Even though obesity is a significant public health concern that poses a substantial socioeconomic burden on the U.S. healthcare system, the reimbursement environment for antiobesity agents is very challenging. With limited options, the unmet need for safe and effective therapies remains high. Phentermine, widely available as a low-cost generic and frequently used as a first-line therapy, is indicated only for three months. Other approved antiobesity agents, such as Novo Nordisk’s Saxenda (liraglutide), Vivus’s Qsymia (phentermine / topiramate), and Currax Pharmaceuticals’ Contrave (naltrexone / bupropion) have high out-of-pocket costs. This report offers insight into payer policies regarding prescription weight-loss agents and their impact on physician prescribing, as well as how payer policy may change in the near future as awareness of obesity as a disease grows.
What is the current state of coverage of key antiobesity therapies such as Saxenda, Qsymia, and Contrave? What restrictions do payers impose?
How do payers anticipate reimbursing emerging therapies such as Novo Nordisk’s semaglutide and Eli Lilly’s tirzepatide? What restrictions will they impose on these drugs?
What are endocrinologists’ opinions of semaglutide and tirzepatide? How do endocrinologists expect to prescribe the agents?
Geography: United States
Primary research: Survey of 91 U.S. endocrinologists and survey of 31 U.S. managed care organization (MCO) pharmacy directors (PDs)
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, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
Rameshwar Prajapati, M.S.(Pharm.), Ph.D., is an analyst on the Cardiovascular, Metabolic, Renal, and Hematologic (CMRH) Disorders team at Clarivate. He focuses on the treatment of obesity and peripheral arterial disease but has also authored content on other cardiovascular, renal, and metabolic indications. Dr. Prajapati earned a bachelor’s degree in pharmacy from Hari Singh Gour University and a master’s degree and Ph.D. in pharmacoinformatics from the National Institute of Pharmaceutical Education and Research, S.A.S. Nagar India.