Health and Healthcare Systems

5 key lessons learned in the US about weight loss drugs

The US market for weight loss drugs, known as GLP-1s, is set to expand on a massive worldwide scale.

The US market for weight loss drugs, known as GLP-1s, is set to expand on a massive worldwide scale. Image: REUTERS/George Frey.

Sean Duffy
Co-Founder and Chief Executive Officer, Omada Health
This article is part of: World Economic Forum Annual Meeting
  • The US market for weight loss drugs, known as GLP-1s, is set to expand on a massive worldwide scale.
  • Given the global burden and prevalence of obesity and chronic diseases, this poses a challenge for global health community.
  • Five key takeaways from the US highlight the clinical and economic realities of GLP-1 expansion.

With obesity and related chronic diseases on the rise worldwide, GLP-1 receptor agonists (used to treat type 2 diabetes and obesity) – namely Eli Lilly’s Zepbound® and Mounjaro®, and Novo Nordisk’s Wegovy® and Ozempic® – are being hailed as potentially transformative solutions.

Since their 2020 surge in the US, these medications have demonstrated significant weight loss impact among Americans, and Wegovy® has specifically been found to reduce cardiovascular related deaths. Ongoing studies show the medications may also potentially prevent chronic kidney disease and protect against dementia.

The manufacturers are experiencing enormous demand for these medicines, and have faced challenges keeping up. As the manufacturers are still ramping up production to meet the growing demand, the lion’s share of both the supply and commercialization efforts of GLP-1s have been pointed toward the US, despite the fact that the medications have gained approval in international markets.

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Given these dynamics, the US presents a preview and case study of the GLP-1 tidal wave that’s likely soon heading for international shores. The experiences gained and strategies adopted by the US healthcare community offer prescient insights that other nations can draw upon as they prepare to grapple with how GLP-1s fit into their healthcare ecosystems.

Here are five vital takeaways from the US that the global health community should heed as it navigates the clinical and economic realities presented by GLP-1 expansion.

1. Unprecedented demand of weight loss drugs breeds coverage pressures

The effectiveness of GLP-1s for weight loss is generating unparalleled public demand and, in turn, high prices from pharmaceutical companies. In the US, the fervour for access to these medications has placed immense pressure on political bodies and insurance companies to provide coverage.

Six in 10 adults believe Medicare should cover GLP-1 drugs for weight loss in overweight individuals, despite current legal prohibitions. This public sentiment in the US recently rose to a fever pitch, and the Biden Administration proposed a rule to enable Medicare and Medicaid coverage of the medicines. The jury is still out on if the Trump Administration will carry this forward.

Similarly, employers are feeling the demand from their employees. In one 2023 survey, employees ranked coverage for weight loss medications as more important than child care assistance, unlimited paid time off, and flexible work models.

Nationwide drug shortages are likely to continue to place pressure on regulatory bodies and pharmaceutical companies to ensure more equitable access as they address their supply chain issues.

As supply ramps and commercialization efforts grow internationally, the above scenarios are likely to repeat on a global scale. Policymakers and healthcare providers must brace for a surge in demand, and very loud voices asking for access to the medicines. Countries should ready themselves with transparent communication to manage expectations and put forward proactive strategies.

2. Costs could spike quicker than anticipated

In the US, soaring demand for GLP-1s led to a rapid escalation in costs, with the market expanding from $26.61 billion in 2023 to an estimated $39.64 billion in 2024. This put significant strain on financial planning within employers and healthcare systems, leading many to scramble for effective cost management strategies, or even to drop coverage altogether.

Consequently, affordability is also a major concern for patients, with out-of-pocket prices reaching $1,000 per month. Roughly half of patients who’ve taken GLP-1s report difficulty affording them, regardless of insurance status.

As GLP-1 medications may require long-term therapy for chronic weight management, insurance companies and healthcare systems must grapple with the long-term financial implications of covering weight loss drugs for extended periods of time.

