As pharmacare gets started in Canada, whether or not to fund weight-loss drugs poses a major dilemma, given the high costs of treating weight-related ailments.
Governments will sometimes say no to paying for costly but not very effective drugs. If the list of covered drugs is too limited, frustrated patients and providers will object, pharma will lobby hard, and private insurance will swoop in to reinforce a two-tier system.
If the public list is too inclusive, costs will skyrocket. It’s a public policy high-wire act.
Weight-loss drugs present a classic dilemma just as pharmacare is finding its feet. I can’t go into the nuances of semaglutides and tirzepatides, and whether the drugs are officially approved for weight loss or not.
Utilization has exploded, and most people who take one of these drugs for a year lose 10 per cent to 20 per cent of their body weight. The jury is out on whether gradual discontinuation can sustain these results.
This is the biggest weight-loss breakthrough since bariatric surgery, crushing the success rates of diet and exercise alone.
If only two per cent of the population had weight-related health risks, and half were good candidates for these drugs, the costs would be substantial. One per cent of the population aged 20 to 75 is about 300,000 people.
If all drugs were priced at the Ozempic level — about $3,600 a year — the annual cost would be about $1.1 billion. It’s a lot, but sustained weight loss should eliminate or defer costly health expenditures down the road. A billion and change is arguably a bargain.
End of story? Maybe. A peer-reviewed study estimates the actual cost of producing these drugs at about $60 a year or even lower — 1/60th of the current price. If the price were $120 a year for 10 million patients, the annual cost would be $1.2 billion.
By comparison, Canadians spend $7 billion to $10 billion annually on commercial weight-loss programs and products, most of which are completely or mainly useless.
Drug prices plummet when their patents expire and generics enter the market. The patents on semaglutide (Ozempic, Wegovy et al.) don’t expire until the end of 2031 at the earliest. Given the enormous profit margins at current prices, they could be cheaper now.
But Pharma could stand firm on the grounds that even at current prices, the drugs are much better value for money than most others. Don’t expect 10 bucks a month anytime soon.
Even if the drugs were free, it’s not a slam dunk that so many should take them. Emerging evidence is encouraging; recent studies report that the drugs reduce cardiovascular events, kidney failure and all-cause mortality among people with Type 2 diabetes and chronic kidney disease.
Perhaps the drugs will turn out to be gifts that keep on giving. Only time will tell.
If patients can discontinue use and sustain their weight loss, it’s a win-win. Otherwise, it’s a lot of pain for inevitable regain.
Drugs with millions of potential patients are a platinum-grade disruption. Prudence dictates caution.
But if studies confirm the successes to date, there will be pressure to make the drugs a go-to option for weight loss. Governments will have to balance the holy trinity of volume, price and impact.
Provinces will want more money from Ottawa. Critics will decry the medicalization of what is significantly a food quality and affordability problem. People will continue to stigmatize weight problems as individual moral failures rather than chronic medical conditions.
This is a clinical and financial minefield, and a huge challenge for pharmacare in its infancy. Let the chess match begin.
Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at [email protected].
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