ICER says GLP-1s 'still have serious affordability issues'

Novo Nordisk and Eli Lilly's weight-loss drugs offer substantial net health benefits and are also cost-effective at current prices – but will still pose an affordability challenge to US healthcare.

That is the conclusion of a draft report (PDF) from the influential Institute for Clinical and Economic Review (ICER), a US healthcare technology assessment (HTA) organisation, which notes that access to the GLP-1 drugs is already limited by "variable insurance coverage and high out-of-pocket costs."

ICER concludes in its document that Novo Nordisk's Wegovy (semaglutide) and Lilly's Zepbound (tirzepatide) are clearly a step forward in helping people lose weight and improve their metabolic health, after saying in an earlier report (PDF) that their prices needed to come down.

At the moment, most people accessing the drugs pay for them out of their own pocket, as insurance in the US has traditionally not covered weight-loss therapies, but that may change in future as studies point to benefits of GLP-1 therapies in cardiovascular disease risk reduction and other obesity-related conditions like knee osteoarthritis, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD).

In its report, ICER notes that Wegovy, Mounjaro, and Novo Nordisk's oral semaglutide – not yet on the market for obesity – are all cost-effective, based on their current prices and the assumption that oral semaglutide will cost the same as the injectable version.

However, "despite these therapies being highly cost-effective, their potential budget impact is large," it says.

"We estimate that fewer than 1% of eligible patients could be treated at current and assumed net prices before crossing the ICER budget impact threshold of $880,000,000 annually," according to the organisation. "This raises serious concerns about affordability."

ICER is planning to hold a webinar next week (18th September) to present the findings of the draft report, which is open for public comment until 6th October. A virtual public meeting to discuss questions raised in the document will be held on 13th November.

Around 40% of the US population is currently living with obesity, and there are racial and ethnic differences in obesity prevalence, with Black and Hispanic adults having higher rates.

In a white paper published earlier this year, ICER highlighted the tension between the scale of the benefits of new obesity medications and the magnitude of the financial implications for healthcare payers.

"Obesity treatments have the potential to transform thousands of lives, but only if we ensure sustainable access for all patients," said Sarah Emond, ICER's chief executive at the time.

"It is incumbent upon the entire healthcare system to focus on innovative pricing, coverage, payment, and delivery solutions, with the goal of broadening access to effective obesity medications."

Novo Nordisk and Lilly have launched direct-to-consumer sales channels to offer their obesity therapies for a fixed monthly fee, and have partnered with telehealth companies to broaden their reach. Both are, however, feeling the pinch from semaglutide and tirzepatide-based weight-loss drugs offered through compounding pharmacies.

Photo by Alexander Grey on Unsplash