**: Yakudu
Written by: Brother Ha Li
Wegour (Semaglutide, Figure 1), which is a strange commodity in 2023, is still likely to be "ahead of the curve and behind us" in 2024.
In the United States, the ultimate fate of GLP-1** drugs depends largely on whether and how quickly they are covered by health insurance. Although the efficacy of GLP-1** has gradually taken root in the hearts of the people, many employers and insurance companies have still not made decisive concessions to the vision of "Ander Mansions", resulting in the ultimate goal of "conquering the world" is still out of reach. In fact, some companies are concerned about the cost of the drug and its impact on the bottom line. Many employers choose to turn away this expensive** drug because of its high cost, and many people with obesity still don't have access to it through their employer's insurance. Essentially, these employers don't have the budget for that.
Figure 1Semaglutide chemical structure.
Most Americans get health insurance through work. But according to a survey released in November 2023 by employee benefits firm Mercer, only 41% of companies said they covered new GLP-1 drugs for obesity, and only 19% of the remaining companies without commitments said they were considering whether to include GLP-1 drugs in their coverage. Counselors who work with employers to provide prescription drug benefits said they don't expect many employers to start covering these drugs in 2024. The reason is still money, and the employer can't afford to pay it.
Employers' insurance is obscure, and health programs don't cover these drugs uniformly. Coverage of Medicaid programs varies from state to state, with few requiring the Affordable Care Act, also known as Obamacare, a major U.S. health care reform bill passed in 2010. The main goal of the bill is to increase health care coverage for U.S. citizens, improve the efficiency of the health care system, and reduce overall health care costs) to cover these drugs. The law also prohibits Medicare, a federal insurance plan, from covering these ** drugs.
United StatesEmployers are "cold and cold" to the first medicine
Not only have there been no expressions of intent to actively cover GLP-1** drugs, but in contrast to the attitudes of many employers and insurance companies that make it harder for people to have access to these drugs. In 2023, they have taken a harsh approach to weight loss for those who do not have type 2 diabetes by using the type 2 diabetes drug ozempic to save the country.
Currently, some employers only pay for drugs such as wegovy for people with severe obesity, or for those who participate in diet and exercise programs. Even so, some employers limit the duration of medication** for members. The Mayo Clinic of the Minnesota Health System has notified staff that it plans to cap $20,000 on "lifetime spending" of ** drugs per health plan member starting in 2024. Other employers, including U.S. hospital chain Ascension, the University of Texas System and Minneapolis Health System Hennepin Healthcare, are considering ending full coverage for these drugs.
Even if these ** drugs are covered by insurance, out-of-pocket expenses can still be a head-off for many people. A 2023 study in the Journal of the American Medical Association (JAMA) found that people with higher out-of-pocket costs were significantly less likely to continue taking their medication one year after starting it. The investigators categorized co-payment (the portion of the medical expenses that a patient has to pay, rather than the part that is covered by the insurance company) into three grades: low (less than $10), medium ($10-$50), and high (more than $50). The researchers concluded that medication adherence rates varied depending on the level of copayment: 71 in the lower copay bracket9% with a medium copay grade of 657% and a high co-pay ratio of 599%。It is clear that the co-payment rate has a significant impact on whether a patient will choose to continue taking the medication. Even if these expensive drugs are covered by commercial insurance, the co-payment will still overwhelm some families and choose to wean off the drug.
American Medicare "wants to talk about it".
Medicare, the federal insurance program, plays a role in expanding drug coverage. Medicare provides health insurance to 66 million seniors and people with disabilities, but expanding coverage may require a nod from Congress. Despite a lot of lobbying by drugmakers and patient advocacy groups in this regard, analysts at Capital Alpha Partners** said Medicare won't partially cover these drugs until at least 2027.
Analysts say that legislating a strategy to expand health insurance coverage is difficult to operate, and the high cost will create a significant barrier to this. An analysis by researchers at Vanderbilt University estimated,If only 10% of Medicare beneficiaries accept Wegovy**, Medicare's costs add a total of $26.8 billion per year, almost one-fifth of Medicare's Part D prescription drug spending in 2019. The possible cost burden of GLP-1** for Medicare is illustrated from this.
