THE SET-UP: Pharmaceutical companies are banking on cashing in on Ozempic, Wegovy, Mounjaro or one of the 16 variations now coming through various pipelines … and not just for obesity. Today’s big reveal is a study suggesting GLP-1s might even “cure” alcohol and drug addiction. The ever-expanding list of diseases and conditions GLP-1s may treat is why a $44 billion market is projected to more than double to $95 billion by 2031.
Its also spawning a new class of drug dealers.
That’s what a new investigation by STAT found … unfortunately, that story is locked behind a paywall. But I was able to cobble together a Frankenstory from the preview and two of STAT’s newsletters. I think you’ll get the gist. - jp
TITLE: How invisible medical groups are powering telehealth’s GLP-1 ‘gold rush’
https://www.statnews.com/2024/10/17/telehealth-online-compounded-glp1-prescriptions-medical-groups/
https://www.statnews.com/2024/10/17/the-glp-1-telehealth-boom-blue-note-cancer-startup-health-tech/
EXCERPTS: In the last two years, telehealth has gone all in on GLP-1s. Dozens of companies have started to offer the wildly popular obesity and diabetes medications, meeting patients who are flooding online for prescriptions that could help them lose as much as 20% of their body weight.
The telehealth GLP-1 boom wouldn’t be possible without clinicians willing to write prescriptions for those hundreds of thousands of patients. Companies are rarely transparent — with patients or the public — about the medical groups behind the screens. But a STAT examination found that just a handful of networks of doctors, nurse practitioners, and physician assistants are writing prescriptions for dozens of websites offering the weight loss drugs, including the compounded versions that have been the subject of conflict and debate among clinicians and industry members.
Telehealth companies have been able to get off the ground in a matter of days by “renting” the services of these medical groups, which have established themselves as an invisible but critical piece of the puzzle enabling the digital cash grab surrounding GLP-1s. That online “gold rush,” clinicians and digital health experts have warned, could put patients at risk by reducing the provision of care to the mere sale of a drug.
Just a handful of networks of doctors, nurse practitioners, and physician assistants are writing prescriptions for dozens of websites offering the GLP-1 weight loss drugs, including the compounded versions that have been the subject of conflict and debate among clinicians and industry members.
Several telehealth companies tied to these medical groups have nudged potential patients to downplay health conditions such as being pregnant or breastfeeding that could disqualify them from receiving the weight loss drugs.
“This is a humongous red flag, and very scary to me,” obesity physician Scott Kahan told STAT’s Katie Porter. “When you set it up in this scenario, the incentives are so misaligned that I can’t imagine it would not be rife with abuse and profit-driven prescribing rather than medical prescribing.”
TITLE: By selling copycat weight-loss drugs, WeightWatchers has become a copycat business
https://www.fastcompany.com/91208476/weightwatchers-compounded-weight-loss-drugs-bad-idea
EXCERPT: Last week, the company announced that it would start providing clinic customers whose insurance doesn’t cover name-brand medication access to compounded versions of Novo Nordisk’s blockbuster drugs Ozempic and Wegovy. The news sent WeightWatchers stock soaring.
“Given the ongoing shortages of branded medications such as Ozempic and Wegovy, WeightWatchers is committed to ensuring our members still have access to effective alternatives and the support they need to achieve the health outcomes they deserve,” [interim CEO Tara] Comonte said in a press release. The company is partnering with a compounding facility registered with the Food and Drug Administration to manufacture the drugs, which will cost members of WeightWatchers Clinic roughly $129 per month out of pocket—as opposed to more than $1,000 for brand-name GLP-1s.
The move could unlock some quick revenue for the company, enticing members whose insurance won’t cover brand-name drugs, or who are dissatisfied with WeightWatchers’ traditional points-based diet method. Just under half of WeightWatchers members already meet the requirements for a GLP-1 prescription (a BMI of 30 or above, or a lower BMI with comorbidities like diabetes or cardiovascular conditions).
But the decision to offer copycat drugs is a risky long-term strategy. To start, WeightWatchers is still playing catch-up with other telehealth companies and online pharmacies that already offer both brand-name and compounded GLP-1s. And acquiring new customers will be tough. Rivals have been shelling out for customers’ attention, via social media marketing, subway ads, and other methods. WeightWatchers will have to keep up.
