This has led to the hope that GLP‑1 medications could be used broadly to treat the obesity epidemic afflicting the United States. In fact, it appears that many people began taking these drugs to lose weight even before the Food and Drug Administration gave formal approval for that purpose, to the extent that drug shortages have been reported.
There is little doubt that the demand for a drug that could help a person lose weight would be high. The obesity crisis in the United States has been spiraling for decades, and it has caused or contributed to a variety of afflictions as well as early deaths for millions of Americans while costing the health system hundreds of billions of dollars each year. More than 40 percent of U.S. adults are considered clinically obese.
Costs and concerns / Given the effects that obesity has on our society, it is understandable that so many have put their hope into these drugs as a solution for drastically improving health outcomes. For instance, there are now calls for health insurance to cover these drugs when used as a weight loss treatment, and there is bipartisan legislation—the Treat and Reduce Obesity Act—that would authorize Medicare Part D to cover GLP‑1 medications.
However, authorizing the coverage of GLP‑1 drugs for weight loss would be extremely expensive. A recent study in the >New England Journal of Medicine estimated that the annual cost to Medicare could be $13 billion to $26 billion a year, which at the high end would increase the total annual cost of Medicare Part D spending by approximately 25 percent. The cost to private health insurers would be even greater: one estimate is that total annual U.S. spending, private and public, on this class of drugs could exceed $100 billion by the next decade.
This proposed spending is poised to occur despite the fact that some groups are raising concerns about some of the unknown effects of GLP‑1 medications. While randomized control trials and real-life studies have shown the efficacy of GLP-1s on weight loss, diabetes, and other valuable health outcomes of interest, more research is needed to fully appreciate the long-term effects of the drugs on the body, both in terms of successfully treating weight loss and the health consequences of long-term use.
If GLP-1s’ short-term success in helping aid weight loss can be translated to sustained weight loss, the high costs of covering the care could be well worth the money. However, there are concerns on this front. For example, a 2023 study by the pharmacy benefit manager Prime Therapeutics investigated claims data and found that GLP‑1 adherence was poor, with just 32 percent of members persistently using the drugs at one year and 27 percent adherence to therapy during the post-year. Another study found that people tend to regain the weight lost after stopping these drugs. This is worrisome given the high cost of covering these drugs and the tradeoffs in covering them instead of other uncovered health care needs.
It’s also unclear whether all the health maladies that derive from patients’ obesity will quickly disappear with their excess weight after taking a GLP‑1 regime. A recent study in >Medical Decision Making Policy & Practice suggests that senior citizens with diabetes and generally fair or poor current health may not see any health benefits from the drug regime even if they were to lose weight. Conversely, early clinical evidence indicates that one of the drugs, Wegovy, may reduce the relative risk of heart attack, stroke, or heart-related death, suggesting a potentially high value of these drugs for other non-weight loss purposes.
In general, GLP‑1 medications hold tremendous potential to become an important tool in fighting the obesity epidemic and improving health outcomes in America and globally. But there are potentially large financial, health, and adherence costs that need to be better understood. It will take time to appreciate the long-term effects and more completely access the tradeoffs of this costly investment. As a result, careful and diligent study is prudent at this time, so we can assure that Americans are investing in a well-understood and best-use option for the long run.
