The Fight for Equitable Access to Obesity Medicines

A pitched battle is underway. The fight is for equitable access to obesity medicines that can be life-changing for people living with obesity. Right now, we have a bit of a stalemate and money is the sticking point.

So when Andrew Ross Sorkin put the question of greed, economics, and health to the CEO of Eli Lilly and a leading obesity medicine physician, the responses were informative. Sorkin quoted Senator Bernie Sanders, who said:

“There’s no rational reason, other than greed, why Mounjaro should cost $1,069 in the U.S., but just $485 in the U.K. and just $94 in Japan. Even with the modest price reductions for Zepbound, millions of Americans will still be unable to afford the diabetes and weight loss drugs they desperately need.”

“An Archaic System”

Asked how these high prices can come down, Lilly CEO David Ricks pointed squarely at dysfunction of U.S. healthcare:

“First of all in the U.S., we have an archaic system where the net price is not the list price. All those other prices are what the government actually pays. In our system, $1,060 is only what individuals pay if they don’t have a copay card. But our average price is, let’s just say $500. It’s still above those levels.

“But in the way we think about access, Japan is a good example. Whoever walks into their doctor and says ‘I think I may need one of these medicines,’ if the doctor agrees and it’s on label, they get the medicine. They get it for a very low out-of-pocket. It’s usually just a few dollars. There’s no prior authorizations, there’s no qualifications, and they get it for the rest of their life. That’s what we call open access.

“If any employer, anyone in the U.S., wants to create that setting, we can match those prices.”

Hurting Patients

Obesity medicine physician Fatima Cody Stanford told Sorkin and Ricks that this issue is a daily struggle for her:

“I fight every day to make sure my patients can get access to these obesity medicines. I know it’s a fight that works against my patients typically. A lot needs to be done within the American healthcare system to ensure the best drug is being utilized for the appropriate patient.”

She tells us that equitable access is a key issue because, for instance, coverage under Medicaid varies greatly from state to state.

Senseless Inertia

So we are left with senseless inertia on access to care with one of the biggest medical breakthroughs we have ever seen. Pharma says they will lower prices if payers will open up coverage policies. Payers say they will open up coverage if Pharma lowers price.

This is a game of chicken where patients are the losers.

Click here to watch the whole fascinating conversation on YouTube.

Andrew Ross Sorkin, David Ricks, and Fatima Cody Stanford at the New York Times Dealbook Summit

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December 10, 2024