Building and Busting Walls Around Obesity Medicines

Obesity care is in an awkward phase. Science has advanced to provide a better understanding of this complex disease and better tools to treat it. But health systems and public understanding can’t keep up. As a result, very effective new obesity medicines exist behind walls that keep most people from receiving their benefits.

For now, very few can penetrate those walls and get the care they need.

Fear and Resistance from Payers

Many but not all payers are fearful of the costs that will add up if more people get access to these obesity medicines. Fear makes people do stupid things. For example, Blue Cross Blue Shield of Texas recently offered the following lame excuse for denying patients coverage for obesity medicines:

“These drugs will no longer be covered due to safety concerns, as well as the lack of data supporting long-term use of these drugs. Some of the safety concerns are the risk of abuse/dependence, rapid heartbeat, high blood pressure, and seizures. Also, weight loss from taking the drug is often for a short time and may be regained once you stop taking it.

“You can still get these drugs after 8/1/2023, but you will have to pay for the full cost of the drug.”

This reads like an inventory of every way that people can misunderstand the risks and benefits of obesity medicines. The FDA approves these drugs because they are safe and effective. Yes, prescription medicines all can have side effects. That’s why they require a prescription – so doctors can monitor them. And yes, when a person stops taking a drug for a chronic condition – whether it’s hypertension or obesity – the problem comes back. Drugs don’t work when you don’t take them.

These problems are not unique to the U.S. Even in Denmark, the source of much of this obesity medicine innovation, payers are resisting coverage for these drugs.

Confusing Weight Loss with Obesity Care

One of the contributors to this problem is the confusion of weight loss with obesity care. Most people presume that the answer to obesity is to simply lose weight. Many more people are ready to give this a try than are ready to take the time and effort to persist with obesity care for long-term health. They’re shocked when they realize that they can’t benefit from these drugs if they don’t take them regularly.

The person who wrote the message above from Blue Cross Blue Shield of Texas was one such mistaken person.

Supply Issues and a High Price

Finally, the makers of obesity medicines bear some responsibility for putting them behind walls that deny access. First they set a price that is very profitable, but so high that many people cannot afford them and payers fear it will bankrupt them. But they misjudged how great the unmet medical need is, and even at that high price, they cannot keep up with demand.

So we expect that the chaos will persist for a while. It will take time for competition to bring prices down, for payers to live up to their responsibility, and for the public to understand that these are not drugs to take casually for weight loss.

But that is where the future will take us. To a time when the walls around obesity care come tumbling down.

Click here, here, and here for further perspective.

Study of Walls, painting by Nicholas Roerich / WikiArt

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July 28, 2023