Anti-Obesity Treatments: A Brief Overview

Various classes of anti-obesity medicines exist today,  all of them designed to promote weight loss, targeting different mechanisms within the body, including appetite suppression, increased metabolism, or fat absorption: 

1. GLP-1 Receptor Agonists: This class, originally developed for diabetes, has gained significant traction in obesity treatment. GLP-1 receptor agonists work by increasing satiety and reducing appetite. Leading brands include:
   • Wegovy (semaglutide), developed by Novo Nordisk
   • Saxenda (liraglutide), also from Novo Nordisk
2. GIP/GLP-1 Receptor Agonists: These dual agonists offer an enhanced weight-loss mechanism by acting on both the GLP-1 and GIP pathways.
   • Mounjaro (US: Zepbound, tirzepatide), by Eli Lilly, is a recent breakthrough in this category.
3. Sympathomimetics: Drugs in this category stimulate the central nervous system, suppressing appetite. A well-known example is Phentermine, often combined with other medications like Topiramate (Qsymia, by Vivus, US only, withdrawn in Europe).
4. Opioid antagonists: Mysimba (US: Contrave, naltrexone / bupropion) reduces appetite and the amount that patients eat, and increases energy expenditure, helping to reduce body weight.
5. Pancreatic Lipase Inhibitors: The longest on the market, drugs like Orlistat (Xenical by Roche) reduce fat absorption in the intestine, leading to modest weight loss.
   
   

While this arsenal of weight-loss supporting medicines is authorized today, actual patient access depends on whether a given healthcare system reimburses their cost or whether out-of-pocket spending is an acceptable alternative. 

Global Reimbursement Landscape

Reimbursement policies for anti-obesity medications vary significantly by region and are driven by country-specific healthcare priorities, reimbursement policies and budget constraints, as well as clinical guidelines.

1. United States

In the U.S., healthcare coverage is fragmented between private insurers, Medicare and Medicaid, which has led to inconsistent reimbursement for anti-obesity drugs. Coverage tends to vary based on specific insurance plans, with some including anti-obesity medications in their formularies with limited coverage, often with stringent criteria such as a BMI threshold and documented failure of lifestyle interventions. Others exclude them due to cost considerations or insufficient evidence of long-term benefit.

Medicare does not cover anti-obesity medications, cannot legally do so to date. However, this may change in the future with the Treat and Reduce Obesity Act…

• Price: High list prices are a barrier to access with Wegovy priced at around $1,300 per month and Saxenda at approximately $1,200 per month. Mounjaro /Zepbound costs around $1,100 per month for the weight loss indications, but has seen recent price cuts when offered in vials as opposed to prefilled pens: $399-549 per month.
• Conditions: Many insurers require patients to meet specific criteria, such as a BMI over 30 or over 27 with obesity-related comorbidities, and often demand prior authorization or failure with lifestyle interventions.
  
  

2. France

In the French healthcare system, reimbursement for anti-obesity drugs is on the horizon. Wegovy has been used in the compulsory health insurance through an early access scheme for patients with a BMI ≥ 40 kg/m² and certain comorbidities. But a final reimbursement agreement has not yet been reached. Most recently, the Haut Autorité de Santé (HAS) recommended reimbursement for Mounjaro: The patient population covered is much more restrictive than the EU Marketing Authorisation, only covering a BMI ≥ 35 kg/m² after failure of other non-pharmacological weight-loss approaches. The reimbursement rate can be up to 65%. Pricing is still to be negotiated. Saxenda is commercialized, but not reimbursed. 

• Price: Saxenda costs around €280 per month, and Orlistat is priced at approximately €30 per month.
• Reimbursement negotiations for Wegovy and Mounjaro are ongoing.
• Conditions: As a second-line treatment option after failure of nutritional and other weight management; complement to a low-calorie diet and increased physical activity for weight control, particularly for weight loss and weight maintenance, in adult patients with a BMIl ≥ 35 kg/m², in the event of failure of well-conducted nutritional management (< 5% weight loss at six months); obesity specialist prescribing only.
  
  

3. Germany

Germany’s healthcare system operates through statutory health insurance, where the reimbursement of anti-obesity drugs has been traditionally excluded as part of the negative list for “lifestyle” medication. The recent HTA of Mounjaro focused on the reimbursement of its type 2 diabetes indication alone. Germany is making strides to manage the burden of obesity, reimbursing health apps (DiGA) for weight loss and most recently putting in place disease management programs (DMP) for obesity. All without reimbursed pharmaceuticals.

Weight-loss products remain fully paid for by patients.

• Price: Wegovy is priced at approximately €250-€300 per month, and Saxenda costs roughly €275 per month.
• The price for Mounjaro will be negotiated for it’s diabetes indication, but also apply for the non-reimbursed prescriptions 
  
  

4. United Kingdom

In the UK, obesity and obesity-related comorbidities are a significant healthcare system problem, especially in light of increasing NHS resource constraints. While the UK stands out as the most promising reimbursed market, the access is cautiously managed. For Saxenda, Wegovy and Mounjaro, NICE (National Institute for Health and Care Excellence) guidelines make reimbursement subject to detailed use criteria, including BMI above 35, comorbidities, specialist prescribing, as well as stopping rules or maximum use duration. 

