% of total body weight. This is remarkable considering that the CDC notes that even “modest weight loss of 5-10%” will likely produce positive health benefits (e.g., improving blood pressure, cholesterol, or blood glucose levels) (CDC, 2022). The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) evidence-based clinical practice guidelines outline the weight loss needed to achieve therapeutic benefit by comorbidities in obese or overweight individuals. The table below summarizes some of the treatment goals (Garvey et al., 2016).
| Comorbidity | Percent Weight Loss Needed for Clinical Benefits |
| Pre-diabetes | 10% |
| Type 2 Diabetes | 5% to > 15% |
| Hypertension | 5% to > 15% |
| Nonalcoholic Fatty Liver Disease | Steatosis: 5% or more Steatohepatitis: 10% to 40% |
| Obstructive Sleep Apnea | 7% to 11% or more |
| Osteoarthritis | > 10% |
Downside Considerations of New Drugs
Although these drugs are effective for weight loss, they are not without challenges.
- While these drugs are approved for chronic use, individuals who discontinue therapy are likely to regain some weight. According to data from a study funded by Novo Nordisk, one year after discontinuing Wegovy, patients regained two-thirds of the weight they had lost.
- These drugs can have troublesome side effects, the most common of which are gastrointestinal – nausea, vomiting, diarrhea, or constipation. However, titrating the dose may help lessen the incidence or severity of side effects.
- The drugs are expensive and may not be covered by prescription benefits or covered with restrictions. According to PSG’s Artemetrx book of business, the annual cost of Wegovy per patient is about $14,000/year. Although most payers cover lifestyle-based weight loss programs (e.g., gym memberships, weight management programs, bariatric surgeries), can they afford to provide continual drug therapy year after year to sustain the weight loss benefits these drugs provide?
Despite the challenges, the promise of the benefits of weight loss and obesity control has led to mounting pressure in the industry for payers to cover these new weight loss drugs. According to PSG’s 2023 Trends in Benefit Design Report, 43% of health plans and employers already cover weight loss drugs, with another 28% considering coverage in the next 1-2 years. What will it take for those 28% to cover weight loss drugs? Will it be additional long-term outcomes data supporting the positive benefits of weight loss (e.g., cardiovascular risk reduction, decreases in absenteeism, increases in presenteeism, and improvements in conditions such as sleep apnea or osteoarthritis) resulting in long-term savings for plans? Or will it be necessary for employers to enhance their benefits by covering these drugs to attract and retain top talent?
Obesity by the Numbers
The CDC defines obesity as “weight that is higher than what is considered healthy for a given height.” Body Mass Index (BMI) is a commonly used screening tool for overweight and obesity and is calculated by taking a person’s weight divided by the square of height. A BMI of 30 or greater is considered obese (CDC, 2022). In 14 states, CDC data from 2017-2020 showed adult obesity of more than 35%, with 40% of adults and 19% of children noted as obese (CDC, 2022). These percentages are alarming, particularly given that there can be serious medical consequences related to obesity (Laurence, 2023), like:
- Increases in high blood pressure and cholesterol (both risk factors for heart disease)
- Links to 30-50% of new cases of Type 2 diabetes in the U.S. (Cameron et al, 2021)
- Estimates of medical costs at 30-40% higher
- Higher average number of days missed from work yearly due to illness or injury
Paradigm Shift in Treatment of Overweight and Obesity
The American Medical Association officially recognized obesity as a disease in 2013. However, it was not until recently that the industry focused on obesity as a chronic disease requiring long-term treatment. Medical treatment has been focused more downstream on the conditions that have resulted from obesity, such as high blood pressure, high cholesterol, and type 2 diabetes. With the entrance to the market of Wegovy and other drugs, is the focus changing to a more upstream approach? What if treatment of obesity was provided earlier to prevent the negative consequences of conditions correlated with obesity? Could healthier patients result in cost avoidance or cost savings for payers? Today, these are unanswered questions. With so much potential and positive benefits of the weight loss these drugs can achieve, what is preventing more plan sponsors from offering coverage? One barrier remains: affordability. It’s not just that the drugs are expensive, but they will need to be covered long-term, so plan sponsors are trying to figure out if and how they can provide coverage for the duration needed to optimize the benefit of the weight loss for their members. While there are no easy answers, plan sponsors must prepare now for how they will respond to a likely continued increase in interest by members for access to weight-loss medications. The strong interest today is likely just the tip of this latest pharmaceutical iceberg.
Weight loss drugs and affordability are a hot topic for plan sponsors. PSG’s next research report, Trends in Drug Benefit Design, sponsored by Rx Savings Solutions, will take a deeper look and provide insights from benefits leaders across the country. Releasing on June 13th, you can sign up now for our webinar that will dive into not only weight loss but many other trending topics. Learn more here or fill out the form below to register.
