Weight-Loss “Anti-Obesity” Medications Remain Inaccessible to Demographics Who Truly Need Them

Fhasal Alam

The conversation surrounding prescription weight-loss medications, or “anti-obesity” drugs, has skyrocketed amidst new developments. Wegovy and Ozempic, two weight-loss drugs that recently entered the market, have given patients in the United States the tools to control their weight—perhaps without necessarily changing other aspects of life usually recommended by physicians, including diet and exercise.

Throughout the 20th and 21st centuries, both American and worldwide obesity rates have substantially increased. As reported by the WHO in 2016, “40% of adults were considered overweight and 13% had obesity,” having tripled since 1975.¹ As a result, pharmaceutical companies like Novo Nordisk, the creator of Wegovy and Ozempic, have mobilized to both create innovative solutions to deliver results and maximize profits amidst the standard Western ‘busy’ life oriented towards unhealthy diets. However, new implications in the sociological and psychological landscapes have emerged; namely, how these drugs will affect the barriers for lower-income patients in the United States, especially for those whose insurance will not cover such expensive and new drugs.

Drugs targeting weight loss and obesity should be offered as a complementary component of a broader health care plan, by which all weight-loss drugs are covered under government-funded insurance programs. Preventing government-funded programs from covering such drugs creates a barrier to access, allowing wealthy citizens to receive accessible care while posing a severe economic burden to lower-income citizens. Today,both public and private insurance companiesrestrict covering medications related to weight loss. Medicare, for instance, still follows an outdated law under the Medicare Modernization Act.² Under the 2003 modifications, Part D prevents the use of covering drugs primarily used for weight loss, which were due to to safety concerns at the time associated with ingredients like fenfluramine and phentermine potentially causing fatal hypertension.³ After employment-based insurance, Medicare and Medicaid were the most common types of insurance at 18.4 percent and 17.8 percent, respectively.⁴ Thus, medicare and other public insurance plans should thus extend their coverage to include these potentially life-changing drugs.

When government programs restrict access to lower-income individuals, high-income populations are favored, for those are largely the customer basis. This constant loop, where the high-income populations are purchasing weight-loss drugs and the companies producing such drugs are prioritizing wealthy populations to maximize profit, poses a threat to the American healthcare system, exacerbating current obesity rates depending on the socioeconomic status of individuals and areas throughout the United States. Company Novo Nordisk reports that due to the low supply of their weight-loss drugs, they mitigate the costs by severely inflating the purchase price—so much so that it’s valued at $1,349 a month.⁵

Along with the price, the patent of the drug also poses an issue. Arguments can be made that because the company developed the drug, it should maintain undivided access to its manufacturing and sale. The US Patent and Trademark Office rejected a challenge by another pharmaceutical company, Mylan, from potential access to manufacture and distribute semaglutide.⁶ Thus, access to manufacture and distribute the core ingredient of Ozempic and Wegovy, semaglutide, is not available to other companies. While maintaining intellectual property is an important incentive for drug development and advancements in novel therapeutics, considering the issue of inaccessibility to patients due to cost proves it null. When at-risk demographics cannot access medications due to monopolization, it poses a threat by exacerbating healthcare inequality.

Beyond socioeconomic status, the evidence for marginalized populations accessing vital prescription drugs—particularly, black and Hispanic populations—is shocking. Racial bias in healthcare underscores insufficient treatment for vulnerable populations. For example, black patients are 17% less likely to receive pain treatment for “extremity fractures in the emergency room,” at lower dosages.⁷ Such biases may stem from malpractice of deliberately not giving adequate pain medication or perceptions of the patient as having an atypical pain tolerance. Extending this racial bias of providing inadequate pain medications to the prescribing of weight loss medications to black patients highlights the exacerbation of healthcare inequality for vulnerable populations. Lack of insurance coverage may elicit lower prescription rates of obesity medications to patients identifying with marginalized communities.

