By: David Ostrowsky
Obesity adversely impacts upwards of 100 million adults in the US and accounts for nearly $150 billion in annual health care spending, yet health insurers have been reluctant to cover high-priced weight loss drugs, ones they frequently label as “cosmetic” or “lifestyle” medications. But, given what transpired earlier this month, is it possible that there could be an impending sea change in the medical field’s perception of such treatment?
On August 8, Novo Nordisk, the Danish pharmaceutical juggernaut, unveiled the intriguing results of a large-scale clinical study documenting the efficacy of its obesity drug called Wegovy: of the nearly 18,000 participants aged 45 years or older suffering from both obesity and cardiovascular disease, 20 percent were found less likely to suffer from further heart disease and stroke symptoms after taking Wegovy. Perhaps, as the results indicated, obesity drugs such as Wegovy do not merely help patients shed weight but also deliver other long-term health benefits. The five-year trial was the first to demonstrate that an obesity drug could trigger lasting benefits to cardiovascular health for patients who are overweight but do not necessarily have diabetes.
So, now the question becomes will such promising results make more insurers feel inclined to provide coverage for a drug that costs $1,349 a month and whose documented benefits have yet to be chronicled in a peer-reviewed or medical journal? (Novo has said it plans to present the results at a conference later this year.)
“It’s going to make it much harder to deny coverage and not pay for these products for a non-diabetic population,” noted Craig Garthwaite, a health economist at Northwestern University’s Kellogg School of Management, in the August 8 edition of the New York Times. “It’s going to make it very difficult to make the argument that this isn’t part of an essential health benefit when there are cardiovascular benefits.”
It's undeniable that Wegovy has potential for delivering profound benefits for those afflicted with heart disease, which remains the deadliest – not to mention costliest – malady in America. Consider that the study’s reported 20 percent lower incidence of heart attack was considerably higher than the 15-17 percent range anticipated by investors and industry analysts. Also, it’s not as though Novo Nordisk is an unproven entity in the world of pharma. Another version of a weight loss drug manufactured by Novo Nordisk, Ozempic, has been approved for reducing blood sugar levels in adults with type 2 diabetes and has been found to lower the risk of heart complications in diabetic patients.
But there’s still murkiness surrounding the findings and legitimate questions as to whether insurance companies will see direct cost savings by covering the medication. Novo Nordisk posited that Wegovy reduced the overall risk of heart attacks, strokes and cardiovascular deaths by 20 percent, but the company failed to categorize the effects of the drug on each of those outcomes individually. Meanwhile, Novo Nordisk also did not detail how much weight patients lost or provide details on side effects of the drug (reportedly, patients have reported experiencing nausea, diarrhea, vomiting, constipation and stomach pain) that may have deterred a sizable number of patients from completing the trials.
On another level, though, perhaps due to the well-publicized favorable results stemming from the Wegovy clinical trials, there will be a shift in how mainstream society – and not just the medical field – perceives obesity. Perhaps, this recent development – the emergence of widely accepted empirical evidence proving obesity is a biological condition that can be treated with a medical remedy – will move the needle in making the epidemic less stigmatized.
As Dr. Ania Jastreboff, an endocrinologist and obesity-medicine specialist at Yale University, was quoted as saying in the aforementioned August 8 New York Times article, “Obesity’s not a personal choice – it’s not behavioral, it’s not something that people choose. Medications like this, we believe, are potentially treating that underlying biology.”