There is a gap between the patients diagnosed as obese and those who are treated for it, which can be (at least in part) attributed to the high cost of drugs and the need for more insurance coverage.
In this exclusive Q&A with Pharmaceutical Executive®, George Hampton, president and CEO, Currax Pharmaceuticals, discusses the obesity treatment landscape, current treatments and innovations, payment options for insured patients and the pros and cons of each, payment options available to uninsured patients, and how pharma can make obesity treatments more affordable.
Pharm Exec: Our understanding of obesity is constantly changing as research reveals new revelations. What is the current understanding of obesity and its treatment(s)?
Hampton: The understanding of obesity and the treatment of obesity is certainly immature. Obesity has only recently been recognized as a disease. There are a few things that really drive our current lack of understanding, and the biggest is that there is no coverage or reimbursement for either the physician or for the medications that treat the disease. At the same time, physicians haven’t received much, if any, training on how to treat obesity, historically. In fact, my chief medical officer tells me that, 30 years ago, he did not have a single class about obesity during his medical school training. Even today, healthcare providers’ knowledge of obesity is immature.
This is also evident in how we’re treating the disease. Only 2-3% of patients who are eligible for pharmacotherapy are actually receiving it.1-2 We have this disease that impacts more than 100 million people, a clear epidemic—42% of the United States adult population—and we’re treating less than 5% of them.1-2 This is unacceptable.
The good news is that we are starting to see obesity walk the same path that hypertension and type 2 diabetes did in the 1990s and early 2000s. The medical and scientific communities are researching and publishing on obesity as a disease, leading to a greater understanding of the disease and to the identification of the underlying causes of obesity by subtypes or phenotypes. Physicians are starting to be able to match therapies to the root cause of the disease and those therapies are more likely to be successful for those patients.
Pharm Exec: How does the obesity treatment landscape currently look? How have the industry, technologies, and treatments grown in recent years, and where are there areas for improvement?
Hampton: Well, you can’t miss the explosion of new therapies and wide-ranging discussions on the treatment of obesity. The investment by major players in the space has raised awareness and shone a light on obesity as a chronic progressive disease. This investment has transformed the obesity market. It is an exciting time to be in the obesity therapeutic space, and I believe we are on the precipice of access for patients.
Pharm Exec: Your company offers obesity treatments. How does your treatment fit into the current landscape of treatments?
Hampton: We have one medicine, Contrave, that is a well-known and trusted medication that’s been on the market for nine years in the United States. It works with the brain’s reward system to reduce both hunger and cravings. It’s an orally delivered, effective, and affordable therapy for patients, especially patients who battle cravings and emotional eating.
Pharm Exec: Affording obesity treatments is a big hurdle for many patients. What are some payment options for insured patients and the pros and cons of each?
Hampton: We find ourselves in a non-reimbursed world with obesity. That will change. But for now, unfortunately, CMS and Medicare do not cover obesity medications. Commercial payers do not cover obesity medications unless an employer buys an obesity rider. What that means is it’s only the rich employers who can afford the insurance, and those patients probably already have the best health care, the best access, and medication coverage.
A very large portion of the population, many of whom are already underserved, do not have access to these medicines. To provide a bridge to access, we’ve created the CurAccess program, and anyone can get our medication for $99 a month. We’re doing everything we can to ensure patient access in a landscape of little to no obesity medication coverage.
Pharm Exec: What payment options are available to uninsured patients in the US?
Hampton: With obesity, because of the lack of reimbursement, the uninsured patients in the US are largely the same as the insured patients. Most people don’t have coverage; so, we can pretty much bucket all patients with obesity as effectively uninsured, which is what compelled us to create the CurAccess program that I mentioned.
Pharm Exec: How does this model differ from what some EU countries are doing for obesity payment options? What can we learn from them?
Hampton: This is one of the treatment spaces where the EU is light years ahead of the US. They have been working with varying reimbursement and therapeutic schemes to try to get obesity under control. A few member states have found a pathway to affordable obesity coverage while slowing the progression of the disease and making a dent in this epidemic. They’re ahead of us in thinking about value. They’re ahead of us in thinking about the medical treatment of the disease, and they’re ahead of us in addressing the underlying causes of the disease through phenotyping.
