Four novel prescription weight-loss agents have launched in the United States since 2012: Vivus’s Qsymia (phentermine/topiramate ER), Arena Pharmaceuticals/Eisai’s Belviq (lorcaserin), Orexigen Therapeutic/Takeda Pharmaceutical’s Contrave (naltrexone SR/bupropion SR), and Novo Nordisk’s Saxenda (liraglutide 3 mg). However, therapeutic options remain limited, despite the high prevalence of overweight and obesity in the United States and increasing awareness of this public health issue. The reimbursement environment for pharmaceutical obesity treatments is challenging; the high prevalence of obesity has restricted access to medical treatments because healthcare budgets cannot afford widespread use of expensive new medications. In time though, the increase in weight-related comorbidities and complications, particularly type 2 diabetes, will pressure insurers’ healthcare resources. Consequently, the market opportunity for a safe and well-tolerated pharmaceutical agent that can induce satisfactory weight loss is considerable, but drug developers will need to be aware of the unique dynamics of the of the obesity market to ensure access, secure reimbursement, maximize uptake, and realize the commercial potential.

Questions Answered in This Report:

  • The obesity market is potentially lucrative, but few prescription weight-loss agents have been commercially successful. How widespread are formulary exclusions of weight-loss drugs in commercial and Medicare prescription drug plans? Which clinical and economic factors are important to managed care organizations when deciding coverage of obesity agents? What kinds of restrictions do PCPs and endocrinologists face in prescribing obesity agents?

  • Despite the availability of some efficacious weight-loss treatments, pharmacotherapy rates are low, and treatment options are few and poorly reimbursed. How do payers’ decisions influence prescribing of weight loss therapies? Will cardiovascular outcomes trials positively affect MCO coverage of these therapies? What percentage of patients do physicians say are paying out of pocket for these drugs?

  • New and emerging prescription weight-loss therapies have advantages and disadvantages over their more established competitors. How do MCO pharmacy and medical directors anticipate covering Zafgen’s emerging therapy beloranib based on various pricing scenarios? What do physicians consider to be the top drivers of prescribing for these new agents? How can market access to new and emerging prescription weight-loss agents be maximized?

Scope:

Markets covered: United States.

Primary research: Online survey with 71 endocrinologists and 70 primary care physicians (PCPs) and 31 MCO medical and pharmacy directors.

Author(s): Stefanie Hoffart, M.Sc.