NEW YORK, July 22 (Reuters) – Many patients have opted for injectable forms of the wildly popular GLP-1 obesity medications through a pilot program of the U.S. government’s Medicare health insurance program for Americans aged 65 and older, according to early indications from doctors and analysts
The U.S. Centers for Medicare & Medicaid Services this month launched an 18-month trial program that for the first time opens access to Novo Nordisk‘s Wegovy and Eli Lilly’s Foundayo and Zepbound as weight-loss treatment alone for a monthly cost of $50
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Millions of people are expected to qualify, and doctors are already being flooded with interest from patients aged 65 and older. For the most part, they say the process is going well — with some hiccups
Many pharmaceutical industry experts had expected that patients would prefer pills over injections, for convenience. Novo’s U.S. chief Jamey Millar in June said the firm’s research indicated that Medicare beneficiaries prefer the oral pill to the injectable on a two-to-one basis
Yet eight of 10 doctors interviewed by Reuters and three pharma sector analysts said many are opting for the injectables
“Hands down — these patients are asking for injections as they know they work and it has been so costly in the past,” said Dr. Sarah Ro, director of University of North Carolina Health’s weight-management program
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Ro said patients who meet the criteria have been generally receiving approvals quickly once the clinicians became familiar with the process
COMPARING WEIGHT-LOSS DATA
U.S. approvals for injectable Zepbound and Wegovy were based on separate trials in which the Lilly drug helped patients lose more than 22% of their weight after 72 weeks, while Wegovy led to 15% weight loss after 68 weeks
Oral Wegovy led to about a 14% reduction in body weight over 64 weeks, and Foundayo about an 11% reduction over 72 weeks, in separate studies
“Prescribing patterns have evolved over time as new options have become available, but the majority of patients are still prescribed injectable therapies,” said analysts with investment bank William Blair in a July 13 note, citing a call with an obesity medicine specialist
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To be sure, demand for the Wegovy pill has been strong, and analysts said the most recent publicly available data from data firm IQVIA show that prescriptions for Lilly’s pill Foundayo jumped in the week to July 10. IQVIA did not confirm the data
But patients generally seem to be opting for the injectables once they learn about the efficacy
“A year ago if you’d asked me, I would have thought people would be jumping at the pill,” said RBC Capital Markets analyst Trung Huynh. “But it turns out that for most people, it’s all about efficacy.”
Spokespeople for Lilly and Novo said they were pleased with the new Medicare program. The Lilly spokesperson said the program is “working very well” and the firm is encouraged by the strong interest. Neither drugmaker provided any details about specific volumes
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FRUSTRATIONS OVER MIXED ACCESS
A CMS spokesperson said the Medicare program’s first weeks have been “positive” with most authorizations completed in under 12 hours
But patients’ ability to get coverage under the demo has been mixed, according to both doctors and patients
Katie Smith, who asked her doctor to send in the prescription on July 1, said she is still waiting for word if she’ll be covered. The Virginia retiree said she is frustrated after years of being unable to access these medications due to cost. The companies’ direct-to-consumer prices range from $149 to $449 per month
“I’m not really sure what’s happening,” she said
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The process has also been “cumbersome” for doctors, said Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai’s Center for Weight Management and Metabolic Health in Los Angeles
“This has required numerous hours and numerous clinical staff and clinicians to come together to make standardized protocols, order sets, and troubleshoot to try to get through the red tape to get access to GLP1RAs for our patients,” she said
Still, many are seeing success. Dr. Christina Nguyen of weight-loss clinic Knownwell in Atlanta said nationwide it had received approvals for about 200 patients in the first week
“We’re getting several approvals every day, if the patient meets the criteria,” she said
(Reporting by Chris Prentice and Mariam Sunny in Bengaluru; editing by Caroline Humer and David Gregorio)
