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Tag: Ozempic

  • Daily GLP-1 pill could work as well as Ozempic

    Daily GLP-1 pill could work as well as Ozempic

    Rebecca Robbins and Gina Kolata report for the New York Times that a new pill to be taken each day could do as much to lower blood sugar and help with weight loss as Ozempic and Mounjaro, injectable weight-loss medicines. The FDA has not yet approved the pill for sale and is not likely to do so before next year. 

    What’s the value of Eli Lilly’s orforglipron pill?  The pill conceivably could be cheaper than the current GLP-1 drugs because it costs less to manufacture a pill than an injectable drug. And, unlike an injectable, the pill does not need to be refrigerated or injected. The market for a GLP-1 pill is significant because many people do not want to inject themselves.

    Lilly reports that, in a clinical trial, two-thirds of the 559 people who took the pill saw their blood sugar levels fall to the normal range. Lilly further reports that people who took the highest pill dose lost an average of 16 pounds. 

    But, it’s not yet clear whether the clinical trial data supports Lilly’s claims about the efficacy of its new pill. Side effects, such as diarrhea and nausea could be worse than claimed, and benefits could be smaller than claimed. Independent experts are not expected to analyze Lily’s data until June.

    Axios reports that Lilly’s Zepbound, an injectable GLP-1 drug, delivered a greater amount of weight loss over 18 weeks for people without diabetes than people who took the pill. People had between  15.3 percent and  36.2 percent weight loss,, according to the data.

    Today, one in eight Americans have taken a GLP-1. But, about four in ten Americans are obese. So, there’s a huge market for GLP-1 drugs. 

    N.B.: Medicare currently only covers weight-loss medicines for people with diabetes and heart disease. It does not cover these medicines for people who simply want to lose weight.

    Here’s more from Just Care:

  • Will the Trump administration support Medicare coverage of Ozempic?

    Will the Trump administration support Medicare coverage of Ozempic?

    Among his final acts as President of the United States, Joe Biden proposed Medicare coverage of Ozempic for obese individuals. It will be up to the Trump administration to decide whether to finalize this proposal or kill it. What would RFK Jr. do about Medicare coverage of Ozempic if he is confirmed as head of the US Department of Health and Human Services posits Jonathan Cohn for The Huffington Post?

    Cohn explains that Medicare coverage of Ozempic would be consequential for millions of people. It would deliver potentially significant benefits to them. At the same time, it could cost the Medicare program a tremendous amount of money.

    Ozempic is a glucagen-like peptide or GLP-1 agonist because it works just like a hormone in our bodies that reduces our blood sugar and desire to eat. GLP-1’s have delivered health benefits since the early 2000’s. They became popular when they could be taken once a week. They are also sometimes referred to as semaglutide.

    Semaglutide–marketed in some cases as Ozempic or Wegovy–treats diabetes, heart disease as well as weight loss. But, it is quite costly, with prices as high as $1,000 a month.

    Today, Medicare only covers semaglutide for people with diabetes and heart disease. By law Medicare covers medically reasonable and necessary treatments for health conditions, with a few exceptions, including weight-loss. The Biden administration is now arguing that when people are found to be obese, it threatens their health, and a semaglutide affords them medically reasonable and necessary treatment.

    If the Trump administration finalizes coverage of semaglutide, the price tag is projected to be around $40 billion over ten years. More than ten percent of the 65 million people with Medicare are obese. But, if the Trump administration does not repeal Biden’s Inflation Reduction Act, which allows for Medicare drug price negotiation, the federal government would have the power to pay a lower price for the drug beginning in 2027.

    RFK Jr. has said that he opposes coverage of semaglutide. He argues that obesity stems from malnutrition. We should be spending taxpayer dollars on healthy meals for Americans, not using it to boost Pharma profits.

    To be clear, the evidence shows that people are obese for a number of reasons, and many of those reasons have nothing to do with healthy eating.

    Here’s more from Just Care:

  • Are weight-loss drugs a modern-day miracle?

    Are weight-loss drugs a modern-day miracle?

    Pretty much everywhere I turn, there’s a new story about the benefits of weight-loss drugs beyond helping people lose weight. It’s still early days, and many weight-loss drugs are extremely expensive. But, if you believe the stories, weight-loss drugs can treat heart conditions, can reduce overall health care spending and, can even treat depression and dementia, reports Simar Bajaj for the New Scientist.

    For now, Medicare covers weight-loss drugs mainly for people with diabetes. They are super expensive, driving up insurance premiums considerably, and there’s a lot we still don’t know about them. Still, what’s coming out about their benefits seems nothing short of a miracle.

    Some former alcoholics and drug addicts appear to lose their desire for alcohol and drugs when they take a semaglutide, a weight-loss drug, such as Wegovy and Ozempic. Their depression and anxiety fade away. So, can their addiction.

    Today about six million Americans take a weight-loss drug or GLP-1 medicine. Before long, it is projected that five times that number–30 million–Americans will be on a semaglutide. These drugs enable people to drop between 15 to 20 percent of their body weight.

    Back in February, Epic, which keeps Americans’ medical records, determined that people who took a GLP-1 were considerably less likely to suffer from depression and anxiety than others.  An earlier study arrived at similar findings. 

