Cardiovascular Deaths and Insurance Denials of Obesity Care

Yesterday brought us one of the most curious mashups of news  we’ve seen in a while. On one hand we have stories about employers and insurance companies conspiring to deny obesity care to their employees and customers; on the other we have the news that the drug they don’t want to cover actually prevents deaths from cardiovascular disease.

This mashup will bring an essential question to front and center. Which comes first in healthcare – saving lives or making money?

In one way or another, every one of us has a stake in answering this question.

The Ethics of Denying
Life-Saving Obesity Care

Yesterday, Healthline published the latest of a string of reports about health insurers and employers denying coverage of semaglutide and similar drugs for obesity. Cathy Cassata reported on two employers dropping coverage – the Ascension healthcare system and the University of Texas system.

Ascension’s decision seems to fly in the face of of their glittering tagline: listening to you, caring for you, we are Ascension. When business decisions get this far out of line with the mission of a business, you can be sure that trouble lies ahead.

ConscienHealth’s Ted Kyle explained to Healthline that health insurance plans are in an awkward position:

“These new drugs work so well that many more people want them and the costs at list prices are too high for health insurance plans to feel comfortable with the expanding use.”

But they will have to figure it out. The ethics of denying access to lifesaving drugs will not hold up well in the glare of public scrutiny.

The Ethics of Pricing Drugs Out of Reach

Likewise, the companies making these lifesaving drugs are in an awkward position. The growth in demand has been explosive, even with the currently very high prices. Novo Nordisk cannot keep up with demand for semaglutide and this news certainly won’t make it easier.

Eli Lilly and Company has a similar drug with certain advantages over semaglutide. It’s called tirzepatide or Mounjaro, indicated only for diabetes. An application for use in obesity is pending before FDA. Even so, the company rang up nearly a billion dollars in sales for this drug in quarterly results announced yesterday.

With list prices in the range of a thousand dollars a month, these are not among the most expensive drugs on the market. But when you multiply that by the huge unmet medical need for obesity treatment, current prices seem unsustainable.

These companies, which profess a commitment to “expanding access to our medicines,” must start living up to those words in obesity care.

Taking the Long View in Progress Against Obesity

Market forces and unmet medical need point to a future with lower prices, higher utilization, profits for innovators, and better access to care. To get to that better future will require work from everyone with a stake in this, says Caroline Apovian, a former president of the Obesity Society:

“All parties in healthcare – government, insurers, pharma, doctors, and patients – will have to come together and figure out how we can affordably deliver the obesity care that we now know will save lives and costs down the road for a completely preventable burden of chronic diseases that come from leaving obesity untreated.”

Let’s get to work and live up to the pretty words we speak.

Click here, here, here, and here for further perspective.

King of Hearts and King of Diamonds, painting by Olga Rozanova / WikiArt

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August 9, 2023