Dealing with the Money Flowing for Obesity Medicines

ICER, the Institute for Clinical and Economic Review, yesterday brought a sharp focus to the challenge of dealing with the money flowing for obesity medicines. Sarah Emond, ICER’s CEO, explained the challenge and the opportunity of this unique moment:

“This new class of obesity medicines offers weight reduction and associated benefits that, if they’re sustained over time, have the potential to markedly improve population health.

“Our own analysis looked at the value of these drugs from a long-term perspective and found them to be cost effective at their current net price. But the rapid uptake and the sheer number of eligible patients is creating an affordability crisis.”

In short, these medicines offer good value. But the size of the challenge with obesity makes them unaffordable right now.

So how do we manage the money flows? That is the billion-dollar question.

Market vs Policy Solutions

Of course, the debate comes down to a basic question. Can the marketplace can meet this challenge? What policy changes will be necessary to fill the gap?

For the moment, the market forces lead to an unsatisfactory answer – just deny access for these vital medicines. Unless someone is wealthy or has exceptional health insurance, they are simply out of reach for most of the people who need them. ICER points to other market strategies that might help, but they all boil down to limiting access in hopes that costs will continue to come down and make these medicines affordable.

Federal policy action might help. This includes expanded Medicare coverage, USPSTF mandates for access as a preventive health strategy, aggressive price negotiation, insurance subsidies, and licensing deals with drugmakers. The ICER report explores the merits and limitations of each of these.

Why Are We Having This Conversation?

In yesterday’s webinar, three stakeholders brought distinct perspectives. Maisha Draves from the Permanente Medical group lamented the profiteering of pharmaceutical manufacturers. Kimberly Lenz of MassHealth explained the stresses that these medicines are putting on Medicaid in Massachusetts. And finally, the OAC’s Joe Nadglowski asked, “If this were any other chronic disease, would we be having this conversation about denying care? Most of the use of these medicines is for diabetes, but the cost concerns are always ascribed to obesity. Are we not seeing weight bias in this?”

These are tough questions and the concern about money flows for obesity medicines are very real. Everyone from pharma, insurers, government, and PBMs has a role to play in navigating to a future where people are getting adequate care for obesity.

We have quite a distance to go.

Click here for the ICER webinar and here for their white paper.

Man in Money Suit, costume design by Will R. Barnes / NY Public Library

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April 23, 2025