The Time Has Come to Make Weight-Loss Drugs Available to Those Who Need Them

Weight loss market

Pictured: Weight loss scale and pile of money/Taylor Tieden for BioSpace

I like Oprah Winfrey. I’ve been a fan of hers since the mid-1980s when she started her nationally syndicated TV talk show in Chicago. What an amazing broadcast career she’s had, not to mention her achievements as an actor, author and producer. Like many Americans, Oprah has struggled with her weight over the years. The difference is that she has done so openly and candidly in the public eye. As a fan and someone who covers the pharma industry, you can understand why I was eager to watch Oprah’s hour-long ABC prime-time special on Monday about weight-loss drugs.  

Monday’s Oprah show, “Shame, Blame and the Weight Loss Revolution,” is interesting in that it came on the heels of her decision last month to part ways with WeightWatchers’ board of directors after nearly a decade. Just two months prior to that, the media mogul revealed to People magazine that she uses a weight-loss drug as a “maintenance tool.” On Monday, Oprah told the TV audience that after 25 years of making fun of her weight “as national sport,” one of the “so-called miracle medications” helped her transform her body and shed the “shame that the world gave to me.”

I’m happy for Oprah, who at 70 has finally reached a point in her life where she has found peace with her weight and a long-sought solution. We still don’t know which GLP-1 drug Oprah is taking, Novo Nordisk’s Wegovy (semaglutide) or Eli Lilly’s Zepbound (tirzepatide). However, it appears that access to the medication is not a problem for the celebrity despite weight-loss drug shortages and the high costs of these drugs—she’s a billionaire, after all. The same is not true for the millions of Americans who struggle with their weight and/or obesity. Availability and affordability are real challenges for those who need GLP-1 drugs.  

Obesity affects 4 out of 10 Americans, according to data from the Centers for Disease Control and Prevention (CDC), and the medical costs for adults who are obese are higher than for people with a healthy weight. It’s no surprise that obesity-related conditions—such as heart disease, stroke, type 2 diabetes and certain types of cancer—are some of the leading causes of premature and preventable death in the U.S. and that obesity affects some minority groups more than others.

The time has come to make weight-loss drugs available to those who need them most and to address the obesity epidemic in this country. As the single largest payer for healthcare in the U.S., the Centers for Medicare and Medicaid Services (CMS) is in a position to have a huge impact on access to these medications, as Medicare currently provides health insurance to more than 65 million people.

While states can decide whether to cover weight-loss drugs under Medicaid, which means coverage varies, Medicare is prohibited from covering medications used for weight loss and to treat obesity. Drugs such as Novo’s semaglutide and Lilly’s tirzepatide are covered under Medicare only for the treatment of type 2 diabetes. Not surprisingly, 76% of older adults think Medicare should cover prescription drugs for weight management, according to a recent national poll.

It appears change is afoot. Two weeks after Wegovy’s FDA label expansion to reduce the risk of cardiovascular death, heart attack and stroke in adults who have cardiovascular disease and are obese or overweight, CMS said Thursday that Medicare will cover the weight-loss medication under its Part D drug program for patients with overweight or obesity who have preexisting heart disease.

And it looks like that’s just the beginning of potential coverage. An analysis this week from the Congressional Budget Office predicts that CMS will select Wegovy for Medicare drug price negotiations under the Inflation Reduction Act “within the next few years.” This would have the effect of lowering its cost as well as that for other obesity medications.

I’m a financial realist. With America’s aging population, Medicare costs continue to skyrocket, which is a fiscal problem for the federal government. Still, the bean counters in Washington must also take into consideration the estimated annual medical costs of obesity in this country. With half of U.S. adults projected to have obesity by 2030, it’s critical to properly weigh the costs and benefits of covering these potentially transformative drugs.

Greg Slabodkin is the news editor at BioSpace. You can reach him at greg.slabodkin@biospace.com. Follow him on LinkedIn.

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