A checkup on weight-loss drugs
20:17 Share

More than a billion people worldwide are obese, and there were 5 million obesity-related deaths in 2019, according to the World Health Organization. The condition is becoming more common almost everywhere in the world, which is why there's so much hype around drugs like Wagovi and Ozempic.

What started as stories about Hollywood waistlines has become a global phenomenon. On this weekend episode of Reuters World News, the impact of these game-changing drugs a few years on. Our health reporters weigh in on how people are using them today and how can they afford to stay on them? Are they as transformational as they were promised? And how might the next US administration handle that? I'm your host, Jonah Green.

When you hear LSEC data and analytics, what do you think of? Comprehensive data you can trust. Exclusive access to Reuters news. Industry-leading analytics and unique insights. Discover new possibilities with LSEC data and analytics. Joining us now are Michelle Gershberg, our global health editor, and Patrick Wingrove, our U.S. pharmaceuticals correspondent. Hey, guys. Thanks for talking today. Hey, Jonathan.

Good to talk to you. And so when these drugs first hit the market, they were for diabetes. Then they got co-opted as this miracle weight loss cure about two years ago, and suddenly all of Hollywood was on it. Now, a few years on, how are these drugs being used now? I love that you use the word miracle because I think it's true. I think they came into the world

And people saw them as a potential silver bullet for an obesity epidemic that has only been worsening and causing all kinds of complications and even death in many people around the globe. And so these drugs work very well. They're powerful for the first time. There is a pharmaceutical that can really help people lose weight in a significant way. I think we're at a point

where there is a greater understanding of how these drugs need to fit into a treatment plan, a way of addressing obesity, that they're not a silver bullet because we are seeing increasing evidence that they can drive up costs with their current prices. We're seeing that people discontinue using them for many different reasons.

And we're also awaiting newer versions of these drugs that may work better for some people, may be more convenient, and ultimately may cost less.

There are two main drugs out on the market now, semaglutide and trizepatide. And those are marketed in different ways. So semaglutide is owned by Novo Nordisk. It's marketed as Ozempic, and that's been out in the markets in 2017, and that's for diabetes. And then as it would go for weight loss, Eli Lilly has trizepatide that's marketed as Manjaro for diabetes and as Zetbound for weight loss. But they are very similar drugs. Who

between the two and the same drug between those different indications. As Michelle mentioned, these are very expensive and I want to kind of get into how people pay for that. But, you know, just generally, how mainstream is this? Is this for a select few or do we see these class of drugs being used all across the country, all across the world in different income brackets? I mean, I think eventually, yes. Right now, they're incredibly expensive. So the

The list price for these drugs is more than $1,000 a month. I don't think a lot of people actually pay that. If they have insurance, they'll have some kind of copay with the drug, and it could be considerably cheaper. For a lot of people, it's still prohibitively expensive. I think that will change over time. As Michelle mentioned before, there are new weight loss drugs coming out within the next few years. Once the

market has enough of them that may drive the price down significantly enough that these drugs could become as used as statins, for example. So it will take time, but eventually, yes, it will be ubiquitous. So for a normal person in the US who wants to start these drugs, do they expect it will be covered? Or is it more common that they're paying $1,200 a month?

I mean, there are different programs in place that would or might prevent them from paying $1,200 a month. I think that's probably an unreasonable price for anyone to pay, right? But, you know, Eli Lilly has, for example, its own program that can bring the cost down to, I think, around...

$650 for people that aren't insured for these drugs a month, which is still a lot, but it's not the same as when you're paying in the thousands. So there's something like 50% of coverage in the United States. Medicaid is covering quite a lot of these drugs as well. Medicare is covering them to an extent in the sense that it will cover them for the diabetes indication and may cover them off-label for weight loss or may cover them for a different indication like heart disease.

Medicaid coverage across the United States is still limited, a little bit more than a dozen states allow for access to these drugs. But it also changes that picture. We know equity is a big question around this, and many doctors have been concerned about that, about entire populations not being able to have access to the drugs where Medicaid covers it.

that changes the picture. And it's very interesting to see how that's going to develop in the next U.S. administration. I mean, that was going to be my follow-up. Do we have any sense...

of what might happen in the future, either because it was already in the works from the Biden administration, or let's say Robert F. Kennedy Jr. is confirmed to be Secretary of Health and Human Services. I think he's been on record saying he's not a fan of these drugs. So do we have any idea what might happen under Trump? Biden has introduced a new rule requiring Medicare and Medicaid to cover these weight loss drugs.

