Citing high costs, payers are favoring bariatric surgeries over Wegovy and similar medications, according to an NYU Langone expert. It's unclear if insurers' policies can quell the booming popularity of GLP-1 weight loss drugs, though.
Weight loss surgeries have an upfront cost between $15,000 and $23,000, and GLP-1s can cost about $1,000 each month. There's more data on how much weight is lost after bariatric procedures — it ranges between 20% and 30%, according to Anita Courcoulas, MD, chief of minimally invasive bariatric and general surgery at Pittsburgh-based UPMC — but patients are hungry for GLP-1s.
A four-year study by Novo Nordisk found sustained 10% weight loss among Wegovy users, but there's no consensus. Some studies point toward sustained GLP-1 results, others don't.
The CEO of Norman (Okla.) Regional Health System told Becker's the rising demand for GLP-1s influenced the decision to close a weight loss clinic and end its bariatric services. In one year, the system noted a 30% decrease in bariatric surgeries. National estimates indicate a drop in weight loss procedures.
Many insurance companies are steering patients toward bariatric surgeries, according to Christine Ren-Fielding, MD, director of the NYU Langone Weight Management Program and chief of the system's division of bariatric surgery.
"Bariatric surgery is the old-fashioned way," Dr. Ren-Fielding told Becker's. "Insurers are now putting up barriers for people who want to be covered for GLP-1s and taking down barriers for people who want to have surgery."
There's also the issue with medication adherence; a recent study from Prime Therapeutics found only 14.8% of patients continued their GLP-1 obesity regimen over two years.
Medicare, commercial insurance companies and employers are confronted with a difficult question: Which option is more effective long-term, and can they afford to cover these newer medications?
Seven other updates on GLP-1 medications:
The future of GLP-1s
1. As drugmakers test experimental GLP-1s, the FDA approved the first generic option. Novo Nordisk brands the generic liraglutide as Saxenda, a weight loss drug, and Victoza, a Type 2 diabetes treatment. In late June, Teva Pharmaceuticals announced the approval. Dr. Ren-Fielding said the generic can increase access but likely won't make a dent in current demand for brand-name medications.
2. Researchers at Cleveland-based Case Western Reserve University discovered that patients taking the medicines for Type 2 diabetes were less likely to develop 10 of 13 obesity-associated cancers than those taking insulin.
Other than cancer, researchers are also investigating whether the drugs can treat kidney-disease related events, sleep apnea, metabolic dysfunction-associated steatohepatitis and a plethora of other conditions.
Safety and efficacy
3. A study linked the use of semaglutide, the active ingredient in Ozempic, Rybelsus and Wegovy, to a potential risk of developing an eye condition that can cause blindness in one eye. Two ophthalmology organizations said vision changes can be temporary side effects to drugs that change sugar levels, adding that this study did not confirm a causal relationship and that more research is needed.
4. Between 2020 and 2023, the number of adolescents and young adults with GLP-1 prescriptions increased from 8,722 to 60,567 — equal to a 594.4% increase in dispenses, according to a study published May 22 in JAMA.
Vibha Singhal, MD, director of pediatric obesity at UCLA Mattel Children's Hospital, said emerging data suggests these drugs are safe to use among adolescent populations.
5. In a study of about 18,000 adults who are overweight or obese, those taking Mounjaro lost 5.9% of their weight after three months, and patients taking Ozempic lost 3.6%, on average. Mounjaro also surpassed Ozempic at the six-month and one-year mark.
'Hunger rebound'
6. Carey Brown, MD, the medical director of Kettering Health Miamisburg's bariatric program, said long-term use is preferable "because a strong hunger rebound will likely occur once you are off the medication," according to a statement in a July 2 post.
Lawmakers push for lower prices
7. In an op-ed, President Joe Biden and Sen. Bernie Sanders accused Novo Nordisk of "price gouging," calling the prices of Ozempic and Wegovy as "unconscionably high." The company said the cost debate is being misconstrued for political purposes and that rebates and pharmacy benefit managers are to blame for high drug costs.
Readers interested in the effects of GLP-1s on health systems and questions about their role in care delivery over the next 18 months are invited to join Becker's for a complimentary editorial webinar on this topic. Sign up here.