Pricing, Insurance, and Bias Driving Disparities in Obesity

In the midst of an argument for lifestyle as the “cornerstone” for dealing with obesity, Frank Hu recently made a point with which we agree. He expressed the importance of GLP-1 agonists for obesity and warned that issues with access could bring wider health disparities. Because pricing of these drugs, health insurance, and weight-related biases are driving huge disparities in access to obesity care.

Health and Economic Burden

Writing for the Wall Street Journal, Stephanie Armour brings the human dimension of this into sharp focus:

“Across the country, some consumers are paying $10,000 a year or more to get popular drugs from Eli Lilly & Co. and Novo Nordisk. Patients report taking on second jobs, racking up credit cards and cutting back on travel or family expenses to afford Lilly’s Mounjaro, a diabetes drug being used off-label for weight loss. They are also self paying for off-label use of Novo’s diabetes drug, Ozempic, and sister drug Wegovy, which is approved for weight loss.”

These are folks in the middle of the income scale. They’re taking on economic stress to buy themselves access to much needed medical care for obesity. But at the lower end of the scale, many people bearing the burden of obesity don’t even have that option.

Implicit Bias at Work

In recent years, we can’t help noticing the remarkable capacity of people to rationalize just about anything. Abuse, exploitation, and hateful behavior pop up in surprising settings and get a pass from people who find ways to rationalize it. Deeply embedded bias helps.

So the rationalization we hear about disparate access to obesity care is no surprise. After all, we have bias toward people in poverty mixing with bias against people with obesity. It is a potent mixture. Thus, a company that professes to care about access to their medicines makes no mention of obesity among the diseases for which they are working to improve access. Not a word.

Health insurers and employers talk a lot about obesity as a health concern. But when it comes to the question of what they will do, they are more likely to deny access to care than to find solutions.

So people living with obesity are stuck in the middle. Those who are wealthy, resourceful, or exceptionally well-insured can receive care. Everyone else is locked out, while a windfall of profits flows from new obesity medicines.

“Lilly and Novo didn’t comment on why they charge people list prices for their products when coverage is denied,” wrote Armour in the WSJ. This is both unsurprising and unacceptable – because it is indefensible.

Click here for Armour’s reporting, here, here, and here for more on access to care.

Fragment of Landscape, painting by Giovanni Segantini / WikiArt

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September 3, 2023