Novo Nordisk's new weight loss drug Wegovy needs a 'significant discount,' ICER says

Novo Nordisk’s weight loss newcomer Wegovy may not be the thriftiest obesity med on the market, but its efficacy and safety could make the GLP-1 agonist the drug of choice among its peers.

That’s according to the Institute for Clinical and Economic Review (ICER), which issued a draft evidence report assessing four different medications for patients looking to manage their obesity.

The cost watchdog’s review suggests GLP-1 meds like Novo Nordisk’s Wegovy and Saxenda represent “a step forward in the magnitude of weight loss achieved.” Still, caveats abound, and, compared to earlier weight loss offerings from Vivus and Currax Pharmaceuticals, the price tags on Novo’s drugs leave something to be desired, the group said.

Among the four drugs reviewed, ICER found patients hit greater weight loss targets with Novo’s semaglutide, sold under the Wegovy moniker, and Vivus’ phentermine/topiramate, which is marketed as Qysmia. There were few serious safety flags with any of the four drugs reviewed, though the watchdog noted that “semaglutide may have lower rates of discontinuation” and, along with Novo’s weight loss predecessor Saxenda, also known as liraglutide, “may have additional cardiovascular benefits that extend beyond weight loss effects.”

ICER blessed Wegovy with a B+ rating, which means the watchdog considered the drug to be more effective than lifestyle changes alone. Novo’s earlier weight loss med Saxenda, which won approval in late 2014, was also found to offer an incremental benefit to patients versus pure lifestyle changes. Novo’s drugs fared slightly better on net health benefit than Vivus’ Qysmia and Currax Pharmaceuticals’ bupropion/naltrexone, which also goes by the name Contrave.

On cost effectiveness, however, the situation was largely reversed. ICER’s draft review found that Qysmia and Contrave—when added to lifestyle modification—were cost effective versus lifestyle modification alone, while Novo’s Wegovy and Saxenda “exceeded commonly used thresholds,” ICER said.

Because Novo’s Wegovy is both more expensive and potentially more effective than Vivus’ drug, Wegovy ought to be considered for patients who’ve failed to hit desired weight loss targets, or for those whom Qysmia is hard to tolerate, “but only with a significant discount,” ICER said. 

The first-year wholesale acquisition cost (WAC) for Wegovy was $17,598 before discounts, ICER noted. In year two of the medicines’ life, the WAC dropped marginally to $17,597.

Curiously, given the evolving conversation around obesity treatment, ICER flagged a high degree of “uncertainty and controversies” in its report.

Contrary to pharmacy claims data, which suggest many people take weight loss medications for a short stretch of time, experts and patients polled by ICER led the watchdog to believe that weight regain after stopping treatment is common. “This points to the need for long-term use of these medications,” the organization argued. 

Those controversies bled over into pricing as well. While the American Medical Association in 2013 recognized obesity as a chronic disease, “medications for weight management are often not covered or require a stepped approach to care, with access granted only after lifestyle changes and other treatments have failed,” ICER explained. Further, when medications are covered, there may still be restrictions imposed on the duration of treatment.

Novo, for its part, said in an emailed statement that it's too early to comment on the draft report. 

Despite a supply hitch tied to a contract manufacturing snafu late last year, Novo Nordisk has been abuzz about its weight loss arriviste Wegovy, which bagged a hotly anticipated approval in obesity last June.

More recently, Novo dialed up its obesity sales target for the middle of the decade, laying out expectations to hit more than 25 billion Danish krone (around $3.72 billion) in the field by 2025. Novo had previously aimed (PDF) to generate around 11.35 billion Danish krone (roughly $1.69 billion) by the middle of the decade, based on earlier weight loss med Saxenda’s 2019 sales of 5.7 billion Danish krone ($849 million).

In the first quarter of 2022, Wegovy recorded revenues of 1.4 billion Danish krone (about $198 million). That came in addition to DKK 2 billion ($283.5 million) from Saxenda.

Editor's note: This story was updated with comments from Novo Nordisk.