More promising news on GLP-1 drugs

November 20, 2023

Source: Lincoff, et al, New Engl J Med November 11, 2023 LINK

There were two important developments in anti-obesity medications last week. Eli Lilly received approval to market tirzepatide for obesity. The drug was already marketed for diabetes as Mounjaro, and the anti-obesity version will be marketed as Zepbound. Tirzepatide is associated with more weight loss than semaglutide (Wegovy and Ozempic). Lilly will offer Zepbound for list price about 20% lower than the price of Wegovy, but we don’t yet know details on rebates. Net costs of this drug will likely continue to be very high.

The results of the SELECT trial of semaglutide were presented at the American Heart Association and published on Saturday in the New England Journal of Medicine. This study showed that those with obesity and a history of heart disease treated with semaglutide were 20% less likely to have a major adverse cardiovascular event over three years and 73% less likely to develop diabetes compared to those who were randomized to receive placebo. Average weight loss over this period was only 8.5 kg (19 lbs), which is lower than in other reported trials. We would expect fewer major adverse cardiovascular events would be prevented when semaglutide is used in a population at lower risk.

Implications for employers:

• There are now two highly effective weekly self-injections approved for treatment of obesity, and it’s nice to see Zepbound debut with a lower list price, even though it leads to a higher level of weight loss.

• The results of the SELECT trial strengthen the case for coverage of GLP-1 drugs especially for those with obesity and a history of heart disease.

• Employers should recognize that while these drugs can prevent adverse outcomes, they will not save money in the medical budget even with very deep discounts.

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