    Time will tell before we know for sure whether weight-loss drugs deliver all these findings. For now, it seems that the findings make sense. People who are overweight are more prone to depression. If they lose weight after taking a GLP-1, it’s more than likely that it will benefit them mentally as well as physically. For most of us, it feels good to lose weight.

    Some scientists believe there’s more to the story. GLP-1s are produced in the brain as well as the gut. So when you take a GLP-1 drug, you could be benefiting your brain directly, improving cognitive functions and emotional control. Indeed, in a small study of people who did not lose weight from a GLP-1, the researchers still saw improvements to their moods, and they experienced fewer depressive symptoms.

    GLP-1s have been found to increase blood flow in the brain as well as to keep nerve cells from dying as quickly as they otherwise do. They bring more glucose to the brain. As a result, the brain can function better. For these reasons, in small studies, GLP-1s have also been found to be responsible for less brain shrinkage in people with Alzheimer’s and to slow the progression of the disease.

    Again, these are early days. The good news is that these weight-loss drugs seem to have myriad benefits. And, for now, they also appear to come with few risks. But, if we know anything, it’s that what’s good for your health today might be found to come with serious side effects tomorrow.

    Here’s more from Just Care:

  • The cost of weight-loss drugs is driving up our insurance premiums

    The cost of weight-loss drugs is driving up our insurance premiums

    Gina Kolata reports for The New York Times that the cost of weight-loss drugs is not what it seems. People must take them throughout their lives, and weight-loss drugs have list prices of as much as $1,300 every four weeks. Ozempic, Wegovy and drugs like them could literally mean a huge increase in people’s health insurance premiums.

    One epidemiologist projects that if prices for these weight-loss drugs are not controlled, they could increase health care spending by 50 percent! What’s interesting is that it is not only the drug manufacturers that are raking in the profits from these drugs. The health insurance companies and pharmacy benefit managers are profiting wildly from them as well.

    The weight-loss drug manufacturers pump up the list price of the drug so that they can then give a major rebate to the pharmacy benefit managers and insurers as a financial incentive to promote and cover them. The insurers and PBMs pocket these rebates or most of the rebates rather than pass them along to consumers.

    Net prices for the weight-loss drugs are, according to the conservative American Enterprise Institute, AEI, much less than the list prices. The AEI believes that the net price for Ozempic is just $300, $650 less than its list price. Similarly, AEI believes the net price for Wegovy is $700 or $650 less than its list price.

    The weight-loss drugs are unaffordable to many Americans because they cannot afford the copays even with insurance, they have no health insurance, or their insurance does not cover them. Medicare does not cover weight-loss drugs for weight-loss. However, it does cover the drugs for people with diabetes. Medicaid rarely covers the drugs.

    Novo Nordisk, a Danish company, expects to generate $11 billion in revenue this year from Ozempic and another $4 billion from Wegovy. Some might argue that the price for these drugs is fair because treating obesity, with its risk of diabetes, kidney failure, heart attacks and strokes, can be very expensive. No other wealthy country pays prices anywhere near as high as Americans.

    Here’s more from Just Care:

  • Why doesn’t Medicare cover Ozempic and other drugs for weight loss?

    Why doesn’t Medicare cover Ozempic and other drugs for weight loss?

    While Medicare covers certain services to treat obesity, Medicare is not allowed to cover Ozempic and other drugs for weight loss under the law establishing Medicare Part D prescription drug coverage. Still, the pressure is on to get Medicare to cover them, Rylee Wilson reports for Becker’s.

    To treat obesity, Medicare covers obesity screening, behavioral counseling, and bariatric surgery. But, the Medicare Part D prescription drug law prohibits Medicare from covering weight-loss drugs and a range of other drugs, such as drugs that treat erectile dysfunction. That could change for weight-loss drugs, given the efficacy of new weight-loss drugs and the public pressure to cover them.

    GLP-1 drugs, such as Ozempic, are more effective for weight loss than the older drugs. Putting aside these drugs, which come with an enormous price tag, Medicare can’t even cover older weight-loss drugs that cost less. Even when they cost less, spending for all these weight-loss drugs are over the long-term. People generally need to take these drugs indefinitely to sustain their weight loss.

    One New England Journal of Medicine study found that covering new weight-loss drugs would increase Medicare spending by more than $25 billion a year. In addition, one of the study’s authors said that these drugs are not cost-effective; they are not so much better than the older generation drugs to justify their huge price tags.

    Today, people must pay more than $10,000 out of pocket for GLP-1 drugs to treat weight loss. If Medicare decides to cover these drugs for weight loss, it will mean higher Part D premiums for everyone with Medicare. Given the drug price monopoly that US drug manufacturers still have—without negotiated drug prices—there’s no end to drug company price gouging.

    Medicare does cover Ozempic and related drugs to treat diabetes.

    Note: Medicare Part D drug coverage will have a $2,000 out-of-pocket cap beginning in 2025. For some people, that’s a huge benefit. But, $2,000 is still unaffordable for a large cohort of people with Medicare. And, as Part D premiums rise, more and more people with Medicare will struggle to afford the premiums for their prescription drug coverage.

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