Chicken Egg Lit from Behind

Obesity Drug Prices, Access, Chickens & Eggs

An interesting conversation popped up in a recent session to prepare for the upcoming White House Conference on Hunger Nutrition and Health. It was about obesity drug prices, utilization, and ultimately, access to care. Darius Mozaffarian was a key speaker at this session organized by the Bipartisan Policy Center. He offered his opinion that you just can’t fix the problem of obesity with drugs:

“There are some really effective drugs now to treat obesity. Those are effective drugs that should be prescribed and patients should get them. But the cost of those drugs is about $16,000 per person per year for life. That’s much, much more than the average family spends on food for just one drug. If the 40 percent of Americans who have obesity get treated with that drug, it would add 1.7 trillion dollars to our 4.1 trillion dollar national healthcare bill.

“So it’s just not feasible to get out of this with drugs. We have to think about healthy food.”

With that short, sincere statement, he summed up a chicken and egg problem with obesity drug prices and access to care – even though his real point was to elevate the importance of good nutrition.

A $1.7 Trillion Fiction

First of all, it’s important to recognize that the scary figure of $1.7 trillion for obesity drugs is a fiction. There is no such thing as a trillion dollar drug. For comparison, one of the most common conditions routinely treated with medicines is high blood pressure. Just a little less than half of all adults have it. But all told, the spending for blood pressure meds adds up to about $30 billion. Not even close to a trillion dollars.

There are several reasons for this. First of all, less than a third of people who need blood pressure meds actually get them. To construct his scary trillion dollar number for obesity, Mozaffarian assumed that everyone would be taking obesity meds if they have obesity – for life. That’s never going to happen.

Then he also assumed that the prices for these drugs would remain high as use of them became more common. Again, this is not the case for blood pressure meds and won’t be the case for obesity meds. As time passes and usage grows, prices come down. Innovators compete and generics come out to put pressure on the pricing for new options as they come along. Pricing for drugs in the U.S. is indeed screwed up, but Mozaffarian’s numbers don’t reflect reality.

The Awful Mess of Drug Pricing

None of this should obscure the fact that drug pricing in the U.S. is indeed a mess. Obesity drugs are no exception. The most innovative drugs for obesity are also the most expensive. But health systems make it so difficult for people to get access to obesity medicines that these wind up being drugs for a very small percent of the people who might benefit from them. A person has to have sufficient wealth to pay for them out of pocket or sufficient status to fight the system to obtain the medical care they need.

So what does a drug company do? They price these meds high to recoup the considerable investment that developing them required. And the highest drug prices in the world are in the U.S. The $16,000 annual cost Mozaffarian quoted for an obesity drug in the U.S. is more like $1,200 in the U.K.

Chicken and Egg

So we have a chicken and egg dilemma. Systemic barriers that limit access to obesity meds mean that only a privileged few get them. That, in turn, sets up an environment for high specialty drug pricing for them. But that high pricing perpetuates the limits to access. It’s a vicious circle that drives up costs and drives down the quality of care for most people. We can blame the system. We can blame the drug companies.

But this needs to change.

Click here for the BPC session from which this conversation came. For more about problems of pricing and access for obesity drugs, click here, here, and here.

Chicken Egg Lit from Behind, photograph by Sauvagette, licensed under CC BY-SA 4.0

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August 12, 2022