While it’s true that GLP-1 prices are significantly less expensive across the globe, given the size of the prevalence of obesity, there is potential for economic challenges as demand grows, regardless of where the international prices stabilize. Robust economic forecasting, budget adjustments and utilization management tools will be necessary to help mitigate disruptions.

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3. The consumer marketplace will become more complex

While shortages of GLP-1s in the US presented challenges for patients and health systems alike, it was a boon to consumer weight loss companies who rapidly adopted telemedicine prescription capabilities.

In addition, in the US, compounding pharmacies are to produce and sell lower-cost versions of semaglutide and tirzepatide to consumers. It’s estimated that 30% of semaglutide in the US is sold by compounding pharmacies. Within this segment, the US has observed a variance in quality and standards.

This burgeoning marketplace necessitates foresight in regulation to strike a balance between encouraging innovation and safeguarding public health. While some international regulators, like the EU, have taken actions to establish frameworks and standards for telemedicine providers and GLP-1 distributors, they can learn from the US experience on GLP-1 demand to further mitigate risks and ensure quality care.

4. Rational coverage strategies are imperative

The prospect of offering blanket coverage for GLP-1 treatments to all individuals living with obesity is likely financially unsustainable, as the sheer volume of potential recipients can overwhelm healthcare budgets. In 2021, the US spent approximately 18% of its GDP on healthcare (nearly twice of the average OECD country) and is currently unable to provide comprehensive coverage.

The US is not alone in this – even Denmark’s universal, tax-funded health system chooses not to subsidize Wegovy for its citizens, in part because the benefits of the drug did not support the high cost.

Knowing this, other countries should explore targeted coverage strategies that prioritize high-risk populations or those most likely to benefit from GLP-1 therapies. Developing criteria for coverage eligibility and fostering partnerships with specialized GLP-1 care providers can help optimize resource allocation and maximize therapeutic outcomes that justify the cost.

5. Lifestyle support alongside a weight loss drug is essential

Perhaps most importantly, a GLP-1 alone is not enough to achieve optimal outcomes. Clinical trials that enabled US Food and Drug Administration (FDA) approval employed nutrition and exercise plans in concert with the medicine. In fact, FDA labels state that GLP-1s are to be used as an adjunct to diet and exercise.

While these medications alone may appear like a clear path to sustained weight loss, there are challenges in long-term adherence to them, likely in part due to access and cost issues. One study showed that 50% of patients with obesity actually discontinued their GLP-1s after 12 months, and a potential outcome of this discontinuation is significant weight regain.

In an effort to mitigate post-GLP-1 weight regain, and optimize the drug’s value for all parties, studies in the US market have shown that clinically rigorous GLP-1 care via evidence-based, scalable, and digital lifestyle programmes can enhance patient outcomes.

Research has also shown that managing obesity can be a complex journey, and taking GLP-1s is just one aspect of the patient experience. Between managing side effects, mitigating muscle loss and supporting struggles with adherence, patients may require ongoing, specialized care to reap the value of these medications.

Health systems that want to reduce wasted expenditures and cover these medicines responsibly can adopt digital lifestyle programmes that sit alongside GLP-1 prescriptions, and digital programmes are a way to do so in a scalable manner. Markets in the US have demanded this, and the number of digital GLP-1 companion programmes and products continues to grow at a significant rate,.

Preparing for a healthier future

As the GLP-1 supply for obesity treatment becomes increasingly available, the US can serve as a valuable case study that sits a few years ahead of what other countries may soon grapple with. This offers both insights and cautionary tales that can inform global approaches to integrating these therapies.

By understanding and adapting to the lessons learned – through cost management, demand preparedness, marketplace regulation, strategic coverage, and enhanced care for GLP-1 patients– nations can help ensure the effective and equitable deployment of GLP-1s to their citizens.

While a great deal of work lies ahead in adopting and leveraging GLP-1s, the global community can pave the way for a healthier future.

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The views expressed in this article are those of the author alone and not the World Economic Forum.

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