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Insurers tighten up on obesity drugs

The ideas and innovators shaping health care
Jul 27, 2023 View in browser
 
Future Pulse

By Ben Leonard, Evan Peng and Erin Schumaker

CHECKUP

The injectable drug Ozempic is shown Saturday, July 1, 2023, in Houston. (AP Photo/David J. Phillip)

Ozempic is helping people lose weight, if they can afford it. | AP

Interest in new weight-loss drugs like Ozempic and Wegovy has spiked, but most people using them have to pay out of pocket.

It ain’t cheap: The price for both can run more than $1,000 a month.

Medicare doesn’t cover obesity drugs, and private insurers are pulling back coverage, according to new data from Found, an online weight-management firm.

Just below 70 percent of coverage requests were denied in June, up from 33 percent in April, Found says.

“Overprescribing, supply chain issues, fawning media coverage, social media and unprecedented consumer demand have led to a perfect GLP-1 [glucagon-like peptide-1 agonist] storm, with the drug now in extremely short supply,” the firm wrote, referencing the class of drugs that affects the brain’s perception of hunger and of which Wegovy and Ozempic are part.

Why it matters: More than 2 in 5 Americans are obese, according to the latest Centers for Disease Control and Prevention data, a number that’s soared in the past two decades.

Evidence is mounting that Ozempic, Wegovy and other GLP-1 drugs could help reverse the trend, but cost could limit the impact.

In Congress: Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) and Reps. Raul Ruiz (D-Calif.) and Brad Wenstrup (R-Ohio) have introduced companion bills that would direct Medicare to cover obesity medications.

 

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This is where we explore the ideas and innovators shaping health care.

President Joe Biden’s dog, Commander, sunk his teeth into Secret Service agents, or otherwise attacked them, 10 times between October 2022 and January, according to an Associated Press report citing Department of Homeland Security records.

A Harvard professor of evolutionary biology speculated that the stress of White House living could be the reason.

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THE NEXT CURES

Activists of a non-governmental organization display red ribbons, symbol of HIV-AIDS awareness, as they pose for photographers during an awareness campaign on World AIDS Day, in a business district of Bangalore, India, Sunday, Dec. 1, 2013. UNAIDS lists India as third worst Human Immunodeficiency Virus (HIV) affected country with about 2.5 million infected people after South Africa with 6 million and Nigeria with 2.9 million. (AP Photo/Aijaz Rahi)

There's good news from Sydney about HIV transmission. | AP

The world should look Down Under for how to eliminate HIV transmission, new data suggests.

At one point, inner Sydney had the highest prevalence of HIV in Australia, but last year, only 11 new cases were reported there.

New HIV infections in the central districts of Sydney dropped by 88 percent between 2010 and 2022, according to Andrew Grulich of the Kirby Institute at the University of New South Wales.

Grulich attributed the success to outreach efforts in the LGBTQ community, including education about the category of HIV-prevention medicines known as PrEP, or pre-exposure prophylaxis, the most common of which is a once-daily pill.

The data, presented Monday at the International AIDS Society’s HIV science conference in Brisbane, Australia, and not yet peer reviewed, means inner Sydney could be the first place in the world to reach the U.N.’s target for ending HIV transmission, defined as a 90 percent reduction in new cases by 2030.

Even so: Other Kirby Institute researchers presenting at the conference, including Skye McGregor, pointed to the continuing need to better educate people about HIV transmission risks.

While men who have sex with men tend to be aware of HIV prevention tools like PrEP, heterosexual people are much less likely to know about them, McGregor said.

Thirty percent of new HIV diagnoses in Australia in 2022 were in heterosexual people.

 

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FORWARD THINKING

Dr. Sunil Singhal, center, directs a special camera to look at a patient's tumor, made visible with fluorescent dye, on monitors at the Hospital of the University of Pennsylvania in Philadelphia, Tuesday, Jan. 23, 2018. Researchers are testing fluorescent dyes that make cancer cells glow to make them easier for surgeons to find, giving patients a better shot at survival. (AP Photo/Matt Rourke)

New funding from ARPA-H aims to improve cancer surgery. | AP

The Advanced Research Projects Agency for Health wants grant proposals to address two cancer surgery problems: tumor-edge visualization and critical anatomy visualization.

The new agency charged with funding high-risk, high-reward research believes that if surgeons can see tumors' edges more clearly, they'll have a better shot at removing them and avoiding damage to healthy tissue.

Developing devices to allow surgeons to see nerves and blood vessels in 3D while operating could similarly improve surgery outcomes.

The request for proposals is the first cancer-focused program from ARPA-H. Called Precision Surgical Interventions, it dovetails with President Joe Biden's goal for his cancer moonshot: reducing the cancer death rate by half in the next 25 years.

"Researchers and innovators across the country are pioneering new techniques and technologies to make cancer removal surgeries more precise, accurate, and achievable," Biden said in a statement Thursday. "It’s an exciting horizon in cancer research and development that could save and extend many lives.”

Why it matters: Two million Americans are diagnosed with cancer each year. While surgery is typically the first option for people with solid tumors, it can be hard for surgeons to tell where tumors end and nerves, blood vessels and lymph ducts begin.

Accidentally damaging healthy tissue can mean more operations, pain and longer hospital stays. Those corrective procedures and treatments cost the U.S. more than $1 billion each year.

What's next? Proposer's Day for interested researchers in fields like oncology, surgery and imaging technology is Sept. 7.

 

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