UnitedHealth Group, which runs one of the nation's largest health insurance companies, is sounding alarms over the cost of new weight-loss drugs being prescribed to millions of Americans.
The drugs, a class known as GLP-1, have the potential to help many patients with obesity, but U.S. list prices can run up to 10 times higher than in Western Europe, said Andrew Witty, UnitedHealth Group's chief executive, during a call with investors Friday.
Many employers hire the Minnetonka-based company to manage their health plans and those clients are struggling with what looks like "an open-ended financial risk," Witty said.
"Innovation that is not affordable is not innovative," he said. "I don't think anybody at UnitedHealth Group has any argument with the prospects and possibility for the future of this drug class. ... But, ultimately, it has to be affordable."
The drugs, which include medicines sold under the names Ozempic and Wegovy, have been touted widely on social media over the past year. They've also become a frequent talking point for celebrities ranging from Tracy Morgan to Amy Schumer.
In August, the California-based health research group KFF published a study showing the list price for a one-month supply of Ozempic was $936 in the U.S. compared with $103 in Germany, $96 in Sweden and $93 in the United Kingdom.
The overall impact on health-cost trends is unclear since it's not known how long patients need to take the drugs and there are unknowns on side effects, said Krutika Amin, a researcher at KFF. What's more, people using the medications might avoid the cost of other treatments and therapies.
Novo Nordisk, the Denmark-based pharmaceutical giant that manufactures both drugs, said the U.S. list price doesn't reflect what patients pay out-of-pocket when the treatments are covered by health insurance. The company said in a statement to the Star Tribune that while about 110 million American adults live with obesity, a large number don't have coverage for anti-obesity medications.
"Every country has a unique health-care system and approaches pricing of medicines in different ways," the company said. "Novo Nordisk believes the most effective way for the millions of Americans who need anti-obesity medicines to be able to access and afford them is to ensure these medicines are covered by government and commercial insurance plans."
In September, analysts with BofA Securities projected the cost impact for insurers would change over time — going from inflationary in the near term to producing modest savings down the road as demand decreases for sleep apnea and dialysis treatments.
"The price of the drug is immediate while the cost savings they generate build over time," analysts wrote in a report for investors.
Ozempic was approved for the treatment of Type 2 diabetes — to improve blood sugar, along with diet and exercise — and reduce the risk of major cardiovascular events such as heart attack and stroke. It's not approved by U.S. regulators for chronic weight management, but has been prescribed on an "off-label" basis.
Wegovy, which has the same active ingredient, has been approved by the Food and Drug Administration for chronic weight management in certain adults with obesity or who are overweight with weight-related medical problems. It's to be used, the manufacturer says, with a reduced-calorie meal plan and increased physical activity.
At UnitedHealth Group, about 80% of prescriptions for GLP-1 medications go to patients for help with diabetes, while up to 20% are for weight loss, said Brian Thompson, chief executive of UnitedHealthcare, the company's insurance division.
Most of the coverage is provided by "self-insured" employers, typically large companies that take the financial risk for medical costs. They hire UnitedHealth Group to administer their employer health plans.
"As we look forward — are our customers considering to cover more or cover less — I would say it's a mixed bag," Thompson said. "Some are seeking coverage, albeit dissatisfied with the price points, some are backing off given the cost. But I wouldn't really be directional one way or the other on whether or not we're seeing more or less coverage on the weight-loss side."
Beyond lowering the list price, UnitedHealthcare is trying to work with manufacturers to connect pricing to patient outcomes and adherence levels, Thompson said. This summer, Eagan-based Prime Therapeutics announced study results showing that only 32% of patients with obesity or prediabetes were still taking the drugs for weight loss a year after they were prescribed.
The report from BofA Securities forecast the weight-loss drugs could provide a "solid tailwind" for pharmacy benefit manufacturers like Optum Rx, which is part of the Optum health services business at UnitedHealth Group.
"Our customers ... are concerned about the prices of GLP-1s as set by manufacturers," Dr. Patrick Conway, the chief executive of OptumRx, said Friday. The division is implementing "clinical evidence-based guidelines so the right people get appropriate medicines."
Excitement over the new weight-loss medications is not confined to patients and celebrities. Given the potential with the drugs, groups like the Institute for Clinical and Economic Review (ICER), a nonprofit research group based in Boston, have launched cost-effectiveness reviews to better quantify their value.
"The vast majority of people with obesity cannot achieve sustained weight loss through diet and exercise alone," Dr. David Rind, the chief medical officer at ICER, said in a statement. "As such, obesity, and its resulting physical health, mental health and social burdens is not a choice or failing, but a medical condition. The development of safe and effective medications for the treatment of obesity has long been a goal of medical research that now appears to be coming to fruition."
On Friday, UnitedHealth Group reported a third-quarter profit of $5.84 billion, up 11% from the same period last year. The results beat expectations and prompted the company to raise the lower end of its earnings guidance for the year.