• Price: The list price of Wegovy 2.4 mg is £175.80/month.
• The list price of liraglutide (Saxenda) is £196.20/month.
• Mounjaro list price ranges between £92 and £122 for four weeks.
• All products have commercial agreements providing confidential discounts on these prices as part of their reimbursement conditions.
• Conditions: Saxenda is recommended alongside a reduced-calorie diet and increased physical activity in adults, only for patient with a BMI of at least 35 kg/m² and with non-diabetic hyperglycaemia and a high risk of cardiovascular disease and if the medicine is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service.
• Wegovy is recommended alongside a reduced-calorie diet and increased physical activity in adults, only if it is used for a maximum of 2 years, and within a specialist weight management service providing multidisciplinary management of overweight or obesity and where patients have at least 1 weight-related comorbidity and a BMI of at least 35.0 kg/m², or a BMI of 30.0 kg/m² to 34.9 kg/m² and meet the criteria for referral to specialist weight management services in “NICE’s guideline on obesity: identification, assessment and management.”
• NICE draft guidance for Mounjaro proposes the drug alongside a reduced-calorie diet and increased physical activity, in adults, only if they have an initial BMI of at least 35 kg/m² and at least 1 weight-related comorbidity. Treatment is to be stopped  if less than 5% of the initial weight has been lost after 6 months.
  
  

Tackling the Challenges in Reimbursement and Market Access

1. High Cost and Budget Constraints The cost of new anti-obesity medicines is a major hurdle for healthcare, given the high prevalence of the condition, but also for patients. Payers are strictly limiting reimbursement to control budget impact for this growing therapeutic area. Obesity is a chronic condition, so potential long-term treatment exacerbates the affordability issue for public and private payers. 

Analyzing the cost-effectiveness or cost savings in the long-run will be important for companies and relevant for payers to learn how these treatments will provide value and contribute to population health.

2. Limited Perception of Obesity as a Disease Despite the medical community recognizing obesity as a chronic disease, many healthcare systems still view it as a lifestyle issue. This is historically based on the underlying legal definition of reimbursable products, limiting the willingness and possibilities of payers to reimburse drug treatments. This can be seen as most stringently applied in the US and Germany. Elsewhere, pharmaceutical weight management remains a restricted last resort option. 

Anticipating label restrictions and carefully crafting the positioning for reimbursement is of relevance for companies in the increasingly competitive field. Managing internal stakeholder expectations and further shaping the medically relevant use of weight management medicines are strategic activities for successful development of the indication.

3. Efficacy Expectations and Outcomes Payers demand robust evidence of sustained weight loss and improvements in obesity-related conditions, such as type 2 diabetes and cardiovascular disease. Drugs like Wegovy and Mounjaro have shown significant short-term benefits, and relevant cardiovascular long-term outcomes are already emerging from on-going studies.

Showing patient benefit beyond weight loss will be key for payers to continue reimbursement or to broaden payment in the future. The medical benefit will help position products as medically relevant and not simply lifestyle treatments. The question of benefit-risk will be central and continues to evolve as new entrants join the market.

4. Variable Reimbursement Policies Reimbursement policies differ widely between countries, making it even more challenging than usual for companies to develop a consistent market access strategy. In Europe, where the self-pay market is considerably less developed, teams may face new challenges and strategies in developing an integrated go-to-market approach between reimbursement and “consumer health” (Note: anti-obesity medicines are subject to prescription).

As outlined above, clear product strategy and market development need to be an integral part of strategic and country-focus access preparedness. Navigating these varying policies requires in-depth evaluation of local healthcare systems and market access landscapes.

Future Outlook

Reimbursement for anti-obesity medicines is a complex and evolving landscape. While innovative treatments like Wegovy and Mounjaro are showing great promise, access to these therapies remains limited by high costs, varying national policies, and historical perceptions of obesity.

Looking ahead, as obesity rates continue to rise and put pressure on healthcare systems, I expect more countries to reconsider their reimbursement policies. Robust clinical outcomes data, advocacy for recognizing obesity as a chronic disease, and a growing innovative pipeline will play crucial roles in shaping future market and access landscapes for anti-obesity medicines. Especially as the broader cardiovascular benefits of these medicines are being demonstrated, payers will be able to better value the medical relevance of these products.

For health tech companies, navigating these challenges requires a particularly coordinated and country-specific effort in positioning strategy, value demonstration, pricing strategies, and engagement with healthcare system policymakers, providers and patients. Understanding the landscape for these therapies and positioning new candidates as valuable solutions is essential as the field is becoming more complex and more competitive. 

Anti-obesity medicines will remain a highly managed therapeutic area based on the sheer number of eligible patients and the related budget impact, expectations and commercial plans should be clear in that regard. But for now, the market landscape still remains to be shaped and developed.

If you are developing a strategy for obesity medicines, an asset in a non-traditional reimbursement area, in a combination or integrated healthcare context, get in touch for a discussion on your commercial and reimbursement strategy projects.

granzow@apersy.com