US employers retreat from GLP-1 coverage just as a stronger obesity treatment arrives
A drug that helped patients shed almost a third of their body weight, a result once reserved for bariatric surgery, is moving toward approval just as some employers grow wary of paying for the obesity treatments already on the market.
Bloomberg reported that data presented at the American Diabetes Association meeting in New Orleans over the weekend showed Eli Lilly's experimental injection retatrutide can help patients lose 30 percent of their body weight over about two years.
The drug cleared a late-stage trial and is not yet approved, bringing Lilly a step closer to filing for clearance, according to CNBC.
The highest dose helped patients lose 28.3 percent of their weight, or 70.3 pounds, on average over 80 weeks, against 2.2 percent for placebo, among those who stayed on the drug, and that about 45 percent of the 2,500 trial patients achieved 30 percent or more weight loss.
The Wall Street Journal reported that participants on 12 mg doses lost about 70 pounds over 80 weeks and that two-thirds dropped below the obesity threshold.
Lilly's chief scientific and product officer, Dan Skovronsky, called the 30 percent figure an "incredible number to see," telling CNBC the level had previously been tied only to surgery.
The result lands as the cost question sharpens.
US employers have resisted paying for GLP-1 drugs because so many people could qualify and many patients stop once they reach a weight-loss goal, even though at least one analysis found the drugs cost effective.
Cigna last week said it would stop covering the medicines for its own employees, according to the network.
At Lilly, fewer than 20 percent of beneficiaries use the drugs for weight loss and are staying on them, chief executive Dave Ricks told CNBC, adding that the company is running an internal study of its health costs and outcomes, including hospitalization rates and progression to diabetes, with results due later this year.
Ricks argued the spending should be reframed.
"We have to prove that in this pilot and prove cost effectiveness and then kind of reset what we expect from our health insurance, which is obesity care should be health care," he told CNBC.
A coverage precedent arrives first through Medicare.
From July, CNBC reported, millions of Medicare beneficiaries will be able to access GLP-1 drugs for weight loss at US$50 a month, after previously paying out of pocket, potentially hundreds of dollars a month.
Timing on retatrutide itself remains open, since it still needs sign-off from the Food and Drug Administration.
Ricks expects it to be used initially in patients with higher body mass indexes, according to CNBC, and pointed to a lower 4 mg dose that helped patients lose 19 percent of their weight with fewer side effects.
"Not everyone will go up to the highest dose level and stay on it for two years," Skovronsky told the network.
Lilly "absolutely" plans to sell the drug through its direct-to-consumer platform LillyDirect once it is approved, Ricks said.
On safety, CNBC reported that gastrointestinal effects were most common and that Lilly observed no cardiac or liver issues, easing analyst concerns, while a slightly higher rate of urinary tract infections than placebo was mostly mild and resolved during treatment.
Reuters reported that the same trial cut moderate-to-severe obstructive sleep apnea severity by 60.6 percent and reduced knee osteoarthritis pain by up to 73.1 percent, broadening the conditions the drug could address.
The "triple G" treatment targets GLP-1, GIP and glucagon, against one or two hormones for existing drugs.
Competition is intensifying around the spending.
Lilly held 60.1 percent of the US obesity and diabetes drug market in the first quarter, against 39.4 percent for Novo Nordisk, CNBC reported.
Novo's Wegovy obesity pill, Bloomberg reported, has passed 3m prescriptions.
CNBC reported that an FDA decision on the company's next obesity drug, CagriSema, is expected in the fourth quarter.
