The high cost of GLP-1 weight loss medications: a broken system

The prevalence of obesity continues to rise, but one class of drugs–GLP-1 receptor agonists–is getting attention for its potential as an effective treatment. These medications have impressive results in helping individuals lose excess weight, but their exorbitant prices have raised questions about the state of the pharmaceutical industry.

Extremely high-cost weight loss medications

GLP-1s are a relatively new class of prescription medications primarily used to manage type 2 diabetes by improving blood sugar levels. However, they have also demonstrated significant weight loss benefits. Drugs like liraglutide (Saxenda) and semaglutide (Wegovy)–both of which fall into the GLP-1 RA class–have been approved for weight management in people with obesity.

GLP-1s typically lead to moderate-to-significant weight loss in individuals with obesity — people can lose approximately 5% to 15% of their initial body weight. While GLP-1s offer a promising solution for weight loss, they come at a staggering cost. A monthly supply of these medications can easily exceed $1,000 or more, making them prohibitively expensive. Their high cost raises both practical and ethical concerns, as obesity is often associated with lower socioeconomic status.

Lower-cost alternatives

One approach to mitigating the high cost of GLP-1 medications is step therapy, a process that encourages patients to try lower-cost treatments before progressing to more expensive options. Metformin, an inexpensive and widely-used medication for type 2 diabetes, is one such alternative. It helps control blood sugar levels and may contribute to modest weight loss in some people. In contrast to GLP-1s, the average cost of generic metformin ranges from $4 to $20 per month, depending on the dosage and location.

Metformin generally does not deliver the same weight loss results as GLP-1s, but for many patients, it can be a more affordable and accessible choice. In some instances, metformin may actually be more appropriate for patients with an underlying health condition. That’s why it’s important that patients seeking support for weight management get holistic care–it leads to better health outcomes and more options for treatment for the patient and provider to partner on developing. It’s also important to note that individual responses to medications vary, and metformin or GLP-1s may not be right for everyone. This highlights the need for a range of treatment options that fit different patients’ needs.

Another avenue to lower the cost of prescription medications is the development and promotion of generic versions. Generic drugs contain the same active ingredients as their brand-name counterparts but are typically more affordable. However, the introduction of generic versions of GLP-1 receptor agonists may take time, as they must first go through patent expirations and regulatory processes.

The importance of price transparency

One of the key issues contributing to the high cost of medications, including GLP-1s that are in a formulary (a list of medications covered by a health plan), is a lack of price transparency. Price transparency in the pharmaceutical industry means providing patients with accessible and understandable information about the costs of prescription drugs and healthcare services. This includes disclosing the prices charged by pharmaceutical manufacturers, wholesalers, and other intermediaries involved in the supply chain.

The pharmaceutical industry is a complicated, multifaceted ecosystem involving drug manufacturers, insurance companies, wholesalers, pharmacies, healthcare providers, and intermediaries such as Pharmacy Benefit Managers (PBMs). PBMs play a pivotal role in managing drug benefit programs for health insurers. While they were originally designed to negotiate lower drug prices and improve access to medications, they have faced criticism for their lack of transparency.

Price transparency in the pharmaceutical industry is a crucial step towards empowering patients and employers to address rising drug prices and opaque pricing structures. By shedding light on the intricacies of drug pricing, we can make informed choices, apply pressure for fair pricing practices, and play a more active role in healthcare decisions. Ultimately, fostering transparency is not just about financial transparency; it’s about promoting a healthcare system that prioritizes affordability and accessibility for all.

Cost of prescription medication impacts DEI

The prohibitive cost of prescription drugs is a pervasive and pressing issue, especially for underserved populations such as women and BIPOC communities. Women, who often shoulder the responsibility of being the primary caregiver and face unique healthcare needs, are disproportionately affected by the high cost of medications. Many women are unable to afford birth control, fertility treatments, and medications for chronic conditions such as osteoporosis, autoimmune diseases, and mental health disorders. These financial barriers can deter women from seeking timely medical care, potentially leading to untreated conditions and worsening health outcomes.

BIPOC communities, who have historically faced systemic healthcare disparities, are also disproportionately impacted by the high cost of prescription drugs. Many members of these communities encounter socio-economic challenges that make it difficult to cover the expenses of essential medications. For instance, Black workers are overrepresented in low wage jobs, which are less likely to have employer-sponsored health insurance benefits.

Even with health insurance coverage, prescription and treatment is influenced by a patient’s gender, race, class, or ability. A recent analysis on GLP-1 use in New York City showed that there’s a higher concentration of GLP-1 use for weight management in wealthy neighborhoods. In lower income neighborhoods, where rates of type 2 diabetes and obesity are higher, the usage rate of GLP-1s was around half of what it was in the most affluent areas of New York City. This highlights a divide along socioeconomic lines of who has access to this breakthrough medication. These economic hurdles, combined with unequal access to quality healthcare, can result in delayed treatment, inadequate management of chronic illnesses, and worse health outcomes.

Moreover, the compounding effects of both gender and racial disparities intersect in healthcare. For instance, women of color may face even more significant obstacles in accessing medications due to the intersection of gender and racial biases.

Working within the system, to fix the system

Addressing the issue of high drug prices requires a multifaceted approach. Policymakers must work to enact legislation that promotes price transparency, encourages generic drug competition, and enables Medicare to negotiate drug prices. Additionally, efforts to eliminate biases in healthcare delivery and promote equitable access to quality care are crucial. By addressing the systemic factors contributing to the high cost of prescription drugs and the resulting healthcare disparities, we can strive towards a more just and inclusive healthcare system that better serves underserved populations like women and BIPOC communities.

There are organizations working towards improvements. Hello Alpha is a virtual primary care platform that offers inclusive, expert care for all by bridging the gaps in women’s health. Through technology and a specially-trained team of primary care providers (PCPs), Hello Alpha delivers whole-person care and expands healthcare accessibility virtually. Their approach to weight management balances lifestyle changes with new medication to deliver strong, sustained clinical outcomes in a cost-effective manner. Every patient partners with a dedicated PCP who provides personalized, preventive care and evidence-based treatment at every visit. The platform eliminates the most common barriers to healthcare with asynchronous telehealth visits that empower patients to get care at any time without appointments, travel, or waiting rooms.

Mark Cuban’s Cost Plus Drug Company aims to address the high cost of prescription drugs and improve access by adopting a transparent pricing model. They utilize a “cost-plus” approach, which means they charge a transparent 15% markup on the actual cost of manufacturing and distributing medications. This ensures that patients pay a fair price for their medications while maintaining quality and accessibility. This innovative pricing strategy seeks to alleviate the financial burden on patients and increase affordability and transparency within the pharmaceutical industry.

Ultimately, the high cost of GLP-1s for weight loss treatment represents the shortcomings of the traditional healthcare system. It also highlights the importance of a whole-person healthcare approach when it comes to any prescription medication or treatment. When it comes to weight management, this personalized care helps providers and patients partner on the right medication, which may or may not include a GLP-1. Price transparency is crucial to empowering patients and holding pharmaceutical companies accountable for their pricing practices. Additionally, the development and approval of generic medications can play a pivotal role in making essential treatments more accessible to all individuals, even those in underserved communities, dealing with obesity. Addressing the high cost of weight loss medications is not only about economic fairness but also about promoting public health and well-being.