When thousands of health care providers and scientists gathered earlier this month at a diabetes conference in New Orleans, one particular session stood out. Researchers described a new drug that could help someone lose more than 20% of their body weight, amounting to an average loss of 52 pounds over a year and a half.
“This is a new era for obesity treatment,” said Dr. Ania Jastreboff, one of the authors of the study, which was published in the New England Journal of Medicine. The results were met with applause and fervent questioning from attendees at the Ernest N. Morial Convention Center.
The evidence for the drug, tirzepatide, and another, semaglutide, is promising. And research shows treating obesity lowers the risk of other costly health concerns, such as diabetes, high blood pressure and stroke. But in a state where 38% of people are obese, ranking fourth in the nation, a big question looms: Who will pay for it?
“These drugs — semaglutide and tirzepatide — have given the kind of weight loss that we previously only got with bariatric surgery. The weight loss is incredible,” said Candida Rebello, a research scientist at Pennington Biomedical Research Center in Baton Rouge who was not involved with this research. “The problem is … most people cannot afford these drugs.”
While doctors are starting to treat obesity as a disease, coverage for expensive weight loss drugs has yet to catch up. Tirzepatide, manufactured by Eli Lilly, will likely cost in the range of $1,000 to $1,500 monthly, and insurance companies won’t cover most of that, if any, said Rebello.
‘The insurance companies haven’t quite caught up’
Weight loss drugs are typically classified as a higher tier drug on insurance plans, said Rebello, putting them in the company of lifestyle drugs like Viagra. Some private insurance companies may cover up to 50% of the cost, but $750 is still out of reach for people who need it most. People from lower socioeconomic backgrounds are more likely to be overweight, Rebello pointed out.
Louisiana’s Medicaid plan does not allow reimbursement for weight loss drugs, though it does cover tirzepatide for diabetes, which it is currently approved to treat.
Blue Cross Blue Shield, which provides health insurance for the majority of Louisiana group plans, said coverage for tirzepatide would be dependent on a member’s plan. But a representative also said many of the company’s health plans do not include coverage for weight loss medications or bariatric surgery. A wellness program that offers coaching and education about weight is available at no cost, the company said.
But such programs are typically not successful. Diet and exercise studies show about a 5% reduction in weight loss, rarely tipping the scales back into a target body weight for patients with obesity. Many people try and fail to lose weight, and evidence shows that it’s not just a lack of willpower that keeps them from succeeding. The pathways in the body that regulate weight loss are altered in some people in a way that makes it very difficult to lose and maintain weight.
“The insurance companies haven’t quite caught up to where the science is,” said Dr. Taniya de Silva, chief and program director of the endocrinology, diabetes, and metabolism fellowship program at LSU Health Sciences Center.
Before it happens
Drugs have historically targeted the downstream effects of obesity: diabetes and the kidney, nerve and eye damage that comes with it. But what if instead, drugs prevented a diabetes diagnosis, or even reversed it?
“Obesity is a big driver of the pathology we see in Type 2 diabetes itself, and if we can use our new agents to achieve significant weight loss, we could even potentially have remission of diabetes,” said de Silva.
Doing that would also lengthen a patient’s life span and reduce the risk of heart disease, which is the No. 1 cause of death in the country. Louisiana has the fifth-highest death rate from disease in the US, and it strikes many Louisiana cardiovascular residents in the prime of their lives.
Patients who took semaglutide, which was approved to treat diabetes in 2021 under the brand name Wegovy, decreased their Cardiometabolic Disease Staging score, a measure of diabetes and cardiovascular disease risk, by half, according to another study released at the conference. The trial participants also lost nearly 17% of their body weight.
The drugs work by making people feel full faster, mimicking hormones in the gut called GLP-1 and GIP. They are also thought to work in the brain, targeting receptors related to appetite, and in the pancreas, by increasing insulin secretion in relation to the amount of glucose in the body.
Right now, tirzepatide is only approved for Type 2 diabetes, sold under the brand name Mounjaro. Researchers hope to get it approved for weight loss after clinical trials showed significant results at higher doses. There were some side effects, such as nausea and diarrhea, and the drug needs to be injected once weekly even after the weight loss plateaus, researchers said at the conference. Patients can still “out-eat” the drug if they don’t make lifestyle changes, de Silva said. So it may not work for everyone.
But it is a significant tool in a state that desperately needs it — if only people can get it.
“Using these drugs in an effective way to improve outcomes for our patients, in the end, would be huge savings,” said de Silva. “But someone has to pay for it upfront.”