Wegovy, the promising obesity drug from Novo Nordisk, reduced the risk of serious heart problems by 20% in a large clinical trial. The study results sent weight-loss related stocks soaring and could increase pressure on insurers to cover these treatments.
Insurers, however, tapped the brakes on the optimism. Although the trial results demonstrate that obesity drugs may have significant health benefits beyond shedding unwanted pounds, organizations representing U.S. insurers emphasized that the data are still preliminary. They also expressed concern about the high costs involved with covering those medications, which are nearly $1,350 per month for a single patient.
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"It's impossible to evaluate the efficacy and long-term effectiveness of a prescription drug based solely on a drug manufacturer's press release," said David Allen, a spokesperson for America's Health Insurance Plans. "Health insurance providers will continue to analyze new evidence as it becomes available."
The popularity of drugs such as Wegovy and Novo Nordisk's diabetes drug Ozempic has skyrocketed for helping people achieve dramatic weight loss over time. Those treatments are known as GLP-1s, a class of drugs that mimic a hormone produced in the gut to suppress appetite. Eli Lilly and Pfizer are working to roll out their own GLP-1s in a bid to capitalize on a weight-loss drug market that some analysts project could be worth up to $200 billion by 2030. Nearly 40% of U.S. adults are obese.
Medicare, most state Medicaid programs, and some commercial insurance plans don't cover the treatments. Some of the nation's largest insurers, such as CVS Health's Aetna, do. Meanwhile, more health insurers are pulling back on coverage. A July survey by Found, a company that provides obesity-care services to 200,000 people, showed that 69% of its patient population does not have insurance coverage for GLP-1 drugs to treat diabetes or weight loss. The results represent a 50% decline in coverage since December 2022.
Related: New pill forms of weight-loss drugs Ozempic, Wegovy could be available in 2023
The new data from Novo Nordisk challenge a longstanding insurance industry narrative that Wegovy and similar treatments are merely lifestyle products that offer a cosmetic, not medical, benefit.
"There's now a long-term, large clinical trial that proves that there's a big cardiovascular health benefit for patients staying on these drugs," Jared Holz, Mizuho health-care sector analyst, told CNBC. "It's just going to open up the market to a bigger patient population over time."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