A real-world analysis released in July 2023 showed that taking GLP-1 drugs led to a sharp increase in total healthcare costs. The data shows that the overall medical cost of a patient before taking Wegovy or similar** drugs averages $12,371 per year. After initiating the medication, the average annual comprehensive medical cost per patient jumped 59% to $19,657. Notably, the average cost of patients in the control group who did not take ** the drug decreased by 4% over the same period. The impact of GLP-1** on healthcare costs is as significant as their effectiveness.
Promote negotiation through competition
As more obesity** drugs become available on the market, and drugmakers launch lower-cost oral drugs (e.g., Eli Lilly's Phase III small molecule** drug orforglipron, Figure 2), the rate of ** drugs is likely to decline. Over time, intense competition can lead to a decline, driving market access.
Figure 2Orforglipron chemical structure.
It is possible that the competition between the two needle manufacturers in the market may lead to a lower level, but there is also the possibility of an upward trend (shadow pricing). Eli Lilly Zepbound (Tirzepatide, Figure 3), which was a late hit, has shown a tendency to spark a first-class war, with their product priced at $1,060 lower than Novo and Nordisk's Wegovy ($1,350) at a price tag of $1,060About 5%. In fact, during the twice-year-a-year drug price increase season, Eli Lilly's type 2 diabetes drug Mounjaro (which uses tirpatide as the active ingredient like Zepbound) has been seen, and its ** was raised by 45%。This seems to be a signal that the future of zepbound may also be chosen. Considering that Eli Lilly and Novo Nordisk have recently accelerated the expansion and construction of new plants, it may not be realistic to expect them to reduce the price of their fist products in the future.
Figure 3Tirpatide chemical structure.
In addition to the "water flowers" general price reductions, drugmakers also offer coupons to patients to try out drugs at significant discounts. However, this kind of behavior will not have a qualitative impact on the patient's ability to pay. The factor that has fundamentally shaken up Wegovy and Zepbound is the launch of new drugs, but it will take time. Analysts expect Eli Lilly's first oral** drug, orforglipron, to be available in the second half of 2026.
In addition to the small molecule drug orforglipron, Eli Lilly is also developing the peptide drug Retatrutide (Figure 4), the "3G** drug (Glucagon GLP-1 GIP triple receptor co-agonist)" Retatrutide, which outperforms Wegovy and Zepbound in clinical data. Related content expansion: The world's first GLP-1R GIPR GCGR three-target agonist is coming, GLP-1 3The era of version 0 is on!
Retatrutide lost 24% of the average body weight in 11 months, and the drug is estimated to be more than three years away, possibly in 2027. However, it is unlikely that retatrutide is lower than semaglutide (wegovy) and tirzepatide (zepbound). On the contrary, it may be superior to its opponent because of its efficacy advantage (besides, retatrutide and tirzepatide can be said to be "born from the same root" and are both assets of Eli Lilly).
Figure 4Retatrutide chemical structure.
Another important pharmaceutical asset of Novo Nordisk, cagrisema (24 mg semaglutide and 2The 4mg amylin analogue cagrilintide, Figure 5) is also currently in phase 3 studies, but it does not appear to have a huge impact on the drug. As it stands, only the oral pill has the potential to shake the high water mark of more than $1,000 a month for Wegovy and Zepbound**.
Figure 5Cagrilintide chemical structure.
If competition still can't push the price of expensive drugs down, then it is necessary to count on the expiration of these patents for GLP-1 and the marketing of generic drugs. Novo Nordisk's Saxenda (Liraglutide, Figure 6) is an early-stage GLP-1** drug whose lead patent expired in February 2023. The patent for liraglutide recombinant injection expired at the end of 2023 and the first half of 2024. Among them, including the main patent of the diabetes drug Victoza. Teva, Pfizer and Mylan are expected to launch their respective patents. According to the SEC filing, the generic version of Liraglutide will be available in June 2024. Sandoz received approval to launch its Victoza version in 2024. Morgan Stanley analysts estimate that key patents for Wegovy, Ozempic and Mounjaro will not expire until the early to mid-2030s. A generic version of Ozempic could be available in 2031.
Figure 6Liraglutide chemical structure.
Discontinuation of the drug ** and ***
Achilles' heel of GLP-1
In addition to the recognition of the efficacy of GLP-1**, what is also deeply rooted in the hearts of the people today is the *** and weight ** after GLP-1 is stopped, and people have basically reached a consensus on this.
One study showed that less than a third of patients who started using Wegovy and similar drugs in 2021 were still using them a year later. and adverse events may have played a role.
