A promising new weight-loss drug might flip the tide on weight problems in Louisiana. However what’s going to it value? | Healthcare/Hospitals
As thousands of healthcare providers and scientists gathered for a diabetes conference in New Orleans earlier this month, one session in particular stood out. Researchers described a new drug that could help someone lose more than 20% of their body weight, equivalent to an average loss of 52 pounds over a year and a half.
“This is a new era for obesity treatment,” said Dr. Ania Jastreboff, one of the authors of the study published in the New England Journal of Medicine. The results were met with applause and passionate questions from attendees at the Ernest N. Morial Convention Center.
The evidence for the drug, tirzepatide, and another, semaglutide, is encouraging. And research shows that treating obesity reduces the risk of other costly health problems like diabetes, high blood pressure and stroke. But in a state where 38% of people are obese, ranking fourth in the nation, a big question arises: Who is going to pay for it?
“These drugs — semaglutide and tirzepatide — have produced the kind of weight loss that we have previously only achieved with bariatric surgery. The weight loss is incredible,” said Candida Rebello, a researcher at Pennington Biomedical Research Center in Baton Rouge who was not involved in this study. “The problem is … most people can’t afford these drugs.”
As doctors begin to treat obesity as a disease, coverage for expensive weight-loss drugs has yet to catch up. Tirzepatide, made by Eli Lilly, is expected to cost between $1,000 and $1,500 a month, and insurance companies won’t cover most of that, if any, Rebello said.
“The insurance companies haven’t quite caught up yet”
Weight-loss drugs are typically classified as higher-tier drugs in insurance plans, Rebello said, putting them alongside lifestyle drugs like Viagra. Some private insurance companies may cover up to 50% of the cost, but $750 is still prohibitive for people who need it most. People from a lower socioeconomic background are more likely to be overweight, Rebello pointed out.
Louisiana’s Medicaid plan does not allow reimbursement for weight-loss drugs, but it does cover Tirzepatide for diabetes, which it is currently approved to treat.
Blue Cross Blue Shield, which offers health insurance for the majority of group plans in Louisiana, said coverage for Tirzepatide would depend on a member’s plan. However, a representative also said many of the company’s health plans don’t include coverage for weight-loss drugs or bariatric surgery. A wellness program that offers coaching and education about weight is available free of charge, the company said.
But such programs are typically unsuccessful. Diet and exercise studies show about a 5% reduction in weight loss, which rarely results in the scale returning to a target body weight in patients with obesity. Many people try and fail to lose weight, and evidence shows that it’s not just a lack of willpower that’s holding them back from success. The pathways in the body that regulate weight loss are so altered in some people that it is very difficult to lose and maintain weight.
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“Insurance companies have not quite reached the state of the art,” said Dr. Taniya de Silva, director and program director of the Endocrinology, Diabetes and Metabolism Fellowship Program at the LSU Health Sciences Center.
before it happens
Drugs have historically targeted the downstream effects of obesity: diabetes and the kidney, nerve, and eye damage that accompanies it. But what if drugs instead prevented or even reversed a diabetes diagnosis?
“Obesity is a major driver of the pathology that we see in type 2 diabetes itself, and if we can use our new compounds to achieve significant weight loss, we could potentially even have diabetes in remission,” de Silva said .
It would also extend a patient’s lifespan and reduce the risk of heart disease, which is the No. 1 killer in the country. Louisiana has the fifth highest death rate from cardiovascular disease in the United States, hitting many Louisiana residents in the prime of their lives.
Patients taking semaglutide, which was approved in 2021 under the brand name Wegovy to treat diabetes, reduced their cardiometabolic disease staging score, a measure of risk of diabetes and cardiovascular disease, according to another study published at the conference. by half. Study participants also lost almost 17% of their body weight.
The drugs make people feel full faster by mimicking hormones in the gut called GLP-1 and GIP. They are also believed to work in the brain by targeting receptors related to appetite and in the pancreas by increasing insulin secretion in relation to the amount of glucose in the body.
Currently, tirzepatide is only approved for type 2 diabetes and is sold under the brand name Mounjaro. Researchers hope it will be approved for weight loss after clinical trials have shown significant results at higher doses. There were some side effects, such as nausea and diarrhea, and the drug needs to be injected once a week even after weight loss has plateaued, researchers said at the conference. Patients can still “overeat” the drug if they don’t make lifestyle changes, de Silva said. So it may not work for everyone.
But it’s a significant tool in a state that badly needs it — if only people can get it.
“Effectively using these drugs to improve outcomes for our patients would end up being a huge savings,” de Silva said. “But someone has to pay for it in advance.”
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