Newly Approved Obesity Drug Wegovy Holds Promise, But Faces Reimbursement Challenges
On Friday, June 4th, the Food and Drug Administration (FDA) approved Novo Nordisk’s obesity drug Wegovy (semaglutide), a glucagon-like peptide 1 receptor agonist, to be injected subcutaneously once-weekly. FDA approved Wegovy based on phase 3 data which showed that Wegovy helped 33% of patients lose more than 20% of their body weight over a 68-week clinical trial period.
Novo Nordisk hasn’t revealed Wegovy’s list price, but hinted that it will be similar to the price of its drug Saxenda, a weight loss treatment that retails at $1,300 per month without insurance.There’s the issue of how payers will view a drug like Wegovy and the obesity condition it treats. If seen as a lifestyle medication, Wegovy will invariably struggle to gain favor with payers. From smoking cessation to weight management to alopecia (hair loss), many insurers limit coverage of what they deem are lifestyle drugs.
Until now, the evidence suggest that many public payers (Medicare, Medicaid, Affordable Care Act (ACA) exchanges) view weight loss treatments as lifestyle medications, which they’re reluctant to pay for.
Indeed, insurance coverage for obesity treatments remains very uneven. By statute, all Medicare plans are precluded from covering weight loss medications. Further, a study examining coverage in the Medicaid and Affordable Care Act exchange markets of obesity drugs only 7 state Medicaid programs covered any of the (weight loss) drugs, and among 136 exchange plans merely 11% had some coverage for any of the drugs.
https://www.forbes.com/sites/joshuacohen/2021/06/05/obesity-drug-wegovy-holds-promise-but-faces-reimbursement-challenges/?sh=5d3dff4c4bd5
