Drug pricing watchdog ICER offers ways to increase obesity drug access

Title

"ICER Proposes Strategies to Expand Access to Costly Obesity Medications"

Keywords

ICER (Institute for Clinical and Economic Review)
Obesity treatment
GLP-1 drugs (e.g., Wegovy, Saxenda)
Drug pricing
Access and affordability
Semaglutide
Healthcare policy
Step therapy
Obesity management
Treat and Reduce Obesity Act (TROA)

Key Facts

- ICER's Objective:
The Institute for Clinical and Economic Review (ICER) aims to address the limited access to obesity treatments like semaglutide (Wegovy) through policy recommendations and affordability measures1 4.

- Current Cost Barriers:
Medications such as Wegovy and Saxenda are considered effective but expensive, with annual prices exceeding typical cost-effectiveness thresholds. For example, semaglutide's cost per year is approximately $13,618, far exceeding ICER’s recommended range of $7,500–$9,8001 6.

- Access Challenges:
Less than 10% of qualified patients can access GLP-1 medications through insurance due to high costs, payer hesitancy, and restrictive utilization policies, such as step therapy and prior authorization5 7.

- Policy Recommendations:

* - Manufacturers:*
Set drug prices proportional to their demonstrated health benefits.

* - Payers:*
Ensure insurance designs grant fair access and minimize excessively restrictive policies like prior authorization.

* - Government:*
Enact laws such as the Treat and Reduce Obesity Act (TROA) to expand Medicare coverage for weight-loss drugs. States should also include these treatments under Medicaid programs4 5.

- Economic Impact:
ICER has highlighted the potential strain of high budget impacts from obesity drugs on healthcare systems, necessitating pricing reform and broader accessibility initiatives to prevent inequities in treatment availability1 4 7.

- Future Forecasts:
Legislative actions like TROA and ongoing outcomes studies (e.g., cardiovascular benefits of Wegovy) may shape a more favorable access landscape for obesity therapies, with reduced prices under acts like the Inflation Reduction Act in the coming years4 5.