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Commentary: Navigating the Obesity Market

Challenges and Funding Dilemmas from an International and Nordic Perspective.

It is no secret that obesity is one of the biggest public health challenges of the 21st century and is one of the leading causes of preventable death globally. It’s estimated that 18% of the global population is obese, with the prevalence of obesity in the Nordics at somewhere between 15% to 21%, with these numbers only expected to rise.

This is the first time that pharmacological interventions have shown to deliver meaningful weight loss.”

Unsurprisingly, the arrival of the GLP-1 receptor agonists as weight-loss medications have captured the world’s attention as potential solutions. This is the first time that pharmacological interventions have shown to deliver meaningful weight loss. The large diabetes companies Novo Nordisk and Lilly are currently leaders in the obesity market.

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The obesity pipeline has more than 80 clinical-stage assets that are being investigated in trials. GLP-1s, on their own or in combination with GIP agonists, account for 35% of current candidates. Glucagon/GLP-1R dual agonists and glucagon/GLP-1R/GIP triple agonists account for 21% of the obesity pipeline, while amylin analogues represent 15%. The remaining 29% includes a range of different mechanisms of action, such as, SGLT2, MGAT2, MC4R, PDE5, PYY, and insulin-receptor modulator. As competition heats up, ultimately head-to-head trials will be needed to demonstrate unambiguous differentiation, which Lilly and Novo have both recently embarked on with Lilly’s SURMOUNT-5 obesity trial and Novo’s REDEFINE 4 trial. Real-world data will also be crucial to understand the long-term value, not only in reducing obesity, but also in obesity-related comorbidities.

It is safe to say that the obesity market has shaken up the pharmaceutical industry, which is seeing unusually high levels of out-of-pocket spend.”

It is safe to say that the obesity market has shaken up the pharmaceutical industry, which is seeing unusually high levels of out-of-pocket spend. However, despite the present optimism in the market, the future progress of these weight-loss treatments is far from linear. One of the largest challenges facing the market is how these treatments will be funded in the future. While patients are currently showing a large willingness to pay out of pocket for these medications, it raises concerns of equity of access as well as uncertainty regarding the willingness to pay out of pocket in the future, once the novelty of these treatments wears off.

At present, there is a general reluctance from payers around the globe to reimburse these treatments due to the vast cost it would put on healthcare systems. With that said, the FDA has recently decided to partially reimburse the use of Wegovy in overweight and obese patients with cardiovascular disease at risk of stroke and heart attack. Other countries will be very eager to learn about the impact of reimbursed usage on both patient outcomes and overall healthcare costs. Innovative contracting models such as subscription and volume-based models are being discussed internationally to find opportunities for reimbursement within feasible budgets.

In the Nordics, Saxenda and Wegovy are available in all countries for patients to pay, largely, out of pocket and Mounjaro is expected to become available towards the end of 2024. There has been some success in reimbursement for GLP-1s for use in obesity, but it has by and large, been short lived. Finland is the only country in the Nordics to have partial reimbursement of Saxenda, where 40% of the cost is covered but only for patients with a BMI of 35 or higher who are also prediabetic and on treatment for hypertension or dyslipidaemia. In Norway, Saxenda was initially reimbursed, however, it lost reimbursement when Wegovy was denied reimbursement in January 2023. In Denmark, Wegovy was partially reimbursed by the private health insurer “Danmark,” but they have also stopped this as of January 2024. In Sweden, Saxenda was denied reimbursement in 2020 and there has been no application for Wegovy. However, in a bid to tackle the rising demand for obesity medications from patients and physicians alike, and to address the lack of reimbursed options, the Nordic countries have decided to approve and reimburse Qsiva, an oral appetite suppressant, that was previously denied EMA approval. It is expected to enter the markets in late 2024.

Despite the lack of reimbursement, there has still been an impressive uptake of GLP-1 treatments locally for obesity. In Sweden, the number of patients on Saxenda grew by 74% from January 2023 to January 2024. In the same period in Denmark, the number of patients on Wegovy grew by 247% and the total sales of Wegovy in Norway grew by a staggering 590%. It will be interesting to follow the development of these treatments to see if interest continues to grow at the current pace or if it tapers off as the hype fades.

Regardless of what the agreements may be in the future, we can be sure that positive cardiovascular outcomes data will be critical to demonstrate cost-savings for health systems and to unlock wider access to novel obesity treatments.”

Regardless of what the agreements may be in the future, we can be sure that positive cardiovascular outcomes data will be critical to demonstrate cost-savings for health systems and to unlock wider access to novel obesity treatments. A wide range of stakeholders including, HCPs, professional associations, patient organizations, and policy makers will need to work together rigorously to help elevate obesity as a public health priority and ensure that patients are able to benefit from these new treatments.

Undeniably, this is an exciting time for the obesity market and the future of this market in 2024 and beyond will determine whether this opportunity will be realized as one of the most significant in decades for the pharmaceutical industry.

Jennifer Lees

About the Author

This Commentary was originally written by Jennifer Lees, Consultant, Iqvia, for NLS magazine No 02 2024, out May 2024.

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