Price of anti-obesity medication fuels public health disparities

Millions of Black and Hispanic adults who are living with overweight or obesity are unable to afford the latest treatment in obesity medicine, according to a study by the Yale School of Medicine researchers. The study authors estimated the overall percentage of US adults who were eligible for semaglutide, a recently approved anti-obesity medication, and examined the prevalence of racial and ethnic disparities. They found that a larger proportion of Blacks and Hispanics who would benefit from the medication had substantial financial barriers that would likely block access compared with other groups.

Figure 1: Racial and ethnic differences in financial barriers and social determinants of health among semaglutide‐eligible adults, 2015 to 2020. Credit: Journal of the American Heart Association (2022). DOI: 10.1161/JAHA.121.025545

"Anti-obesity interventions have advanced over the past decade. Recently, several randomised controlled trials showed that a drug designed to treat diabetes was very effective at reducing appetite and food intake," said Lu, first author of the new study. "Our findings show that many eligible-adults may not benefit from this drug for a variety of social reasons including access to affordable, health insurance, or income levels."

Approximately 70% of Americans have obesity or overweight, according to the Centers for Disease Control and Prevention. The drug semaglutide (brand name, Wegovy) requires once-weekly injections. The estimated US$1,500 per month price means millions of eligible patients are unable to afford the popular anti-obesity medication.


Semaglutide received U.S. Food and Drug Administration approval in 2021 for patients with a body mass index (BMI) of 27 kg/m2 or greater who have at least one weight-related condition (such as high blood pressure, Type 2 diabetes, or high cholesterol), or in patients with a BMI of 30 kg/m2 or greater.


Currently, insurance may not cover semaglutide. Experts from The Obesity Society (TOS) have advocated for comprehensive treatment. For example, in a 2018 position statement, Dr Ania Jastreboff, an associate professor of endocrinology & metabolism, and of pediatric endocrinology at Yale School of Medicine, and other TOS members stated that treatment required "steadfast care and compassion for each individual patient and inclusive insurance coverage."


For the study, ‘Racial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States’, published in the Journal of the American Heart Association, Drs Yuan Lu, assistant professor, Harlan Krumholz, Harold H Hines, Jr Professor of Medicine, and Yuntian Liu, research associate, used data from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2020, investigators from the Yale-based Center for Outcomes Research and Evaluation (CORE) found significant differences.


A total of 13,711 adults were included in the final analysis. In 2015 to 2020, 51.1% (48.3%–53.2%) of US adults (≈43.3 million) met the Food and Drug Administration eligibility criteria for semaglutide. The percentage of adults eligible for semaglutide was highest among Black adults (56.6% [54.2%–59.1%]), followed by Hispanic adults (55.0% [52.8%–57.3%]). Among adults eligible for semaglutide, 11.9% (10.1%–13.6%) were uninsured, 13.3% (12.1%–14.5%) lacked a usual source of care, 33.6% (30.2%–36.9%) had low family income, and 38.9% (36.5%–41.3%) lacked higher education.


Compared with White individuals, significantly larger proportions of Black and Hispanic individuals were uninsured, lacked a usual source of care, had low family income or lacked higher education (p<0.001 for all).

"Many adults with overweight and obesity who do not respond adequately to lifestyle interventions, could benefit from a pharmacological therapy for long-term weight management,” said Krumholz, senior author of the study and director of CORE. “The removal of financial barriers for highly effective medications should be a top public health priority and is essential if we are to achieve health equity.”

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