Novo Nordisk’s Saxenda (liraglutide) and Wegoby (semaglutide) are paving the way for new drugs that reduce appetite. However, their cost-effectiveness is questionable and many payers say no to coverage — for now.
To understand David Skomo’s struggles to reach a healthy weight, we need to go back decades.
“Perhaps from an early age, weight management has always been a problem I’ve been working on,” he says.
Skomo, 50, Chief Operating Officer of Pharmacy Benefits Manager Weldyne, was a little overweight in middle and high school, but never became obese. But as he grew older, it became more and more difficult to achieve his healthy weight.
It wasn’t because of the lack of attempt. He saw his meal. He exercised. And Skomo had some success, but as is often the case with weight loss, the pound had a way to come back. “If you really work hard, diet and exercise, you lose weight,” he says. “But that also means that your body has the will to not eat when telling you that it’s the answer. That’s where it gets really difficult.”
However, Skomo had never tried a weight loss drug. “Some of the early products had no merit at all,” he says. “They were dangerous, addictive and not what I wanted to get involved with.”
Still, Skomo was willing to read the positive results of Wegovy (semaglutide) approved by the FDA in June 2021 and give it a try. At that time, Scomo was qualified for this drug because he had a high body mass index (BMI) of 29 and high blood pressure. Skomo, a trained pharmacist, said the fact that Wegovy has a different mechanism of action is a compelling reason to try it. “I was able to see how this drug differs significantly from previous generations of weight loss drugs,” he says. Scomo talked to his wife, who is also a pharmacist, and she agreed. His only appointment was the possibility of gastrointestinal side effects.
Almost a year later, he lost 18% of his weight and had a BMI of 23. “He told himself that he would be thrilled if he could lose £ 30 over time,” he says. .. “And I’m now losing up to about 35 pounds.”
Saxender was the first
Stories like Skomo are part of the reason why new classes of weight loss drugs are so powerful. While the idea that medicines can stop the spread of obesity in the United States is fascinating, weight loss medicines have a past check of lack of long-term efficacy and, in some cases, lack of safety.
But now, while high drug prices can be a problem, there is a cohort of new drugs with new mechanisms of action that can bring drug weight loss to the mainstream of healthcare. Novo Nordisk’s Saxenda (liraglutide) was the pioneer of the first approval in 2014. The results of a clinical trial published in 2015 showed that nearly two-thirds of adult patients lost at least 5% of their body weight after taking Saxenda for 56 weeks. One-third of patients lost more than 10%.
Next is Novo Nordisk’s Wegoby.
Then, in late April of this year, Eli Lilly made a splash and published the results of a phase 3 trial of the weight-loss drug Munjaro (tilzepatide). According to the company, the drug helped reduce people’s weight by 22.5%.
All three drugs were first approved by the FDA as diabetes drugs before Novo Nordisk and Eli Lilly set out to get the authorities’ OK to add signs that they could be used for weight management. The FDA approved Mounjaro as a type 2 diabetes drug in May. Eli Lilly is expected to look for indications for weight management of the drug if ongoing clinical trials are successful.
Paradigm shift
Dr. Robert Kushner, MD, one of the researchers involved in Wegoby’s Phase 3 trial and a professor at Northwestern University’s Faculty of Medicine at Fineberg, said: Managed Healthcare Executive® This drug marks the beginning of second-generation obesity medication. “There is a paradigm shift in the treatment of obesity, which is parallel to our understanding of the underlying appetite dysregulation of the disease,” he says.
Saxender was the first step in a new direction, but we need it every day
The administration, Kushner points out. It was a big step forward when Wegoby, and now Munjaro, proved to be effective, but requires weekly injections instead of daily, Kushner said.
According to Kushner, these new treatments can correct the underlying appetite dysregulation that underlies weight problems in many patients. “By taking advantage of the appetite effects of naturally occurring gastrointestinal and pancreatic hormones, we can biologically alter appetite dysregulation,” he says.
All three drugs utilize glucagon-like peptide-1 (GLP-1), a natural hormone released in response to food intake that regulates appetite and calorie intake. By binding to and activating the GLP-1 receptor, the drug helps patients feel full faster. In addition to targeting GLP-1, Mounjaro also targets the glucose-dependent insulinotropic polypeptide (GIP), a hormone that regulates blood glucose. Clinical trial data suggest that this dual approach can enhance weight loss. However, all three medications can cause gastrointestinal side effects.
Kushner, along with Wegoby, it’s important to the prescriber,
Patients should contact their medication and diet counseling on a regular basis. However, Kushner emphasized that the reused diabetes treatments have exceeded the efficacy threshold. And happiness. “
High price
Evidence of efficacy and long-term benefits is essential for these weight loss drugs, as manufacturers put high price tags on them. Payers scrutinize them through cost-effective lenses that are complicated by weight loss medications. How are all the cost savings associated with preventing the myriad conditions resulting from overweight and obesity considered?
In 2019, a team of researchers reported the results of a cost-effectiveness analysis of six weight-loss drugs, including semaglutide (not yet branded as Wegovy) and Saxenda, along with a lifestyle intervention plan.Results reported to the journal Obesity science and practiceShowed that semaglutide is second only to romayla (phentermine) in efficacy after 1 year. However, although the weight loss due to Lomaira decreased after one year, semaglutide had five weight loss effects. Still, researchers who reported receiving consulting fees from Novo Nordisk found that semaglutide was not cost-effective due to its high price.
However, there are some caveats. The analysis was based on a one-year, three-year, and five-year period, so it was not possible to take into account the long-term savings of having a healthy weight. The analysis was also conducted before Novo Nordisk began selling semaglutide as Wegovy.
Researchers spent $ 8,273 annually on the price of semaglutide as a treatment for type 2 diabetes (as a diabetes drug, semaglutide is sold under the brand name Ozempic). The price of Wegovy is high. According to the Novo Nordisk website, the monthly list price is $ 1,349 and the annual price is $ 16,188.
Skomo says he hopes that approval of additional medicines will be better for patients, not only in terms of finding the right medicines, but also in terms of facilitating the entry of medicines into the market.
“There is a lot of prescription placement and that kind of competition in the market, which should help start reducing some of the cost of medicines,” he says. “So when we get more products on the market, I think it’s in mutual favor.”
Skomo states that WellDyne recommends adding Wegovy coverage to clients, but most people haven’t received that advice yet. .. “The dilemma is that we have effective and safe medicines that help patients get healthier, but they can’t afford them,” he says. “There is no doubt that we need to increase coverage and reduce costs.”
Jared Kaltwasser is a health and medical writer living in Iowa. Managed Healthcare Executive®..
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