Certain EU member states are using levers and measures, such as BMI and the different classes of obesity, and deploying the whole range of treatment options on the market today—not just one therapeutic class. Other member states are focused on phenotyping. These countries are encouraging physicians to look at what is really driving the disease by phenotype and then matching the prescribed, and reimbursed, medication to the phenotype of the patient. In some cases, the member states are getting very serious about making sure that the patients themselves are focused on losing weight and treating their obesity before they are allowed access to reimbursed medications.
These are sophisticated approaches to complex problems. They’ve thought this through and have run different reimbursement scenarios for three to four years now.
Pharm Exec: How can pharma make obesity treatments more affordable in the US, especially for uninsured patients?
Hampton: Well, I certainly don’t want to speak for other companies, but we know that obesity is not a one-size-fits-all disease. It’s going to take different classes of medications across the different causes of obesity to curb this epidemic in the US. These medications are different, and each company has to figure out how to best help their patients.
Pharm Exec: In what ways can the general population be educated on these options available to them?
Hampton: I think there are a few ways. The first thing the general population needs to realize is that for those who are battling obesity, it’s not their fault. Obesity is not a lifestyle choice. For the longest time, societies have said: “That’s your fault. Shame on you.” And our reimbursement landscape of no coverage reflects that. Thankfully, we’re shifting away from that perception. We now have clinical proof that obesity is a complex chronic disease.
Where should patients go for information? The best place to start is to talk to their physician. Just like with any other disease, they should go to their physician and talk boldly about their health and weight concerns. And frankly, physicians have to better understand the disease and treatment options and get more comfortable with bringing up the subject of weight with their patients. In the doctor’s office is where we will make progress against this disease. No physician has trouble talking about hypertension or type 2 diabetes. But obesity has been a forbidden topic, and that must change. Mental health used to be taboo; now, it is included in the standard set of questions in a primary care physician’s office.
There’s a lot of self study that patients can do about their health and their weight. There is a broad range of resources these patients can tap into, and we see our patients using everything from social media channels to patient groups. But we have a long way to go to be supporting these patients over time.
Pharm Exec: How does the Inflation Reduction Act (IRA) factor into this? Do you foresee the IRA impacting obesity treatment pricing in the future?
Hampton: IRA passed through a legislative shortcut called reconciliation that leads to all sorts of problems. But truthfully, it doesn’t apply to us right now because obesity medications don’t have coverage. I think everyone is comfortable saying there shouldn’t be a patient who doesn’t have health care in the US. We can all get behind that. That is why there is so much momentum around patients with obesity getting coverage for medications.
Pharm Exec: Any final thoughts or things you’d like to share?
Hampton: This is the most exciting time for obesity care. The stigmatism of obesity and blaming patients has shifted. There is a broader understanding that this is a disease that needs to be treated medically. The medical community is coming up to speed quickly on the need to treat obesity. In fact, there are giant leaps forward in the understanding of what’s driving the underlying causes of obesity. The products available today, their different mechanism of action (MOAs), and the products that are coming address different causes for the disease. This allows us to treat obesity, just like every other disease, with a range of medications that address the root cause of the individual patient’s disease.
Finally, the likelihood that obesity medications will be covered is accelerating. We see an affordable pathway to obesity coverage in the EU. We see federal employees being covered. We see real momentum for Medicare coverage coming through a vote on TROA (the Treat and Reduce Obesity Act) soon. If we as a country start covering the disease of obesity, I believe pharma is in a position to deliver the medicines necessary to curb this epidemic and improve these patients’ lives.
References
- CDC, “Adult Obesity Facts,” accessed August 2023. https://www.cdc.gov/obesity/data/adult.html
- Amanda Velasques, Caroline M. Apovian. Updates on obesity pharmacotherapy. Ann N Y Acad Sci. 2018. 1411(1):106-119. DOI:10.1111/nyas.13542
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