WeightWatchers’ full-throated embrace of GLP-1s—especially compounded ones—could also erode its credibility with consumers. The brand has spent more than 60 years marketing itself as a trusted, reliable, community-based support program. That message was already muddied by WeightWatchers’ decision to offer GLP-1 prescriptions. It could be further compromised by the pivot toward compounded semaglutide.
One issue is that pharmacies that manufacture copycat versions of name-brand drugs are subject to uneven regulatory scrutiny. Some compounding facilities are FDA-approved; others operate without regulatory approval, which has led to adverse effects for some patients like vomiting and illness.
WeightWatchers says that it’s contracting with an FDA-registered facility. But even if it follows the highest safety standards for its compounded semaglutide, it’s sending customers a decidedly mixed message for a business that, at its heart, is about selling people on behavioral change.
Dietician and eating disorder specialist Christy Harrison says that doctors across the weight-loss ecosystem are seeing patients ask for GLP-1s as a result of the surge in marketing from telehealth companies. “So many people come in just wanting [GLP-1s] and don’t want to talk about behavioral things they can do to support their health.”
By seeking out a quick profit through compounded medications, WeightWatchers may become just another online pharmacy trying to grab customers’ attention and help them gain access to cheaper medication.
Key Lessons for Ethical and Affordable Access to GLP-1 Drugs Like Ozempic and Wegovy
https://ldi.upenn.edu/our-work/research-updates/key-lessons-for-ethical-and-affordable-access-to-glp-1-drugs-like-ozempic-and-wegovy/
EXCERPTS: The clinical success has made GLP-1 receptors meteorically popular, but the drugs are costly, sparking widespread debate about their affordability and accessibility. The drugs come at a high cost for Americans, who pay around $1,000 per month if their health insurance does not cover it. And in fact, insurers rarely cover the weight management formulations, so many who might benefit from the drug but cannot afford to pay go without.
GLP-1 receptors are less expensive in many other countries (for example, a recent U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) hearing noted that Ozempic costs over 15 times more in the United States than in Germany), but still not necessarily affordable. In the study appendix, investigators found that the price of Wegovy varies by up to five times across different countries, with the U.S. paying the most at $1,349 and Japan paying the least at around $280. This is the most detailed public data on international prices so far. As a result, many countries with public health systems face distressing decisions about whether to reimburse these drugs and, if so, for which groups.
Drawing lessons from other countries’ approaches to covering GLP-1 drugs, LDI Senior Fellow Ezekiel Emanuel and colleagues give four key guidelines that should inform future policies to ensure fair and effective access to these critical medications across the U.S. and internationally.
Use up-to-date cost-effectiveness analysis: Coverage decisions must incorporate the latest data on the clinical benefits of GLP-1s. Though only a few years old, many previous analyses were outdated and did not reflect more recent findings, such as the cardiovascular benefits of these drugs. New data is regularly published, finding new or magnified benefits of GLP-1s. Therefore, particularly for these drugs, frequent updates are essential to accurately assess the drugs’ long-term benefits.
Lower prices but keep them high enough to provide long-term innovation incentives: While reducing prices is critical, they should remain sufficient to incentivize research and development at pharmaceutical companies. Because GLP-1s are cheap to make, they may also be candidates for alternative payment models, such as subscription-based agreements that give firms large payments in exchange for a nearly unlimited supply of drugs for the whole population. This could help ensure broader access while maintaining company profitability.
Set priorities for coverage rather than issuing blanket denials: Instead of wholesale refusals of coverage, policymakers should prioritize individuals who could benefit most from these drugs. To ensure that those most in need receive treatment even if cost constraints limit broader access, coverage should be allocated based on criteria such as severity of obesity, comorbidities, and age. The current U.S. system relies largely on the patient’s ability-to-pay which is not ethical, the authors write. This is evidenced by the fact that GLP-1 use in the United States is concentrated not in areas with the most obesity, but in areas with the highest average income.
Treat high-cost drugs similarly regardless of the condition they treat: It is not right to cover GLP-1 drugs for diabetes but not for obesity. Deep-seated bias may lead governments to avoid treating people with obesity, because the condition can be seen as a failure of will. Avoidance also may derive from the number of people with obesity being so large—far larger than the number with diabetes—and therefore more costly to treat, the authors note. Still, countries should adopt fair policies for coverage and pricing, regardless of the drugs’ novelty or condition they treat. Barring new drugs simply because they treat a so-called lifestyle disease fails to maintain “a standard of equal moral concern.”