With the Rise of GLP-1 Agonists for Treating Obesity, Will Access Challenges Prevent Progress?

Image Credit: Adobe Stock Images/Jelena Stanojkovic

A new article published by the JAMA Network highlights GLP-1 agonists as a promising treatment for obesity, with patients achieving anywhere between 12% and 18% weight loss in trials, higher numbers than any other pharmaceutical therapies to date. As a result, stocks of companies such as Novo Nordisk and Eli Lilly have skyrocketed, which Dariush Mozaffarian, MD, DrPH, author of the article, reports to be a combined $1 trillion.

Despite the success that has come with GLP-1 agonists, significant challenges remain when it comes to factors such as:

• Cost and Access: Currently, GLP-1 agonists have an astronomical price tag in the United States. Despite some discounts, the expensive fee remains, creating a significant challenge for the average citizen to obtain it.
• Efficacy and Adherence: Reportedly, these medications peak after 12-18 months of use, requiring persistent use to stay on track. Otherwise, patients typically regain the lost weight. However, Mozaffarian reports that only 27% of patients continue treatment after a year.
• Equity: Disparities such as income and ethnicity result in health inequity issues.¹

“Yet clinical and public confusion exists around real-world costs, tolerability, and access. One-half of US adults are interested in taking a prescription weight-loss drug, and 93 million meet GLP-1 weight-loss eligibility criteria,” explained Mozaffarian. “US list prices are $12,000 to $16 000 per year; even with maximum negotiated discounts, costs will likely exceed $6500 per year. If all eligible US adults received GLP-1 agonists at discounts, the annual cost would be $600 billion—equal to all other US prescription drug spending combined.

“There are hopes that competition will lower prices, but each GLP-1 agent is protected by approximately 20 patents, many to 2040 or beyond. Even if current prices decrease, experience with other major drug classes suggests that newer agents in this class will be introduced, with incremental benefits but continuing high prices and aggressive marketing, making it unlikely that total costs will meaningfully decrease soon.”

With all of these challenges, Mozaffarian believes that patients, clinicians, and payers all face a common issue. An effective but costly program employing consistent use of GLP-1 agonists against an inexpensive, yet less effective combination of older drugs and behavioral coaching. While combining a version of the two may be even more effective, it does nothing to confront the previously mentioned challenges. Because of this, Mozaffarian suggested a different approach.¹

“In the face of this dilemma, an alternative solution can be considered: a new paradigm of initial, staged GLP-1 agonist treatment supported by long-term lifestyle programming that addresses structural barriers,” suggested Mozaffarian. “Given the critical role of nutrition, this means not merely supplying advice but providing healthy food: a Food Is Medicine (FIM) approach using medically appropriate groceries or meals.”

Mozaffarian noted that an effective program would include elements such as efficient guidance and tracking of nutrition, tips for cooking healthy meals, an exercise program, and would stress the importance of effective sleep habits. Further, such a program would leverage technological solutions, such as telehealth, apps, artificial intelligence, and gamification.

The current prices for GLP-1 agonists have led to conversations about support from employers, with many challenged with deciding whether they will cover the treatment or not. According to Rebecca Pifer of Healthcare Dive, only one-quarter of employers currently cover these drugs as a part of their healthcare plans. However, medical experts believe that they show great potential to bring obesity rates under control.²

“That potential, paired with the cost of the drug, is leaving employers stuck between a rock and a hard place,” Pifer reported. “Employers want to provide access to therapies that could benefit their workforce, but don’t want to bankrupt themselves in the process.”

At the beginning of 2024, the Morgan Company compiled a ‘Market Perspectives’ report regarding this issue, offering three key thoughts:

1. A combination of media-influenced awareness, increased employer coverage, and efforts aimed at expanding positive changes for health conditions will keep demand high.
2. Superior primary healthcare, supplemented with the appropriate technology can efficiently tend to the treatment of obesity.
3. Creating and implementing strategies to confront the demand of continued high-quality care for patients will be vital going forward.^3,4

“With development of GLP-1 agonist/FIM programs, might effective, cost-effective, and equitable obesity treatment be within reach? Or is the hope too large and the challenge too great? These questions can only be answered through rigorous testing of staged GLP-1 agonist/FIM approaches. At a time when clinical and public perspectives on GLP-1 agonists oscillate between positive and negative hyperbole, but with real challenges of cost, long-term tolerability, and equitable access—and when FIM shows early promise to improve nutrition-related disparities—it is time to combine and test these advances in a new paradigm that might start to curb the health, equity, and cost burdens of obesity,” concluded Mozaffarian.

References

1. GLP-1 Agonists for Obesity—A New Recipe for Success? JAMA Network. February 29, 2024. Accessed March 1, 2024. https://jamanetwork.com/journals/jama/fullarticle/2815919

2. GLP-1s for weight loss leave employers in a bind over coverage. Healthcare Dive. October 13, 2023. Accessed March 1, 2024. https://www.healthcaredive.com/news/glp1-employer-coverage-weight-loss/696309/

3. Batiste B., Marcheva B. Market Perspectives. Morgan Health. January 2024.

4. The Future of Employer Coverage for Glucagon-Like Peptide 1 Receptor Agonists in Weight Loss. Pharmaceutical Commerce. January 12, 2024. Accessed March 1, 2024. https://www.pharmaceuticalcommerce.com/view/the-future-of-employer-coverage-for-glucagon-like-peptide-1-receptor-agonists-in-weight-loss