Report on Retreat of Obesity Drug Marketing Shows Lack of Parity in Coverage

A report predicting the end of several marketing relationships for obesity drugs highlights the role that stigma plays, both among providers who prescribe therapy and payers who decide what gets reimbursed.

The Pink Sheet, which covers drug approvals and business transactions, last week chronicled the fortunes of several drugs that showed promise but have suffered lackluster sales for several reasons, including stigma. The report said providers’ past bad encounters with earlier generations of weight loss drugs have affected sales.

But Ted Kyle, RPh, MBA, an advocate for persons with obesity who founded ConscienHealth after years in the pharmaceutical industry, recently told attendees at Patient-Centered Diabetes Care, presented by The American Journal of Managed Care and Joslin Diabetes Center, that stigma has played a large role in the refusal of payers to cover obesity therapy.

It was Kyle’s view that “Bad coverage habits are dying hard, but they are dying.”

According to the Pink Sheet report, however, disappointing sales results from the past 2 years may have already colored decision-making on long-term marketing plans for several therapies:

· Contrave, created by Orexigen and marketed by Takeda, is scheduled to see a fleet of 900 dual-purpose sales reps drop to 160 this fall, when the companies’ agreement ends. This relationship was already damaged by Orexigen’s handling of preliminary cardiovascular outcomes trial data.

· Arena’s Belviq, being marketed through an agreement with Eisai, is down from a peak of 600 sales reps to 230.

· Vivus’ Qysmia has only 50 sales reps, according to the report, which said the company is trying to get FDA to cancel requirements for long-term cardiovascular outcomes results, which have been mandated in recent years.

Obesity drugs seemed like a winner in the summer of 2013, when the American Medical Association declared that obesity was disease. The American Board of Obesity Medical formed in 2011 to grant diplomates to specialists in treating this chronic condition.

Yet coverage was slower to materialize. The Pink Sheet report noted that resistance to reimbursement includes both private and public payers, even though Medicare will pay for bariatric surgery for those very obese.

At the Patient-Centered Diabetes Care conference, which took place April 7-8, 2016, Kyle said that failing to give providers the full complement of tools to treat obesity is short-sighted.

“Whether or not healthcare plans cover care for obesity, we are paying for obesity,” he said. “Our ‘sick care’ system does a great job of paying for the result.”

Cost of branded therapies may be a factor, too. The Pink Sheet report said low-cost phentermine—an amphetamine—takes up 75% of the market, with the rest split among several branded drugs.

An emerging drug may be Saxenda, the version of liraglutide approved for obesity. Victoza, the version approved in diabetes care, is a leader in its class of glucagon-like peptide receptor agonists.

Another speaker at Patient-Centered Diabetes Care, Janine V. Kyrillos, MD, FACP, ABOM, an obesity specialist at Thomas Jefferson University Hospital in Philadelphia, said 93% of obese patients have unmet medical needs. Studies have found when providers simply criticize them for being overweight, 79% become disheartened and simply eat more.

CDC estimates that about one-third of Americans are obese, and data show that states with the highest current rates of obesity could reach 60% if current trends continue.