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For Obese Patients, Wegovy Is Worth the Cost?

According to the National Institute of Health, 42.4% of Americans are classified as obese. Do these goofballs suggest prescribing these drugs to the "obese"? Really? At $12,000 per person per year that would add up pretty fast. Think your health insurance is expensive now?

I wonder if Mr Persaid or his co-author has research paid for by the pharma industry? Just kidding...I'm sure they wouldn't dare.

BTW, in the 1960s only about 13% of Americans were obese. I guess we've all mutated and can't control our weight without being drugged. Yup, good diet and exercise no longer work for about half the population because big pharma says so.

PS. For folks who are grossly obese, these drugs may very well be a smart investment. That's a much smaller cohort.

For Obese Patients, Wegovy Is Worth the Cost

North Carolina is wrong to deny coverage. Breakthrough treatments curb additional health risks.

By Govind Persad and Ezekiel J. Emanuel, WSJ

Feb. 23, 2024

Diet, exercise, oral weight-loss medications and even bariatric surgery weren’t enough to help Meghan Ray manage her weight. When Ms. Ray was diagnosed with two serious medical conditions that could worsen with weight gain and even risk vision loss, her doctors recommended that she begin taking the weight-loss drug Wegovy. For two years, the treatment proved extraordinarily effective. But a few weeks ago North Carolina said it would no longer cover GLP-1s—the class of drugs including Wegovy, Ozempic and Mounjaro that have helped Ms. Ray, a state employee, and thousands like her.

The North Carolina State Health Plan joined Medicare, other health plans such as Ascension of St. Louis, and the University of Texas as well as Belgium and Germany in declining to cover these drugs for obese people. For North Carolina, cost was a major factor. With 25,000 people already on GLP-1s, the state’s health plan spent $100 million—more than 10% of the plan’s overall prescription-drug spending—on these drugs last year. By 2028 the plan projects the state will spend more than $600 million yearly.

“We’re leaning in on cost-effectiveness,” said Sam Watts, executive director of the North Carolina State Health Plan. “We’ve got to do the greatest good for the greatest number of members.”

Mr. Watts’s answer is ethically confused. Cost-effectiveness supports covering GLP-1 drugs. No health plan can cover every beneficial drug. Limits are inevitable. But North Carolina’s decision was a mistake because it considered only costs, not value for money. Cost-effectiveness means weighing a drug’s cost against its expected benefits, namely how much longer and healthier patients’ lives will be. Some interventions, like vaccines, are cost-effective and cost-saving: Covering them saves society money. The MMR vaccine costs pennies per dose to prevent measles—a disease that causes pneumonia in 1 in 20 infected children and encephalitis in 1 in 1,000.

Even costly interventions often deliver good value for money. Despite the expense of Sovaldi, the $1,000-a-day pill to cure Hepatitis C, its cost-effectiveness meets commonly accepted standards. It reduces the need for very expensive medical care, including liver transplants.

Wegovy and the other GLP-1 drugs are medical breakthroughs on par with gene therapy and the mRNA technologies that produced Covid vaccines. They help obese patients lose about 15% of their body weight and decrease heart attacks and other harmful—and costly—cardiovascular conditions by 20%. Even at their current high prices, these weight loss drugs are cost-effective. And we are learning that they might be helpful against other diseases, such as depression, making them even more cost-effective.

North Carolina covers many drugs that are less cost-effective than Wegovy. Austedo, which treats neurological disorders, and cancer drugs Ninlaro and Opdivo cost between three and eight times as much to deliver a similar amount of health benefit—yet each is covered by the health plan.

Why, then, aren’t these new weight-loss drugs covered? Society long viewed obesity as caused by bad choices and a lack of willpower. There is now ample evidence this isn’t the case, and that many people don’t have control over their food system and environment that naturally lead to weight gain.

Bias against people with obesity can’t determine whether to pay for GLP-1s. We don’t let a person’s life choices determine coverage in other areas. The North Carolina State Health Plan already pays for plenty of diseases that often result from bad lifestyle choices such as lung cancer, cirrhosis, heart disease, and Type 2 diabetes. Many involve factors outside patients’ control—like obesity.

Perhaps obesity is so common that North Carolina believes it can’t cover everyone who could benefit from interventions. The answer, nevertheless, can’t be to deny coverage altogether. If all patients can’t be covered, the ethical choice is to cover those for whom GLP-1 would provide the biggest health difference. Contrary to intuition, this would be obese—not diabetic—patients who frequently develop diabetes, arthritis, high blood pressure and strokes and, more important, tend to lose more years of life.

North Carolina’s experience illustrates that spending on healthcare requires trade-offs. Money spent on drug coverage could have been spent on improving education, fighting crime or repairing roads and bridges. State funds are limited so it is imperative that the greatest value be gained from the money spent. To properly navigate trade-offs, instead of banning states and insurers from considering cost-effectiveness, we need to consider cost-effectiveness fairly and honestly. Otherwise more will make North Carolina’s unethical mistake of focusing on cost alone.

If North Carolina refuses to cover drugs based on value for money, there is another policy option. Instead of cutting coverage for GLP-1s, North Carolina could help reduce obesity by taxing the products that have fueled the nation’s obesity epidemic. This is something Philadelphia and other cities have done and the American Academy of Pediatrics recommends. Revenue from taxes on ultra-processed foods, sugary sodas and fast food could pay for drugs, such as GLP-1s, to treat the diseases they have caused.

Coverage for weight-loss drugs could reduce obesity immediately while less consumption of harmful foods could help prevent it. Fewer people would need expensive treatments like Wegovy in the longer term.

Mr. Persad is a law professor at the University of Denver. Dr. Emanuel is a physician and vice provost for global initiatives at the University of Pennsylvania.

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