Weight** is also a serious challenge for GLP-1 drugs. According to a study published Dec. 11 in the Journal of the American Medical Association, people who take tirpatide (the active ingredient of zepbound) lose an average of nearly 50 pounds in less than a year, but if they stop taking the drug, they will lose more than half of their body weight. Previous studies of semaglutide showed similar results to tirpatide, with patients who discontinued the drug regaining about two-thirds of their previous body weight.
These studies appear to confirm previous fears that patients will need to take GLP-1 drugs for a long time, possibly for life, to maintain their health benefits. This phenomenon is not unique to ** medicine, and patients who are familiar with chronic diseases such as high blood pressure, high blood sugar and high cholesterol need to take medication for life. This means that for insurers that underwrite** products, these drugs may increase costs to the healthcare system in the short term, but they may not necessarily provide the corresponding benefits.
Weight** after discontinuation of the drug leads to dependence on GLP-1 medications, which leads to huge problems in terms of insurance coverage. Patients will be treated with medication for life, which will cause great financial pressureMoreover, whether the health plan will continue to cover the cost of GLP-1 drugs after drug discontinuation is also a key issue in the industry.
The opening of the third battlefield
GLP-1 peptides have been approved for type 2 diabetes and obesity, but developers are still eyeing the "third battlefield", and the expansion of indications is expected to prompt insurance companies to provide more coverage of GLP-1 drugs. This third battleground is cardiovascular disease from the current point of view. Novo Nordisk is a leader in clinical research on cardiovascular diseases. Novo Nordisk found that semaglutide reduced the risk of heart attack, stroke and cardiovascular death by 20% in people with heart disease. If the scope of the Wegovy label is expanded, doctors can prescribe it as a heart medication, thus circumventing the insurance company's **exclusions. Pharmaceutical companies hope the data will convince more doctors to prescribe more semaglutide and have more health plans cover these drugs.
Novo Nordisk and Eli Lilly are also studying whether their drugs can target indications such as sleep apnea, chronic kidney disease and musculoskeletal problems. More clinical readings are expected in the coming quarters to years.
** Whether the medicine will change
How to pay for prescription drugs?
Americans' craving for the drug, and the cultural and economic shockwaves it could bring, seem to have just begun.
Jefferies analysts estimate that the U.S. obesity drug market could exceed $100 billion by 2031, with 30 million to 35 million obese patients seeking GLP-1**, which is only about 15% of all patients.
Obesity drugs, as well as other expensive** that cover a wide range of patient groups, such as the future breakthrough for Alzheimer's disease**, could be a catalyst for changing the way the U.S. pays for high-cost prescription drugs. In today's healthcare system, and the way pharmaceutical companies interact with it, they don't support GLP-1 drugs that have a significant short-term budget impact but long-term value. That is, the healthcare system is more inclined towards short-term economic considerations and less supportive of products that put more pressure on budgets in the short term, even though they may be of significant value to the healthcare system and patients in the long term. Between $1 million in drugs for a few dozen patients and a product for 100 million patients, insurance agencies may be inclined to cover the former.
North Carolina's treasurer, Dale Folwell, agrees. Folwell oversees the state employee health program, which has seen its costs skyrocket as thousands of workers suddenly began taking ** medications. The plan to spend 1 on these drugs in 2023$1.2 billion, well above $61 million in 2022. Folwell called on the program to stop covering these drugs until Novo Nordisk lowers prices. Folwell arguesExtreme costs already threaten the solvency of the program, and if this insurance remains the same, there will be no choice but to triple the premiums for all workers. Currently, North Carolina has reached a compromise with state staff: people who are already taking ** can continue to take it, but starting in 2024, new prescriptions will no longer be covered.
References (swipe up and down):
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2.treasurer folwell calls on novo nordisk to lower the unfair cost of weight loss drugs. north carolina department of state treasure. 24. 10 .2023.
3.landsverk, g. how weight-loss injections like ozempic, mounjaro, and 'triple g' compare in cost, results, and effectiveness. business insider. 26. 12. 2023.
4.landsverk, g. a new class of 'game-changer' weight-loss drugs exploded in popularity in 2022, and supply can't keep up. business insider. 25. 11. 2023.
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*Disclaimer: This article is only to introduce the research progress in the field of pharmaceutical diseases or briefly describe the research overview or share relevant information about medicine, and is not and will not make a recommendation of ** or diagnostic solutions, nor does it constitute any recommendation for related investment. If there is any omission in the content, please contact and point it out!