Greed versus Health and Obesity Care

Doomstone“Money makes the world go around.” Joel Grey and Liza Minnelli explained this in Cabaret. But sorting it out in healthcare – and specifically in obesity care right now – is quite a challenge. A lot of money is in play and so the tension between greed, health, and obesity care is painfully obvious.

The unmet need for obesity care is great. Options for that care are better than they’ve ever been. But in the process of sorting out those options and delivering the needed care, people at every step in the process are eager to get money for the value they deliver.

Paying for Innovation

The value chain starts with pharmaceutical innovators who have taken considerable risks to bring breakthrough medicines to market for obesity. The risks are great and the failures were many before semaglutide and tirzepatide made it into the marketplace. Prior failures have been devastating to the companies that saw their efforts in obesity go down in flames.

But now, sales of semaglutide are soaring into the billions of dollars for obesity and the closely related diagnosis of type 2 diabetes. Tirzepatide is not even yet indicated for obesity – FDA approval is likely to come later this year. But even so, sales of this drug have already soared to a rate that will amount to billions of dollars annually. This is only a start. Unmet medical need for safe and effective obesity treatment is so great that neither Novo Nordisk nor Eli Lilly and Company have been able to meet demand yet.

Novo Nordisk has scaled back marketing and limited the supply of starter doses to ensure that they can keep patients supplied once they start treatment. Thus sales for these drugs for obesity alone will likely surpass ten billion dollars just two years from now. With more and better options, analysts expect that the market for obesity meds will grow to $100 billion or more.

Delivering Outcomes

It took a lot of work and a good many failures to get to the point of having these safe and effective obesity meds available. But figuring out how to deliver the care necessary for good clinical outcomes is yet another big challenge. Most health professionals don’t have adequate training to understand this disease. They were taught false notions that denied the role of physiology and placed blame on patients and left them with mostly ineffective DIY options. A few people find success despite the odds, but most are left struggling with feelings of failure and self stigma.

Growing numbers of professionals are becoming competent in obesity medicine and telehealth providers are stepping up with systems for delivering better care at scale. Some will offer good care and good health outcomes. Some will only promise weight loss and eventually flop. Providing care for this condition is a marathon, not a sprint.

Controlling Costs

On top of all these challenges is the challenge to control costs. Right now, the cost of these medicines – especially in the U.S. – is the highest it will ever be. Already, health plans are negotiating prices that are half of the thousand-dollar monthly list prices you’ll read about in news accounts. This is only a start of the price negotiation process.

This is where the natural human tendency for greed plays a big role. PBMs have a role in negotiating these costs, yet they don’t do it with any transparency and have business incentives to hang onto some of the profits. Employers and consumers pay for the insurance premiums that finance all of these drug costs. But the numbers are a moving target. If people get better care for obesity, costs for the diseases that result from obesity will come down – but how soon and by how much remains uncertain.

One thing is certain. The need is great for better obesity care and the health outcomes it will bring – but greed is a big factor in how soon more people will get the care they need.

Click here and here for further perspective on how people are struggling to sort out the costs for delivering obesity care.

Doomstone, photograph by Amy Felce, licensed under CC BY-ND 2.0

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May 28, 2023