Cost of Wegovy, weight loss drugs may be too expensive for Americans

Also this year, federal regulators will consider approving tirzepatide, which appears to help people lose more weight. Eli Lilly has sold tirzepatide under the Mounjaro brand name for $1,000 a month since it was approved in May to treat diabetes. Other similar drugs are likely to be approved in the coming years.

These new anti-obesity drugs, like those for high blood pressure and cholesterol, must be taken indefinitely, so once people start taking them, they will need to keep taking them or the weight will regain.

Meanwhile, the American Academy of Pediatrics recently changed its guidelines for obese children to recommend more aggressive treatment, including medication for children under 12 years old. Guidelines released late last year by the American Diabetes Association also recommend aggressive treatment of obesity, including the use of medication, for people with diabetes.

The global anti-obesity drug market is expected to grow 25 percent over the next five years, driven largely by demand in North America, according to an analysis by business research firm Medi-Tech Insights.

more:How will the obesity epidemic end? with kids.

The price of obesity

According to ECRI, treating the health effects of obesity costs the US healthcare system $170 billion annually.

Americans also spend an additional $70 billion a year trying to lose weight—mostly unsuccessfully, and often “on unproven remedies that may even be counterproductive or dangerous,” Sabak said.

Diet pills are currently overpriced based on the value they provide, but “not significantly,” Lind said.

Although older-generation drugs are less effective, ICER estimates that they provide long-term value that outweighs their cost by reducing obesity-related diseases.

For example, Qsymia, a combination of phentermine and topiramate, costs $1,465 a year, but ICER estimates its benefits justify the $3,600 to $4,800 annual cost.

By comparison, semaglutide typically costs consumers $13,618 per year but delivers $7,500 to $9,800 in value, ICER found.

Lind said the drug should eventually offset the cost by preventing heart attacks, joint surgeries and other costly treatments.

However, people with a very high body mass index (ratio of weight to height) were more likely to suffer health consequences than people with a BMI close to the obesity threshold (30). As a result, cost savings will come mostly from limited sources, said John Cowley, a Cornell University health economist.

“This is where the cost savings in preventing extreme obesity comes in,” he said.

Why weight loss treatments haven't been covered so far

In the past, it made sense for insurance companies not to cover anti-obesity drugs, Lind said. This is because many drugs only promote about 5% weight loss, which is the lower limit of what can affect someone's health.

Many approved weight-loss drugs have been pulled from the market after being shown to be dangerous. In 2022, the U.S. Food and Drug Administration withdrew the weight-loss drug lorcaserin, sold under the name Belviq, because of an increased risk of cancer in people who took the drug long-term. One of the combination drugs, fenfluramine (a combination of fenfluramine and phentermine), was withdrawn in 1997 after it damaged heart valves in patients.

“If every decade or two of obesity treatments results in people dying, it makes sense why someone would say they wouldn't cover them,” Lind said.

But now that effective drugs are available, a lack of insurance no longer makes medical sense.

“Nobody would ask anyone with high blood pressure to exercise without giving them beta blockers or other approved medications,” Schabacker said. “If those Americans who are eligible for treatment are covered by an insurance plan or Medicare/Medicaid, it will help reduce health care costs for secondary conditions such as hypertension, diabetes, and musculoskeletal disorders.”

Bias also contributes to this lack of reporting, he and others say.

“Obesity is considered a choice, a consequence of people's behaviour, so it is less reported than other diet-related diseases such as type 2 diabetes and high blood pressure,” Cowley said.

National surveys show that the vast majority of obese people are trying to lose weight. “It's not a lack of effort,” he said.

Decades of research now show that human biology works to regain lost weight, slowing metabolism, for example, when someone loses weight. However, it is still believed that patients should be able to help themselves.

“We have better evidence that losing weight through diet and exercise doesn't work for 95 percent of people; there's no point in pretending it does,” he said.

Rethinking obesity:

If health insurance coverage for anti-obesity drugs is allowed to be uneven, it could exacerbate economic and racial disparities, especially among children, Cowley said.

“Teenagers and young adults whose parents have health insurance will get coverage. Others won't,” he said.

Obesity was more common among low-income women but not among low-income men, he said.

People with low incomes and fewer food choices are more dependent on cheap, highly processed foods, which often lead to obesity, Schabacker said.

“This exacerbates the obesity problem and makes it worse by not providing adequate treatment for it, despite the fact that it is available,” he said.

Who will pay for these drugs?

Now, the burden of paying for weight loss treatments often falls on the patient. Most health plans don't cover the cost of weight-loss drugs, and government programs like Medicare don't.

In a recent investor presentation, Novo Nordisk said 40 million U.S. adults have at least some Wegovy coverage. (Approximately 108 million American adults meet the definition of obese.)

“Insurance policies can be very confusing and thus cause people to forego getting these drugs from their drug plan—even though they might be covered,” said Ted Kyle, founder of ConscienHealth and former president of the Obesity Action Coalition, a 75,000-strong -Member non-profit organization dedicated to empowering people with obesity.

The lack of coverage explains at least in part why historically only about 2 percent of obese Americans have received weight-loss drugs or surgery.

Once multiple weight-loss drugs hit the market, there will be some competition, and prices may moderate, said Lind, an internist at Beth Israel Deaconess Medical Center. But if a drug looks better and becomes the drug everyone wants, “that drug will continue to cost a lot.”

The emergence of these new expensive drugs could also benefit cheaper, less effective drugs already on the market, he said. “We may also see some attempts to get patients to the most affordable drugs first.”

Rind's organization, ICER, has recommended that Medicare start paying for anti-obesity drugs.

Commercial insurers should also cover the drugs, he said. But while it may appear that people will save money by losing weight, these cost offsets will occur many years into the future, by which time patients may have changed insurance plans.

Patent protection will keep low-cost generics off the market for at least two decades.

Perhaps, Linde said, insurance companies and drug companies will come to an agreement that he calls a “Netflix plan,” where the insurer will set an amount and the manufacturer will offer what they are willing to pay.

As with preventive care, the government could also require all health insurers to cover cost-effective weight loss treatments, which would reduce disparities, Cowley said.

He also said insurers often used incentives to keep policyholders from wasting money. Cheaper diet pills can be offered without copays, but newer diet pills may cost patients more out of pocket.

This will “at least make consumers think twice before opting for more expensive options.”

Contact Karen Weintraub at kweintraub@usatoday.com.

USA TODAY's health and patient safety coverage is supported in part by funding from the Masimo Foundation for Healthcare Ethics, Innovation and Competitiveness. The Masimo Foundation does not provide editorial opinion.