Many US patients opt for obesity drug injections, defying some expectations

By Chris Prentice and Mariam Sunny

NEW YORK, July 22 (Reuters) – Many patients have opted for injectable forms of the wildly popular GLP-1 obesity drugs through a pilot program of the U.S. government’s Medicare health insurance program for Americans 65 and older, according to preliminary information from doctors and analysts.

The U.S. Centers for Medicare and Medicaid Services this month launched an 18-month trial program that for the first time provides access to Novo Nordisk’s Wegovy and ‌Eli Lilly’s Foundayo and Zepbound as weight-loss treatments only, at a cost of $50 per month.

Millions of people are expected to qualify, and doctors are already inundated with interest from patients 65 and older. For the most part, they say the process is going well, with some hiccups.

Many pharmaceutical industry experts expected that patients would choose pills over injections for convenience. In June, Novo’s U.S. chief, Jamey Millar, said the firm’s research showed Medicare beneficiaries preferred the oral pill to the injectable pill on a two-to-one basis.

But eight in 10 doctors and three pharmaceutical industry analysts interviewed by Reuters said most preferred injectable drugs.

“Of course – these patients want injections because they know it works, and in the past it was very costly,” said ‌Dr. Sarah Ro, director of the University of North Carolina Health’s weight management program.

Patients who meet the criteria often receive approval quickly once clinicians become familiar with the process, Ro said.

COMPARISON OF WEIGHT LOSS DATA

U.S. approvals of injectables Zepbound and Wegovy were based on separate trials in which the Lilly drug helped patients lose more than 22% of their weight after 72 weeks, while Wegovy led to 15% weight loss after 68 weeks.

In separate studies, Oral Wegovy led to a reduction in body weight of approximately 14% over 64 weeks, and Foundayo led to a reduction of approximately 11% over 72 weeks.

“Prescribing patterns have evolved over time as new options have emerged, but the majority of patients are still prescribed injectable treatments,” analysts at investment bank William Blair wrote in a July 13 note, citing a call with an obesity medicine expert.

To be sure, demand for the Wegovy pill has been strong, and analysts said the latest publicly available data from data firm IQVIA showed prescriptions for Lilly’s pill Foundayo rose in the week to July 10. IQVIA has not verified the data.

But patients generally seem to prefer injectable medications after learning about their effectiveness.

“If you asked me a year ago, I would have thought people would jump on this pill,” said RBC Capital Markets analyst Trung Huynh. “But it turns out that for most people, it’s all about effectiveness.”

Spokespeople for Lilly and Novo said they were pleased with the new Medicare program. A Lilly spokeswoman said the program was “working very well” and the company was encouraged by the strong interest. Neither drugmaker provided any details about specific volumes.

DISAPPOINTMENTS WITH MIXED ACCESS

A CMS spokesperson said the first weeks of the Medicare program were “positive” with most authorizations completed in less than 12 hours.

But patients’ ability to engage in demo coverage is mixed, according to both physicians and patients.

Katie Smith, who asked her doctor to send the prescription on July 1, said she is still waiting to hear back on whether she will be covered. The retiree from Virginia said he has been frustrated for years because he hasn’t been able to access these medications due to cost. The companies’ direct-to-consumer prices range from $149 to $449 per month.

“I’m not quite sure what it is,” he said.

D., director of obesity medicine at the Cedars-Sinai Center for Weight Management and Metabolic Health in Los Angeles. Amanda Velazquez said the process was also “cumbersome” for doctors.

“This required numerous hours and numerous clinical staff and clinicians coming together to create standardized protocols, order sets, and troubleshooting to try to cut through the bureaucracy to provide access to GLP1RAs for our patients,” he said.

Yet many are seeing success. Dr. of Knownwell weight loss clinic in Atlanta. Christina Nguyen said she received approval for about 200 patients nationwide in the first week.

“We get several approvals every day if the patient meets the criteria,” he said.

(Reporting by Chris Prentice and Mariam Sunny in Bengaluru; Editing by Caroline Humer and David Gregorio)