I understand it's fairly standard for an incoming president to essentially put on pause all of the orders that were put in place by the previous president. So, yeah, there's this big question about whether he's actually going to

scrap this rule, which is supposedly incredibly popular across the entire United States amongst Democrats and Republicans. Yeah, and we're trying to read the tea leaves on this, right? As are many other people following this. Robert F. Kennedy Jr. has made statements casting doubt on the value of weight loss drugs.

He does have this view of, you know, the importance of making America healthy again, right? That's kind of a slogan that he's been using. And as part of that, his thinking has been that we have to improve the way Americans eat, getting away from processed foods, eating healthier foods, and that that will solve obesity. It seems like more recently, he's made statements that have softened that line a bit, understanding that

The drugs may have a place as part of a continuum of dealing with obesity. And on the flip side, we also have someone like Elon Musk, who is a very influent, playing an influential role in the incoming Trump administration, who recently said we should make these available at low cost to everybody. And so we come it brings us right back to that cost question.

of what kind of pressure is going to be brought to bear on Novo Nordisk and Eli Lilly and anyone else coming into this market to begin to offer their drugs at a lower price so that more people can get them. Has there been any noticeable impact on health care costs? The health care cost issue is tricky.

Because the early promise of the drugs was that by treating obesity, you will help reduce the incidence of diabetes or heart disease or reduce the risk and reduce hospitalizations and other major, you know, big ticket health care costs. And so far, what we've been seeing from the data is that there isn't a cost savings that's happening.

Because the drugs are expensive, the use of them overall are driving up costs. We're looking at analyses of medical claims data that show that the average cost per person of healthcare in the universe of people who are using these drugs goes up within the first couple of years. It's possible that over time, the cost savings start to come into the system, but at

But at the moment, the evidence that we're seeing is that it drives the cost up. And also partly because something like 75% of people stop using the drug after a period of time. So what you do is you see people try it and there's a lot of cost put into that, a lot of money spent to try the drug, and then they stop using it. So the cost issue is not yet fully settled. Are these drugs meant to...

be used long-term, forever? Or is there a rethinking about how people should interact with them? I think as Michelle said earlier, I think a lot of people are taking these drugs for a period of time and then eventually coming off them. There were, well, there was some talk about how if people did stop taking the drugs, they would just put the weight back on. So they would need to take them indefinitely, in effect, unless they made some quite

serious changes to their lifestyles. Then perhaps they could come off the drug and they wouldn't immediately gain the weight back. But if they're not going to do that, then yeah, theoretically, they have to be on the drug for a long time.

Are there still supply shortages? Because I know that was also a big story when this drug became co-opted for some off-label uses in the early days. But are people still able to get these drugs if they need them? It feels like there should be a simple answer to that question. And it is actually turning out to be quite complex. Patrick, do you agree? I absolutely agree. I think shortages in the past, when it came to drugs, it was a problem.

a pretty black and white matter, right? And now for these drugs, it really isn't. Eli Lilly's drugs are supposedly in good supply now, but there's question about whether that's actually the case. When the drug came out of shortage, one of the representative groups of compounding pharmacies, some of the big ones that are regulated by the FDA, sued the FDA and said, no, it's still in shortage. And the FDA has come back and said, okay, we're going to review the data and

and come back to you and you can keep compounding it in the meantime. And what is compounding? So US law allows, there's kind of a group of pharmacies that can acquire the active ingredient of a drug, even if it's still under patent protection, if it's in shortage.

and they can make a version of that drug and distribute it throughout the United States. And that's what you're seeing being made available in many online pharmacies, places like HIMS and HERS, even through Weight Watchers, a compounded version of semaglutide, for example. And it's being sold for a lot less money than the brand name drug, and people are using it. But there are also a lot of concerns about where pharmacies are sourcing their ingredients and

How rigorous are their manufacturing practices to ensure that the drug that people are buying is really the drug? It's the same as the brand name, right? It's as effective and is it as safe? Also, there is, it creates an opening, unfortunately, for counterfeit versions.

