Skimming Profits, Sowing Disparities, and Dimming Prospects

The revolution in obesity care brought on by semaglutide and tirzepatide is beginning to look a little shaky, says Tina Reed on Axios. The U.S. healthcare system is skimming profits from them, thus sowing disparities, and quite possibly dimming the prospects for broad gains in health.

Peter Antall is Chief Medical Officer at the digital health company Lark. He tells Reed:

“I don’t believe that we’re having second thoughts about the power of the medications. But I think the shine is coming off how they’re being used in real practice. That’s where many of us are concerned.”

More to the point, Reed writes that “high sticker prices and uneven insurance coverage skews which patients can get them – and which patients can consistently stay on them.”

Stark Disparities

A new study, published as a preprint, documents stark disparities in who has access to these medicines. Privately insured, middle-aged, White females who frequently see a doctor (especially endocrinologists) are in luck. Black, Hispanic, Medicaid, and uninsured patients are not. Their data come from the electronic health records in OneFlorida+ for 319,949 adults.

GLP-1 agonists, with all their potential to deliver better health, do nothing for the many people who cannot access them.

Some Are Doing Quite Well

For more privileged individuals, though, the benefit is great. Gina Kolata paints a very clear picture of this in the New York Times. She describes physicians who have struggled with obesity for a lifetime and have tapped into these medicines for remarkable gains in health. These are people who know how to work a health system corrupted by business skimming profits from medical advances. Kolata writes:

“The doctors know they are privileged.

“The doctors also know how to advocate for themselves and navigate the medical system better than many of their patients do.”

She describes how one physician is able to buy his medicine in Europe where he travels for medical meetings. There, it costs a quarter of what it had been costing him here in the U.S.

Yes, the disparities are glaring.

How Long?

Skimming profits from these drugs occurs everywhere we look within U.S. healthcare systems. Pharma sets high list prices that put these drugs out of reach for many people. Pharmacy benefit managers negotiate big discounts from pharma but do their best to pocket that money for excess profits. We hear reports of some drug plans charging co-pays that exceed the average net prices. This is abusive.

It is not easy to work within a health system as convoluted as American healthcare is. But that system promotes disparities that are dimming the prospects for realizing the full potential of these medicines.

How long will this continue? These medicines will have little benefit if practically no one can get them and afford to keep taking them.

Click here for the new preprint on disparities in obesity care, here for Reed’s story on Axios, and here for free access to Kolata’s article in the Times.

Notturno, painting by Luigi Russolo / WikiArt

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February 12, 2025