Medicare Coverage for GLP-1 meds; Oprah and Weight Stigma; Vast Underusage of Bariatric Surgery; Digital Diabetes Tools not Worth It; Obesity Costs in Pennsylvania at $20B.
From Dani Blum at The New York Times, media icon Oprah Winfrey takes on weight stigma in her ABC News Special… starting with her own.
Respected bariatric surgeon Dr. Bruce Schirmer, writes in JAMA Surgery on Metabolic Bariatric Surgery – A Vastly Underused Treatment.
STAT reports digital tools for diabetes management did not deliver benefits that justify cost.
Global Data published that obesity ‘…has a substantial economic impact on Pennsylvania with 2022 estimates of $19.9 billion in lost economic activity…’ or 2.2% of Pennsylvania’s 2022 GDP.
NEWS
Reuters in reporting from data source IQVIA, states ‘…Eli Lilly’s powerful weight-loss drug Zepbound hit 77,590 new prescriptions in the U.S. for the week ending March 8…’ which surpassed Novo Nordisk’s GLP-1 Wegovy medication, for the first time since it was launched.
Even more wild is the market analyst view of weight loss drugs to reach at least $100 billion by the end of the decade.
The drugs are ‘…on pace to this year surpass widely used cancer immunotherapies as the best-selling medicines.’
This is only ‘…as long as they have a history of heart disease and are using it to prevent recurring heart attacks and strokes.’
The approach is based upon recent FDA approval for use of anti-obesity medications such as Wegovy, to reduce the risk of heart attacks and strokes in people with a history of cardiovascular disease, and who have a body-mass index above a certain threshold.
Last year, Novo Nordisk published high level outcomes of a study with Wegovy to decrease cardiovascular risk by about 20% versus a placebo, or dummy drug.
About 10 million Medicare beneficiaries are said to be obese; paying for just a tenth of these members at the current list price of $1,300 per month, would cost about $26 billion, or almost one-fifth of the total Medicare budget.
Beyond cost, how will Novo Nordisk ensure supplies for the newly eligible individuals?
Loftus additionally notes ‘…CMS said anti-obesity medications still aren’t eligible for Part D coverage if they are used for weight loss alone.’
This is a move in the right direction; obesity is a chronic disease, and its treatment can impact people with co-existing cardiovascular diseases such as high blood pressure, and stroke, as well as sleep apnea, polycystic ovarian disease, hip and knee osteoarthritis, and liver disease.
We can treat this disease burden, to enable people to live healthier and happier lives, and reduce total costs of care.
John Wilkerson at STAT notes ‘…Medicare will likely choose the obesity drug semaglutide for price negotiation within the next few years.’
This stems from a report presented to National Academies’ Roundtable on Obesity Solutions by the Congressional Budget Office; the proposal is to analyze direct costs of anti-obesity or GLP-1 medications, and potential savings associated with improved health outcomes.
At their current prices, the meds would cost the federal government more than it would save from reducing other health care spending; this equation could be improved by lower drug prices.
In a welcome addition, the CBO is reviewing evidence about the effects of bariatric surgery.
OPINION
From Dani Blum at The New York Times, media icon Oprah Winfrey takes on weight stigma in her ABC News Special… starting with her own.
Oprah was ‘…done with the shaming…’ through decades of dieting, in admittance last December to taking a weight medication.
‘I felt like I was freed…’ said Amy Kane, who was featured on the television program having lost 160 pounds on Mounjaro.
Clinical experts taking part in the show included Dr. Scott Butsch at the Cleveland Clinic, ABC News chief medical correspondent Dr. Jennifer Ashton, and Dr. Amanda Velazquez from Cedars-Sinai Medical Center in Los Angeles.
In addition, Sima Sistani, CEO of recently beleaguered WeightWatchers was featured – she spoke in defense of her decision to purchase weight loss medication company, Sequence Health, last year, stating that the WW behavior-change program was ‘…missing the third prong, which was biology.’
Oprah closed the program with three statements, clearly intended to accept a wide range of viewpoints.
‘…For people who feel happy and healthy celebrating life in a bigger body and don’t want the medications, I say bless you.
And for all the people who believe diet and exercise is the best and only way to lose excess weight, bless you too if that works for you.
And for the people who think that this could be the relief and support and freedom that you’ve been looking for your whole life, bless you too because there is space for all points of view.’
One approach that was obvious in its absence, is the value and impact of bariatric surgery – as we know – the most durable, effective and cost-effective treatment for people with severe obesity, and further, a lack of reference to a whole-person, multimodal approach to care.
Dr. Bruce Schirmer, highly respected bariatric surgeon and academic leader at the University of Virginia Health System, writes in JAMA Surgery on Metabolic Bariatric Surgery – A Vastly Underused Treatment.