There are two sides to this. So there is a very legitimate compounded market, right? So with pharmacies that are regulated either by state pharmacy boards or the FDA or both, and they're selling compounded versions of

of the drugs and those are sourced according to these companies from FDA regulated manufacturers and other suppliers. So that shouldn't be conflated with the people that set up a website and sell any old thing in a vial and call it compounded semaglutide. So that's really no different than where someone takes an insulin pen and puts an Ozempic label on and says it's Ozempic.

It's the same thing. It's legitimizing or taking advantage of a legitimate market to sell something fake. Right. Like a bag you buy in the street, you know, it's still a bag. It might not be a Louis Vuitton bag. Not that I've done it before, but... Yeah, exactly. A little bit like that.

We live in New York, you know, so... Exactly, a little bit like that. The only big difference, obviously, being that if you buy a counterfeit bag, the worst thing that can happen is it breaks in a couple of weeks and maybe you lose some of your shopping. And if you take a counterfeit drug, you take your life into your own hands. It can be very dangerous. If we take a step back, what...

What have been some of the biggest impacts on the more societal level of these drugs? There are many layers of impact, right? One of the big consequences of this is it has created a whole new dialogue around obesity and what could be done about it. And we did see that in some recent reporting in talking to doctors who say, we have patients who are obese who for years avoided the doctor. They felt shamed,

They felt helpless because nothing could be done. You know, they had tried all kinds of ways to lose weight and

and deal with the the health consequences that can come with excess weight and you know nothing worked and so they had given up and they also felt like every time they went to their doctor they were being judged or harassed and now that feels different right because there is something that they can try and it can help them and then their doctor says oh well look you haven't had you

sort of a full workup, like a cholesterol test or an A1C test in a long time. Let's check you out. And oh, we find out that actually you do have diabetes or prediabetes or you have sleep apnea and we should also treat that. And so it starts to affect vaginal

the total health care of a person in a way that was perhaps closed to people before. And then the conversation around that has also changed about fitness and about diet and nutrition, really. We understand that even with these drugs, you need to eat differently. You need to eat healthier foods. You need to ensure that you're getting enough protein and enough balance in your diet. Many people describe

that their cravings for foods that are ultra-processed, high in fat and sodium and sugar, start to decrease dramatically. They're not interested in that food anymore. And so that creates a new conversation around how

how to eat, and also the kind of exercise that you need to ensure that while you're losing weight, you still have muscle, that you're not losing muscle mass. And it's very interesting to see that. And some people may stop taking the drug and try to just keep going with diet and exercise regimen. Other people might do it alongside use of the drug.

In some cases, people find they can't tolerate the drug, but they might change how they eat and how they move. And so that is really instructive right at the level of education. If there's a segment of the population who has now been on this drug and

It has changed their cravings, you know, that they crave less sugar, less processed food. Has that created this kind of health awareness that companies might have to respond to? I think we're already seeing food companies respond to this in our

highlighting products that are high in protein or even introducing new products that are helping promote muscle mass, as well as foods that are specifically being described as GLP-1 friendly, you know, that they're complementary in a dietary sense to the

treatments that people may be taking and I think the question though that remains for the food companies is whether or not the marketplace will be still as interested in these foods that are essentially processed foods or is

is the shift that might take place favoring foods that are not processed, right? Or less processed because that's what people want to eat. Again, we don't have big picture data. We hear it anecdotally of some people saying, you know, I used to like, you know, these chips or these snacks, and now I don't even feel like I want them anymore. You hear about people with

other diseases or other symptoms that are not diabetes or obesity. And their doctors say, hey, why don't you try

And it seems to have a lot of off-label uses. What do we know about that? Well, the drugs are being tested against a number of different kinds of diseases and illnesses. And we've started to get data. For example, Eli Lilly has data showing that its drug can help with sleep apnea. And there are studies about its ability to curb impulses for alcohol addiction. And so that's

That part of it remains fascinating. There's something about the pathway through which these drugs work that affects all kinds of human behaviors and also elements of human health. Absolutely. It's going to be very interesting to see if this is more of a cravings drug than a weight loss drug.

Thank you.

Thanks again to Michelle and Patrick.

Reuters World News is produced by Gail Issa, Sharon Reich-Garson, David Spencer, Christopher Waljasper, and me, Jonah Green. Our senior producers are Carmel Crimmins and Tara Oaks. Our executive producer is Lila DeKretzer. Sound design and musical composition by Josh Sommer. We'll be back on Monday with our daily headline show. To make sure you never miss an episode, click follow on your preferred podcast player or download the Reuters app.

you