The newest generation of weight-loss medications has taken the world by storm. Demand exceeds supply, availability is limited, and manufacturing capacity is falling behind. In this sellers’ market, the wealthy and/or the well-connected have ready access, while those with the greatest medical need may, or may not, be able to obtain them.

“These new medications are highly effective for obesity, type 2 diabetes, and cardiovascular risk reduction,” said William H. Herman, MD, MPH, the Stefan S. Fajans/GlaxoSmithKline Professor of Diabetes and Professor of Internal Medicine and Epidemiology at the University of Michigan School of Public Health, and Director of the Michigan Center for Diabetes Translational Research. “And a lot of people are using them for uncomplicated obesity, more for cosmetic reasons than for health reasons. From a societal perspective, you want the population at the highest risk for adverse health outcomes to have access to these drugs. Unfortunately, in our society, those who can afford them get them, while those who can’t afford them don’t.”

Dr. Herman will explore the health economics of weight-loss medications alongside three presenters offering differing answers in the Sunday, June 23, debate Keeping Up with Hollywood—Who Should Be Prioritized for New Antiobesity Medications? The session will take place from 4:30 p.m. – 6:30 p.m. ET in Room W308 of the Orange County Convention Center.

Health economics takes a societal perspective on access to care, Dr. Herman noted, explaining that the United Kingdom, Canada, Australia, and other countries around the world generally require a health economic analysis to support new drug pricing. The United States does not.

“We see inequities in these new antiobesity medications in several ways,” said Deborah Horn, DO, MPH, MFOMA, Associate Professor of Surgery at The University of Texas (UT) McGovern Medical School and Medical Director for the UT Center for Obesity Medicine and Metabolic Performance. “One certainly is economics. It’s challenging for the average American to pay $1,100 to $1,400 a month for these drugs, $550 if you’ve got a coupon, but that only lasts for 12 months.”

Dr. Horn will detail why patients who have already benefited from antiobesity medications should be prioritized for continued treatment with these drugs.

There are clear inequities in insurance coverage and between those with health insurance and those without, she said. There are also inequities in messaging around appropriate use.

“Just because you are overweight does not mean these meds are necessarily right for you,” Dr. Horn said. “The medications are approved for anyone with a BMI greater than 27 with at least one comorbidity or a BMI greater than 30 alone. Should these costly medications be reserved for individuals with a more severe disease? Or is preventing disease progression in the beginning more important? Those questions are being raised in the insurance space because 50% of the adult U.S. population on average meets overweight or obesity criteria.”

Pam R. Taub, MD, FACC, FASPC, Professor of Medicine and Director of Step Family Foundation Cardiovascular Rehabilitation and Wellness Center at the University of California San Diego Health System, will explore the challenges of patients who are overweight and have cardiovascular disease.

Neda Rasouli, MD, Professor and Director of Endocrinology, Metabolism, and Diabetes at the University of Colorado Anschutz Medical Campus, will focus on individuals with Class 3 obesity and no comorbidities.

The current generation of antiobesity medications are just the beginning, Dr. Horn added. Dual and triple incretin mimetics are currently under development and undergoing clinical trials. Additionally, small molecule formulations are being developed, promising similar efficacy with oral dosing. Some of the agents currently in trials demonstrate such effectiveness that dosing must be reduced to avoid excessive weight loss in individuals with less severe disease.

“The landscape is changing quickly,” Dr. Horn said. “The discussion we have now will be different in six months and continue to advance. It all comes down to how providers help choose the best medication for the person sitting in front of you.”

For those unable to attend the 84^th Scientific Sessions in person, this session will be available on-demand on the virtual meeting platform following the meeting for registered participants.