Novo, Lilly's 'paradigm shifting' obesity drugs suffer from cost and coverage issues: docs' survey

A survey of 100 doctors in the U.S. who prescribe weight loss medications shows that more than 75% consider new GLP-1 drugs from Eli Lilly and Novo Nordisk “paradigm shifting.” But the physicians also have significant concerns about the cost of the treatments, patient eligibility for coverage and long-term safety risks.

As patients have flooded the weight loss market, demand for Lilly’s tirzepatide and Novo’s semaglutide drugs Ozempic and Wegovy has skyrocketed. In the second quarter, the companies posted revenue increases of 28% and 34%, respectively, year over year. The prospects are so bright that Lilly has become the most valuable biopharma company in the U.S. as measured by market cap, and Novo has done the same in Europe.

Lilly's tirzepatide is currently only approved in the U.S. to treat diabetes, but it has posted impressive results in weight loss trials, and an obesity approval from the FDA could come as soon as this year. As for Novo's Wegovy, the weight management therapy won its FDA nod in 2021, and, since then, demand has been so strong that Novo has struggled to keep up on the supply side.

Amid the surge in demand, there have been few discouraging words about the GLP-1 drugs. But doctors in the survey—which was conducted last month by InCrowd and included 50 endocrinologists and 50 primary care physicians—have raised a few.

They were asked to classify tirzepatide and semaglutide in a variety of categories, assigning a rating of 1) very strong performance, 2) very poor performance or 3) neither strong nor poor performance. As it applied to two categories—cost of the drugs and coverage eligibility—only between 12% and 15% of doctors gave either drug a very strong performance rating.

For tirzepatide, 47% of doctors rated Lilly’s pricing as “very poor.” On GoodRx, the minimum price for a carton of four pens (monthly supply) is $990. That price only applies to the drug as a diabetes therapy; Lilly hasn't revealed its commercial strategy for the drug as a weight management therapy. 

As for Novo’s semaglutide treatments, 42% of the physicians rated the company’s pricing as “very poor.” Ozempic, a diabetes drug, which doctors commonly prescribe for weight loss, is listed at a minimum monthly price of $906. Novo’s obesity treatment Wegovy—which is the same formulation as Ozempic but in a higher dose—has a minimum monthly price of $1,303.

“They are effective but too expensive for the majority of patients, even with insurance coverage,” a primary care physician remarked.

There also are some safety and side effect concerns with the drugs, as 40% of doctors assigned each a neither strong nor poor performance rating in that category.

“Very promising, but longer-term data and real-world data are necessary,” an endocrinologist told InCrowd.

Some of the noted side effects of the treatments have been nausea, constipation, vomiting, diarrhea and dizziness.

Doctors rated the effectiveness of both drugs very highly, with tirzepatide outperforming semaglutide by a small margin. While 81% of doctors gave tirzepatide a “very strong performance rating” for efficacy, 74% did so for semaglutide.

As for patient satisfaction, 77% of doctors gave tirzepatide a “very strong” rating while 69% did the same for semaglutide.

Another notable finding from the survey was that the respondents estimate 30% of weight management patients receiving semaglutide are getting it from non-physician outlets such as spas.