Market Forces, Vanity, Obesity, and Diabetes

Daikoku, Ebisu, and Fukurokuju Counting MoneyWhen “health plans” tell someone seeking treatment for obesity it’s a vanity thing, we are not fooled. They simply don’t want to pay the bill. Health plan? Not really. It’s a lot like car insurance. It pays for a wreck. Not so much for preventing one. Writing in the New York Times today, Gina Kolata tells the story of Maya Cohen seeking out treatment for obesity, having it labeled as vanity, then making do with a diabetes medicine – and the stiff copay that market forces allow to pass.

This is obesity care for only the top 0.1 percent of people with sufficient privilege to access it. Everyone else, step away from the clinic. So we should not be surprised that obesity grows without relief, despite widespread pretense of concern. It’s public health theater, with nothing real behind the words.

Barely Any Access to Care

Cohen is exceptional. She lives in Maine, but she sought out care from one of the foremost obesity medicine physicians in the world, Caroline Apovian at Brigham and Women’s. Apovian leads the Center for Weight Management and Wellness there.

Cohen had despaired about the effect that her weight was having on her life and her health. So when Dr. Apovian prescribed semaglutide in the form of Wegovy, she felt hopeful. Those hopes faded quickly when she learned that it would cost $1,500 per month and her health insurance – supposedly a good plan – was calling it a “vanity” prescription. The only workaround was to get a script for semaglutide in packaging for diabetes. It’s branded as Ozempic. Cohen’s insurance would pay for that, but she has to chip in $70 monthly for a copay.

“It has absolutely changed my life,” says Cohen. She has lost 54 pounds and shrunk her waist from 46 to 33 inches. She has more energy and her joints no longer hurt.

Apovian sees this potential for obesity care often denied. It’s infuriating because untreated obesity typically leads to diabetes and other complications. Obesity medicine physician Fatima Cody Stanford tells us that this is intolerable:

“It is imperative that insurers cover anti-obesity medications just like they do medications for other chronic diseases. Why is there a double standard? Why is weight bias so pervasive that we won’t even treat it with evidence-based therapy? We must provide care for our patients with obesity, and it pains me that I am often unable to do so.”

“Separate Marketplaces”

This is a marketplace running amok. The maker of semaglutide, Novo Nordisk, has set up a thin veil between Ozempic for diabetes and Wegovy for obesity. The packaging is different. The dosing is different. It’s the same drug, but a 51 percent higher price for obesity than for diabetes. And by the way, the supply of Wegovy is limited by supply chain issues.

Douglas Langa, the head of U.S. operations for Novo Nordisk explains that the higher price for Wegovy “reflects efficacy and clinical value in this area of unmet need.” In other words, the obesity market deserves a higher price.

Market forces don’t require access to care because it’s way too easy to blame the people who live with it. Obesity care is already out of reach for most people, so what difference does an extra 51 percent really make? Such cockeyed pricing decisions simply reflect a broken marketplace.

This is obesity care for the privileged 0.1 percent of people who can access it. The system turns everyone else away. It’s got to change.

Click here for Kolata’s story in the New York Times and here for more on the dysfunctional state of drug pricing.

Daikoku, Ebisu, and Fukurokuju Counting Money, painting by Keisai Eisen / WikiArt

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June 1, 2022