Ways of Paying for Innovation in Obesity Care

The FlashesHow can we possibly afford paying for all of the innovation that’s coming in obesity care? This is hardly an academic question. It’s a practical one that flickers in the minds of policymakers who balk at finding ways to make effective treatment for obesity more accessible to the people with great medical needs for it. They imagine that everyone, everywhere, all at once might start taking expensive obesity medicines and bankrupt the system.

Others tell us that affordable prices for advanced obesity medicines are entirely possible right now – making much better access to care a reasonable hope.

Now a commentary in Obesity offers a cautious, moderate perspective. Yes, prices can come down, write Eric Finkelstein and Junxing Chay. But paying for innovation in obesity care will still be necessary if we want to benefit from that innovation.

Getting Value for Money

Finkelstein and Chay have a simple point to make. We can’t get something for nothing. Innovative drug development is what has brought us the breakthroughs in obesity treatment that are currently causing quite a sensation in popular media. And frankly, there’s more to come because competitors to Novo Nordisk and Lilly see an opportunity to make money by innovating to meet the need for more and better options.

But the real question, according to Finkelstein and Chay, is whether we will get good value for money. They tell us that we have options for doing this:

“Medicare will negotiate drug prices for the first time in program history after Congress passed the Inflation Reduction Act of 2022. However, this will not begin until 2026 and it applies only to medicines that are part of the covered benefit, which weight loss medicines currently are not. But this too could change as the Act now allows for considering cost-effectiveness in decision-making, thus opening the door to greater coverage for anti-obesity medicines that show good value for money.”

We’ve Been Here Before

There’s nothing new about this situation. Expensive and valuable new medicines have caused sticker shock before. Cures for hepatitis C came into the market with stunningly high prices and now, those prices are coming down and access is getting much better. Many generations of new and expensive blood pressure medicines came into the market at high prices that limited their use in early days. Now they’re all “cheap as chips” and the health burden of uncontrolled hypertension is a fraction of what it once was.

We can do this.

Who Will Pay and Benefit?

The real question, you see, is who will pay and who will benefit. Right now, we are on a course where the good medical care for obesity goes only to people with sufficient wealth to pay for it. They either pay out of pocket or buy gold-plated health insurance that doesn’t block access to care for the complex chronic disease of obesity.

Some places are taking a different track. In Pennsylvania, for example, the Medicaid program now offers access to obesity medicines. Professionals who care for underserved communities in the state tell us this has made a huge difference in their ability to help people with obesity improve their health.

This is progress. We need more of it.

Click here for the commentary by Finkelstein and Chay, here for the analysis that prompted it.

The Flashes (I Lampi), futurist painting by Luigi Russolo / WikiArt

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May 4, 2023

One Response to “Ways of Paying for Innovation in Obesity Care”

  1. May 04, 2023 at 5:05 pm, Michael Jones said:

    I sorely wish these drugs were cheaper and I certainly think they could be, however, the study published by Levi et.al. appears to have left out the company’s R&D, employee salaries, and infrastructure in their estimated minimum price of $40 per month.