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How Other Nations’ Policies Can Guide Fair Access to Life-Saving Obesity and Diabetes Drugs Amid High Prices
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In recent years, GLP-1 receptor agonists like semaglutide (sold under brand names Ozempic and Wegovy) have become revolutionary treatments for obesity and type 2 diabetes, offering substantial weight loss, and myriad other benefits including improved renal and cardiovascular health.
The clinical success has made GLP-1 receptors meteorically popular, but the drugs are costly, sparking widespread debate about their affordability and accessibility. The drugs come at a high cost for Americans, who pay around $1,000 per month if their health insurance does not cover it. And in fact, insurers rarely cover the weight management formulations, so many who might benefit from the drug but cannot afford to pay go without.
GLP-1 receptors are less expensive in many other countries (for example, a recent U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) hearing noted that Ozempic costs over 15 times more in the United States than in Germany), but still not necessarily affordable. In the study appendix, investigators found that the price of Wegovy varies by up to five times across different countries, with the U.S. paying the most at $1,349 and Japan paying the least at around $280. This is the most detailed public data on international prices so far. As a result, many countries with public health systems face distressing decisions about whether to reimburse these drugs and, if so, for which groups.
Such decision making underscores broad ethical concerns about health equity, the allocation of scarce resources, and the prioritization of patient populations most in need.
Drawing lessons from other countries’ approaches to covering GLP-1 drugs, LDI Senior Fellow Ezekiel Emanuel and colleagues give four key guidelines that should inform future policies to ensure fair and effective access to these critical medications across the U.S. and internationally.
Use up-to-date cost-effectiveness analysis: Coverage decisions must incorporate the latest data on the clinical benefits of GLP-1s. Though only a few years old, many previous analyses were outdated and did not reflect more recent findings, such as the cardiovascular benefits of these drugs. New data is regularly published, finding new or magnified benefits of GLP-1s. Therefore, particularly for these drugs, frequent updates are essential to accurately assess the drugs’ long-term benefits.
Lower prices but keep them high enough to provide long-term innovation incentives: While reducing prices is critical, they should remain sufficient to incentivize research and development at pharmaceutical companies. Because GLP-1s are cheap to make, they may also be candidates for alternative payment models, such as subscription-based agreements that give firms large payments in exchange for a nearly unlimited supply of drugs for the whole population. This could help ensure broader access while maintaining company profitability.
Set priorities for coverage rather than issuing blanket denials: Instead of wholesale refusals of coverage, policymakers should prioritize individuals who could benefit most from these drugs. To ensure that those most in need receive treatment even if cost constraints limit broader access, coverage should be allocated based on criteria such as severity of obesity, comorbidities, and age. The current U.S. system relies largely on the patient’s ability-to-pay which is not ethical, the authors write. This is evidenced by the fact that GLP-1 use in the United States is concentrated not in areas with the most obesity, but in areas with the highest average income.
Treat high-cost drugs similarly regardless of the condition they treat: It is not right to cover GLP-1 drugs for diabetes but not for obesity. Deep-seated bias may lead governments to avoid treating people with obesity, because the condition can be seen as a failure of will. Avoidance also may derive from the number of people with obesity being so large—far larger than the number with diabetes—and therefore more costly to treat, the authors note. Still, countries should adopt fair policies for coverage and pricing, regardless of the drugs’ novelty or condition they treat. Barring new drugs simply because they treat a so-called lifestyle disease fails to maintain “a standard of equal moral concern.”
These lessons emphasize the imperative for balanced, evidence-based approaches to U.S. and international insurance coverage policies that consider both the clinical benefits of GLP-1 drugs and the economic realities of varying health care systems.
The study, “International coverage of GLP-1 Receptor Agonists: A Review and Ethical Analysis of Discordant Approaches,” was published on August 16, 2024 in the Lancet. Authors include Johan L. Dellgren, Govind Persad, and Ezekiel J. Emanuel.
Author
Miles Meline, MBE
Senior Policy Coordinator
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