The intersectional tensions between socioeconomic status and race highlight the importance of extending healthcare coverage for Ozempic and Wegovy. Lower-income populations are already underserved in weight loss healthcare, and those identifying as black or Hispanic within those populations are more at risk.

Further, restricting insurance companies from covering these weight-loss drugs also threatens raw costs for consumers. Without insurance companies providing lower rates against one another, lowering selling prices is not incentivized. However, advocacy for policies undertaken in the past has enabled the covering and decrease of drug prices previously seen as unnecessary. For example, organizations including the American Association of Retired Persons (AARP) have advocated for the fair coverage of vital drugs, including insulin. As a result, drug companies must “be transparent about their prices” and state governments have established “drug affordability boards, which have the authority to evaluate the cost of drugs and to make recommendations on how to get prices down,” along with the Inflation Reduction Act of 2022 that enables Medicare to negotiate prices with pharmaceutical companies.^8,9 Such policy changes highlight the importance of advocacy in the healthcare policy field. Legislation is needed to prevent the monopolization of and extend public insurance coverage for weight loss drugs.

The stigmatization of obesity proves an unsettling obstacle in changing the dynamics between treating obesity and allowing insurers to cover the medications. Because current U.S. policymakers may not align with the medical view that obesity is, indeed, a medical condition that should be treated under medical practice and a health plan, strategies to allow insurers to cover the medication may be stifled. This stifling can only occur for so long; millions of Americans cannot afford such expensive medications. Advocacy for healthcare policy truly makes a difference in changing access to drugs. Although the journey takes years for implementation, we must continue to hinder the exacerbation of healthcare inequality and spearhead healthcare policy change to foster marginalized populations’ accessibility to weight-loss drugs.

References

1. Prillaman, M. (2023). The “breakthrough” obesity drugs that have stunned researchers. Nature, 613(7942), 16–18. https://doi.org/10.1038/d41586-022-04505-7
2. Social Security Administration. (2019). Medicare modernization act. Ssa.gov. https://www.ssa.gov/privacy/pia/Medicare%20Modernization%20Act%20(MMA)%20FY07.htm
3. Tu, L. (2023). Should Insurance Cover Wegovy, Ozempic and Other New Weight-Loss Drugs? Scientific American. https://www.scientificamerican.com/article/should-insurance-cover-wegovy-ozempic-and-other-new-weight-loss-drugs/#:~:text=Most%20private%20insurance%20companies%20and
4. Bureau, U. C. (2021). Health Insurance Coverage in the United States: 2020. Census.gov. https://www.census.gov/library/publications/2021/demo/p60-274.html#:~:text=Of%20the%20subtypes%20of%20health
5. Kolata, G. (2023, June 14). New Obesity Drugs Come With a Side Effect of Shaming. The New York Times. https://www.nytimes.com/2023/06/14/health/obesity-drugs-wegovy-ozempic.html?login=smartlock&auth=login-smartlock&login=smartlock&auth=login-smartlock
6. Arkin, J. (2023). Novo Nordisk Beats Challenge to Wegovy, Ozempic Obesity Patents. News.bloomberglaw.com. https://news.bloomberglaw.com/ip-law/novo-nordisk-beats-challenge-to-wegovy-ozempic-obesity-patents
7. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial Bias in Pain Assessment and Treatment recommendations, and False Beliefs about Biological Differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113
8. Bunis, D. (2022, August 16). Prescription Drug Win Caps AARP’s Yearslong Fight for Lower Prices. AARP; AARP. https://www.aarp.org/politics-society/advocacy/info-2022/fight-to-lower-prescription-drug-pr ices.html#:~:text=Since%202019%2C%20AARP%20state%20offices
9. Centers for Medicare & Medicaid Services. (2023, September 12). Inflation Reduction Act and Medicare | CMS. Www.cms.gov. https://www.cms.gov/inflation-reduction-act-and-medicare