HJAR May/Jun 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2024 31 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement of drugs when the drugs are in short sup- ply, but the FDAdoes not evaluate the com- pounded drugs for safety or effectiveness. A clinical trial funded by Novo Nordisk found that, on average, people regained two- thirds of the weight they had lost in the year after they stopped taking semaglutide. 13 This is a concerning statistic because many peo- ple stop taking weight-loss drugs within a year of beginning treatment. 14 Adverse side effects, high out-of-pocket costs, and supply shortages can all be determining factors in whether someone continues treatment. The likelihood of regaining weight after cessa- tion of medication suggests that people may need to stay on the drugs for life to control their weight, but because of the newness of this class of medication, we do not yet know how a lifetime of use will impact people’s health or the drugs’ effectiveness. The reason for the popularity of this new class of medication is obvious. Some peo- ple who have had little success with other approaches to weight control are finally achieving significant weight loss thanks to these drugs. But their potential side effects, their high costs, and the possible need to stay on them for life may limit their im- pact. Our understanding of these drugs is still evolving; further research is needed to assess their benefits and risks in the long term. n REFERENCES 1 Goldman Sachs. “Why the anti-obesity drug market could grow to $100 billion by 2030.” Oct. 30, 2023. https://www.goldmansachs.com/intel- ligence/pages/anti-obesity-drug-market.html 2 Centers for Disease Control and Prevention. “Adult Obesity Maps: Overall Obesity.” Last up- dated Sept. 21, 2023. https://www.cdc.gov/obe- sity/data/prevalence-maps.html#overall 3 Arkansas Center for Health Improvement. “Assessment of Childhood and Adolescent Obesity in Arkansas: Executive Summary.” De- cember 2023. https://achi.net/wp-content/ uploads/2024/02/240119-FINAL-2022-23-Ar- kansas-Student-BMI-Report.pdf#page=3 4 Golden, A.; Reed, T. “Arkansas among the top states for prescribing trending weight loss drugs.” Axios NW Arkansas, Jan. 29, 2024. https://www. axios.com/local/nw-arkansas/2024/01/29/ arkansas-weight-loss-drug-ozempic-diabetes- obesity 5 Wilding, J.P.H.; Batterham, R.L.; Calanna, S.; et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” New England Journal of Medicine 384, no. 11 (Feb. 10, 2021): 989–1002. doi: 10.1056/NEJMoa2032183 6 Wadden, T.A.; Bailey, T. S.; Billings, L.K.; et al. “Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial.” Journal of the American Medical Association 325, issue 14 (Feb. 14, 2021): 1403–1413. doi:10.1001/ jama.2021.1831 7 Weghuber, D.; Barrett, T.; Barrientos-Péres, M.; et al. “Once-Weekly Semaglutide in Adolescents with Obesity.” New England Journal of Medi- cine 387, no. 24 (Nov. 2, 2022): 2245-2257. doi: 10.1056/NEJMoa2208601 8 Hampl, S.E.; Hassink, S.G.; Skinner, A.C.; et al. “Clinical Practical Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.” Pediatrics 151, issue 2 (Jan. 9, 2023). doi: 10.1542/peds.2022-060640 9 U.S. Preventive Services Task Force. “High Body Mass Index in Children and Adolescents: Inter- ventions.” Draft Recommendation Statement, Dec. 12, 2023. https://www.uspreventiveservices - taskforce.org/uspstf/draft-recommendation/ high-body-mass-index-children-adolescents- interventions 10 International Foundation of Employee Benefit Plans. “GLP-1 Drugs (U.S.): 2023 Pulse Survey.” Accessed March 28, 2024. https://www.ifebp . org/store/Pages/weight-loss-drugs.aspx 11 Klein, P.; Paralkar, S. “Memorandum: Re: Ac- tuarial Review of Anti-Obesity Medication.” Memorandum to Senator Jimmy Hickey, Jr., and Representative Aaron Pilkington. Jan. 12, 2024. https://www.arkleg.state.ar.us/Home/ FTPDocument?path=%2FAssembly%2FM- eeting+Attachments%2F055%2F26327%2FHand out+C1+-+Memorandum+-+State+of+Arkansas+- +AOM+Review.pdf 12 Amin, K.; Telesford, I; Singh, R.; Cox, C. “How do prices of drugs for weight loss in the U.S. compare to peer nations’ prices?” Peterson-KFF Health System Tracket, Aug. 17, 2023. https:// www.healthsystemtracker.org/brief/prices- of-drugs-for-weight-loss-in-the-us-and-peer- nations/#List%20prices%20of%20drugs%20 used%20for%20weight%20loss%20in%20 the%20U.S.%20and%20peer%20nations 13 Wilding, J.P.H.; Batterham, R.L.; Davies, M.; et al. “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial ex- tension.” Diabetes, Obesity and Metabolism 24, issue 8 (August 2022): 1553-1564. https://doi. org/10.1111/dom.14725 14 Gasoyan, H.; Pfoh, E.R.; Schulte, R.; Rothberg, M.B. “Early- and later-stage persistence with antiobesity medications: A retrospective cohort study.” Obesity 32, issue 3 (March 2024): 486- 493. https://doi.org/10.1002/oby.23952 The most common side effects reported by people using GLP-1 agonists are gastroin- testinal issues such as nausea, vomiting, di- arrhea, or constipation. Others include dizzi- ness, fatigue, and headaches. In some cases, more severe side effects include gastropa- resis, pancreatitis, or bowel obstructions. For many, the high cost of the drugs can be a barrier. A survey conducted by the In- ternational Foundation of Employee Benefit Plans in October 2023 found that only 27% of U.S. employers provide coverage for GLP- 1 agonists for weight loss. 10 Medicare does not cover drugs for weight loss, although it can cover GLP-1 agonists for their other medically accepted indications — including, in the case of Wegovy, to lower the risk of heart attack and stroke. Medicaid programs cover GLP-1 agonists for weight loss only in certain states, not including Arkansas. In January, a consulting firm reviewed possible weight-loss medication coverage costs for Arkansas’ state employee health plan. The consultant concluded that the potential medical savings resulting from positive impacts on state employees’health would not offset the overall cost of the drugs, resulting in a net loss of nearly $200 million by 2030 if the plan were to provide coverage for the drugs for weight loss. 11 For Americans without coverage for weight-loss drugs, the out-of-pocket costs can make the medications difficult or im- possible to afford. The drugs are generally much more expensive in the U.S. than in other countries: An August 2023 analysis found that a one-month supply of Wegovy cost $1,349 in the U.S., compared to $328 in Germany. 12 Drug manufacturers such as Novo Nor- disk and Eli Lilly have struggled to keep up with the demand for weight-loss drugs. Food and Drug Administration (FDA) rules allow the creation of compounded versions