Payer coverage has been cited as the most frequent barrier to patient access to obesity therapy. While most new obesity therapies have lower wholesale costs than SGLT2 inhibitors, lack of coverage puts them out of reach for most Americans, according to a new study.
With obesity being closely tied to diabetes, one would think treating obesity would be an obvious first step to combatting diabetes. However, a study published today in Obesity, the official journal of The Obesity Society, finds that is not true. In fact, doctors are 15 times more likely to prescribe therapies for diabetes than those for obesity.
While 6 new treatments for obesity have received FDA approval in recent years, uptake has been lukewarm, and today’s research puts numbers behind what Wall Street analysts have written for several years: only 2% of the 46% eligible adults in the United States population is taking these medications.
Payer coverage–or lack of it–is often a barrier to access, and today’s study is the first to quantify the scope of the disparity in prescribing. “Out-of-pocket cost to patients is likely a significant barrier to antiobesity pharmacotherapy initiation and long-term adherence,” the authors wrote. “While the new antiobesity pharmacotherapy whole acquisition costs are somewhat lower than that of SGLT2s, the lack of insurance coverage makes antiobesity pharmacotherapy far less affordable for most Americans.”
In May, the well-regarded pharmacy publication, The Pink Sheet, chronicled the declining presence of sale representatives for several once-promising obesity therapies, due to stigma and refusal of many health plans to cover the drugs or only on non-preferred tiers. That report said in some cases, past problems with earlier generations of obesity drugs had affected coverage decisions.
The research published today examined data from IMS Health National Prescription Audit and Xponent assessed adoption rates of antiobesity pharmacotherapies and sodium glucose co-transporter-2 inhibitors (SGLT2s), a new treatment for type 2 diabetes that reached the market in 2013.
“The adoption rate of SGLT2s was nearly exponential while the adoption rate of new antiobesity pharmacotherapies was linear,” the authors wrote. "Considering the relative prevalence to diabetes and that obesity is a major cause of diabetes, these results are paradoxical and suggest systematic barriers against the prescribing of antiobesity pharmacotherapies.”
The comparison with SGLT2s is significant, because 2013 was also the year that the American Medical Association declared obesity to be a disease. There was hope at the time among advocates for better obesity care that the policy change would open the door to better payer coverage.
According to the data examined by the researchers, in August 2015, the number of dispensed antidiabetes prescriptions, excluding insulin was 15 times the number of dispensed antiobesity prescription. SGLT2s accounted for 4.9% of the market share, which was equivalent to three-quarters of all dispensed anti-obesity prescriptions. Of the anti-obesity medications dispensed, 74% were phentermine, an older drug similar to an amphetamine, while 18% were newer drugs.
Ted Kyle, RPh, MBA, and Fatima Cody Stanford, MD, MPH, MPA, wrote a commentary accompanying the study on its clinical implications. “By comparing the adoption rate of new obesity medications to the considerably faster rate for new diabetes medications, this new research provides an important snapshot of the problem,” they wrote.
Kyle and Stanford have frequently written and spoken on the disparities in coverage for persons with obesity, including a commentary (with co-authors) that appeared last fall in Evidence-Based Diabetes Management. In that article, they presented survey data that showed employees often learn health plan will not cover obesity therapy but will still penalize them for not achieving wellness benchmarks.
Asked via email if the lack of payer coverage is the obvious stumbling block to more robust prescribing patters, Kyle said, it was more complicated than that. "Most physicians in primary care are not well-equipped to provide evidence-based medical care for obesity.Â Poor reimbursement for this kind of care has created a chicken-and-egg problem. Physicians have little reason to acquire new skills when they will not be reimbursed for using them."
Are doctors more likely to write prescriptions when payer coverage improves? The answer is yes, Kyle said. "Coverage is improving, and the delivery of care is improving, but progress is coming slowly."
Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ. Low adoption of weight loss medications: a comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s [published online August 29, 2016]. Obesity. doi:10.1002/oby.21533.