Obesity – Access & Reimbursement – Access & Reimbursement – Obesity / Overweight (US)
Obesity is a significant public health concern. Although inexpensive phentermine is commonly prescribed for weight management, newer therapies like glucagon-like peptide-1 (GLP-1) receptor agonists and glucose-dependent insulinotropic polypeptide (GIP) / GLP-1 receptor agonists are gaining popularity owing to their superior efficacy. However, high prices and poor reimbursement environments often limit the prescription of these novel weight loss medications for obese / overweight patients. While branded therapies like Novo Nordisk’s Wegovy (semaglutide SC) and Eli Lilly’s Zepbound (tirzepatide) offer significant weight loss benefits, they are often associated with high patient out-of-pocket (OOP) costs and various cost controls instigated by payers. Nevertheless, the increasing demand for these therapies has resulted in shortages, presenting new challenges for payers and physicians in overseeing their use.
Question answered
- Which antiobesity therapy has the highest rate of preferred tier coverage on MCOs’ largest fully insured commercial plans?
- What restrictions do payers impose, and how do market access dynamics influence the surveyed physicians’ prescribing?
- Launched in November 2023, how will MCOs cover Eli Lilly’s Zepbound in their commercial plans? Will the results from the Phase 3 SURPASS-CVOT study lead to more favorable coverage of Zepbound?
- How do the MCOs think they will cover the emerging therapies including Eli Lilly’s orforglipron and retatrutide for obesity?
Content highlights
Geography: United States
Primary research: Survey of 50 U.S. endocrinologists and 50 U.S. primary care physicians; survey of 30 U.S. managed care organization pharmacy and medical directors
Key drugs: Phentermine, Qsymia, Saxenda, Wegovy, Xenical, Zepbound
Key companies: H2-Pharma, Eli Lilly, Novo Nordisk
Product description
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment. Each report includes up-to-date analyses of drug coverage and restriction policies as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies.
Solution enhancement
Access & Reimbursement includes key analyses from the Clarivate Real-World Data Product—comprehensive and timely data that provide clarity around the healthcare experiences and activities of hundreds of millions of patients, HCPs, and payers. Analyses include payer mix, percentage of claim rejections for key therapies, and reasons for claim rejection.