The compelling opening sentences being with ‘…Obesity is a disease.’
Schirmer continues ‘…the general public believes that individuals with obesity have obesity due to a lack of discipline in their eating habits and just out of laziness.’
And then states ‘…In case you haven’t heard: IT JUST ISN’T SO!’
Terrific and thank you.
The use of ‘…GLP-1 medications like Ozempic and Wegovy to treat addiction is very, very, exciting…’ as per Nora Volkow, director of the National Institute on Drug Abuse, at the STAT Summit.
Volkow added that ‘…pharmaceutical industry has never spontaneously embraced us…’ such that we’ve ‘…never considered addiction as a disease that is worthwhile to invest in, despite the very high rate of mortality.’
Marcus Schindler, Novo Nordisk’s chief scientific officer, said they are running two large Phase 3 trials of their GLP-1 drug in Alzheimer’s.
Volkow speaking on the GLP-1 meds ‘…advocated for a high-quality clinical trial that would more precisely measure the medications’ impact on substance use.’
DATA
Metabolic bariatric surgery is the most effective treatment for severe obesity, resulting in substantial sustained weight reduction with improvement in comorbidities and quality of life, and increased life expectancy.
A recent clinical trial published in The Lancet Diabetes & Endocrinology conducted across nine centers in France, had enrolled over 250 patients with obesity, of which over 200 had diabetes too.
At five years following bariatric surgery, over 70% of the excess weight had been lost, with extensive remission of diabetes too.
The study intent was to compare two different types of gastric bypass, with overall outcomes fairly similar.
The Peterson Health Technology Institute, headed by health policy expert Caroline Pearson, undertook a systematic review of digital tools for diabetes management; think of companies like Livongo, Virta and Omada.
Referring to the study, STAT writers Katie Palmer and Mario Aguilar note ‘…digital tools used to manage diabetes with the help of finger-stick blood glucose readings don’t result in clinically meaningful improvements over standard care.
As a result, they don’t reduce health care spending — they drive it up.’
Pearson added ‘…Most of the solutions in this category do not deliver clinical benefits that justify their cost…’ and does not support broader adoption for most products.
While most of the interventions did provide some improvement in blood glucose, they were not considered clinically meaningful.
Rightly so, the report recommends buyers align payments and performance, ideally in a risk-sharing approach, tied to outcomes.
Now that some of these companies are exploring the role of GLP-1 medications, it will be valuable to see a report of the same on digital health solutions for weight management [meaningful tag to Jared Dashevsky].
NBC News references researchers from Johns Hopkins University, who state ‘…Powerful weight loss medications aren’t reaching the people who need them most.’
Getting a prescription, finding a pharmacy with the drug in stock, and paying for it – the uptake is still fairly limited, only further exacerbated by ‘…deep racial and geographical disparities.’
Dr. Chiadi Ndumele, at Johns Hopkins Medicine in Baltimore, reviewed over 18,000 patients with obesity, and found only 2.3% were prescribed a weight loss drug.
Engaging in an obesity conversation with patients can be hard, and when coupled with weight bias and weight stigma, leads to under- or unaddressed treatment.
Global Data, supported by Eli Lilly and Company, published on Obesity’s Impact on Pennsylvania’s Economy and Labor Force.
The impact of obesity on medical cost, and the labor force was reviewed, at household, employer, and government levels.
In my home state, obesity ‘…has a substantial economic impact on Pennsylvania with 2022 estimates of $19.9 billion in lost economic activity and 156,300 fewer adults in the workforce…’ or 2.2% of Pennsylvania’s 2022 GDP.
Obesity ‘…raises health-related absenteeism and employer disability costs by over $1.7 billion annually.’
The impact of obesity to employers in 2022 was $2.3B in higher healthcare costs.
The report notes access to and utilization of obesity treatment remains limited and recommends that ‘…state policy makers and to employers can increase access to modernized and evidence-based obesity care.’
This is a damning report on the current status of obesity care, its clinical and economic impact, and the lack of strategies to manage the disease of our time.
Treatment of a non-Medicare adult population over a 10-year period to reduce weight by up to 25% through targeted interventions would reduce the incidence of new cases of type 2 diabetes by 39%, stroke by 36%, and coronary heart disease and heart attack by 25% and 20%, respectively.
The medical costs among the modeled population would decline by an average of $14,034 per person, or $27.5 billion over 10-years at the state level.
People, what are we waiting for?
ADDITIONAL TOPICS
JAMA Network Open publishes Long-Term Body Mass Index Variability and Adverse Cardiovascular Outcomes
