STAT reports ‘…Obamacare insurance is considering a technical change that would require insurers to cover obesity drugs in a market of more than 20 million Americans.’
Goldman Sachs analysts are featured by Reuters that weight-loss drugs ‘…could boost gross domestic product by 1%.’
Marketing guru Scott Galloway writes ‘…Nobody I know is on Ozempic. Yet, nearly everyone I know is on Ozempic.’
The Wall Street Journal notes China has more obese people than anywhere else in the world, totaling 200 million, and can access e-commerce platforms to buy Ozempic shots.
STAT reports ‘…Obamacare insurance is considering a technical change that would require insurers to cover obesity drugs in a market of more than 20 million Americans.’
Medicare is prohibited by law to cover drugs for weight loss, and most state Medicaid programs do not provider cover either.
So the majority of Americans on a GLP-1 drug are either covered by their employer, or through self-pay, direct to consumer, telehealth providers.
The government is merely requesting feedback on the idea, but if coverage were to occur for ACA beneficiaries, with high plan deductibles of almost $10,000, enrollees could still face high out-of-pocket costs.
Reuters informs of Indian drugmakers who ‘…have begun developing their own versions of Novo Nordisk’s wildly in demand Wegovy.’
Sun Pharma, Cipla, Dr Reddy’s and Lupin – some of the world’s largest generic drugmakers – have started work on Wegovy versions.
Novo Nordisk plans to launch Wegovy in India in 2026, with its patents due to expire in China in 2026, in Japan and Europe in 2031, and in the U.S. in 2032.
Analyst Vishal Manchanda said ‘…Dr. Reddy’s and Cipla are making a copy of the innovator drug more like a generic version, while Sun is working on its own innovator drug.
So, Sun will have to do clinical trials. Its drug will be novel and patented.’
Goldman Sachs analysts are featured by Reuters that weight-loss drugs ‘…could boost gross domestic product by 1% in the coming years as lower obesity-related complications are likely to boost workplace efficiency.’
In a scenario with 30 million users, GDP could increase by 0.4%, and rise by 1% with 60 million users.
OPINION
Opinionated marketing guru Scott Galloway writes ‘…Nobody I know is on Ozempic. Yet, nearly everyone I know is on Ozempic.’
People are hesitant, he continues, especially on the Upper East Side of Manhattan, to ‘…acknowledge they need a drug to lose those last 15 pounds.’
Galloway’s approach is to align with other factors, such as AI, tech layoffs, and record profits from the likes of Meta, Google, and PayPal – he calls it Corporate Ozempic.
It seems that Ozempic may become a metaphor for the business world, adding to the comical office chatter of low-hanging fruit, tightening our belts, and ducks in a row; should we Ozempic our engineering team, maybe Ozempic the sales process, or simply choose to Ozempic on annual bonus payments?
The Wall Street Journal notes China has more obese people than anywhere else in the world, totaling 200 million with an additional 400 million who are overweight.
Buyers can access e-commerce platforms to buy Ozempic shots, ‘…simply by declaring they have been diagnosed with diabetes – without providing proof.’
A monthly dose of Ozempic retails at $139 on JD.com.
Companies are also developing new drugs; Innovent Biologics, a China-based drugmaker listed in Hong Kong, said last month that its first phase 3 clinical trial of GLP-1 drug mazdutide had met endpoints; notably the company has a license agreement with Eli Lilly.
FDA criteria for weight loss medications ‘…require that therapeutics show a minimum 5% weight loss over the placebo or that 35% of participants achieve a 5% weight loss, doubling the placebo group’s rate.’
In JAMA Internal Medicine, Drs. Agarwal, Narayan and Stanford argue that by ‘…focusing only on weight loss as the primary weight medication end point…’, the FDA ‘…is encouraging inaccurate measures of medication efficacy for both patients and clinicians.’
Measuring what matters – ‘…the FDA should require fat loss, rather than weight loss, as the primary end point…’ for anti-obesity medication trials.
As we have done extensively in clinical trials of bariatric surgery, over the past thirty years, GLP-1 and additional medications should seek to serve patients through resolution of obesity-related diseases, from diabetes and hypertension, to stroke, heart attacks and cancers.
Barriers to access GLP-1 meds, from months-long primary and specialty clinic wait times, clinicians with weight bias or lack of experience, high prices and supply issues, confusing coverage criteria, have driven many patients to direct-to-consumer, or DTC models of care, through telemedicine.
In The New England Journal of Medicine, Golovaty and Hagan describe prominent weight management companies such as Noom and WeightWatchers, wellness centers, and online DTC platforms, in efforts to reduce costs and inconvenience for patients.
They may also pose risks – uncoordinated care if the patients have other underlying chronic conditions, side effects exacerbated due to other meds which may interact with the GLP-1 drug, and weight cycling.
A lack of oversight of the quality of care provided by means of DTC platforms, prompted the authors to develop a ‘…framework for identifying the features of online DTC platforms that would promote safe, reliable, and evidence-based care.’
The framework is based upon best practices for diagnosis, evaluation and counselling, prescribing, monitoring and maintenance of antiobesity medications.
Although I agree that ‘…DTC prescribing is ultimately a reaction to the shortcomings of traditional models of care…’ we must drive a ‘…closer integration between DTC platforms and traditional health care systems…’ to deliver connected, whole-person care.
DATA
Simar Bajaj at STAT writes on older GLP-1 drug liraglutide, that was shown to significantly reduce opioid cravings in a small analysis of 20 patients with opioid use disorder.
There was a 30% reduction in opioid cravings over the three-week study, presented at the American Association for the Advancement of Science conference in Denver last week.
More interesting, when patients were reviewed five years following bariatric surgery, even if they regained half to three-quarters of the total weight lost, 63% were still free of diabetes.
This argues, and has been shown in the past, for a metabolic benefit of bariatric surgery, over and above the mechanisms of weight loss.
Researchers in Copenhagen published in eClinicalMedicine that there was a four-times greater likelihood to maintain weight loss after one year of stopping therapy, for those on supervised exercise plus GLP-1 therapy, compared to those who only took the drug.
So, combination therapy for one year – drug and exercise – works better than drug alone, when the treatment is stopped, suggesting that weight loss obtained with obesity pharmacotherapy is challenging to maintain after termination of treatment.
Or put another way, supervised exercise combined with obesity pharmacotherapy has the potential to prevent body weight and fat mass regain after treatment termination compared with obesity pharmacotherapy without exercise.
We know this well in my practice of bariatric surgery – the surgery alone does not work well.
